Yukihisa Tamura

Dislocation of the extensor tendons over the metacarpophalangeal joints

Twenty-seven patients who had received treatment for dislocation of the extensor tendons over the metacarpophalangeal joint were reviewed. Sixteen patients had traumatic dislocations, seven had spontaneous dislocations, and four had congenital dislocations. The long finger was most frequently affected. The other fingers were affected almost equally. Displacement of the extensor tendon always occurred in the ulnar direction in the long and ring fingers. The index and little fingers exhibited different patterns of dislocation: two patients had ulnar dislocation of both the common and proprius tendons, and the remaining five patients had divergent dislocation of the two tendons. Nonsurgical treatment was undertaken in six cases. Surgery was performed in 21 cases. No recurrent dislocations were reported in any of the patients. Based on our experience, patients seen within 2 weeks of injury initially should be treated with splinting of the involved metacarpophalangeal joint. Chronic dislocations should be treated with a primary repair of the defect in the sagittal band. When the sagittal band is absent or deficient, the tendon must be stabilized using a loop procedure with a tendon slip.

Long-standing extended dynamic splintage and release of an abnormal restraining structure in camptodactyly

62 patients with camptodactyly of the little finger have been reviewed, and only five cases failed to respond to conservative treatment. These cases are reported. One patient could straighten the deformed PIP joint with snapping, and the other two were resistant to conservative treatment and were found to have a restraining structure requiring release. These findings are in keeping with an imbalance between flexion and extension forces due to long-standing malposition of the extensor lateral bands. Operative treatment should be reserved for cases of failed conservative treatment, which should be started as early as possible.

The use of an afferent arteriovenous fistula in digit replantation surgery: a report of two cases

Two cases of successful digital replantation are presented in which arterial inflow was provided by a proximal arterial-to-distal venous anastomosis. This technique provides an alternative means for replantation when no suitable artery for anastomosis is available in the amputated part.

Premature Closure of the Distal Radial Physis

Two cases of fracture of the radius treated by pinning resulted in severe wrist joint deformity due to premature closure of the epiphysial growth plate. Inappropriate pinning through the physis damaged the growth plate in both cases. They were treated by bone bridge resection with free fat interposition. The bone bar resection was effective in correcting the wrist joint deformity, and bone growth was expected without bone grafting.

Dislocation of the Distal Radioulnar Joint Associated with an Intraarticular Fracture of the Ulnar Head: Report of Two Cases

This article presents two cases in which an intraarticular fracture of the ulnar head occurred in association with a dorsal dislocation of the distal radioulnar joint. After open reduction and internal fixation of the osteochondral fragment, final outcomes were excellent.

Camptodactyly Resulting from Paradoxical Action of an Anomalous Lumbrical Muscle

A 17 year old girl presented with camptodactyly resulting from an anomalous insertion of the lumbrical muscle into the flexor digitorum superficialis tendon. The fourth anomalous lumbrical muscle paradoxically caused flexion of the proximal interphalangeal (PIP) joint of the little finger when the patient extended the fingers fully. She was operated on, and the lumbrical tendon was cut at its insertion into the flexor digitorum superficialis tendon. The tight fascial band and skin contracture at the PIP joint were released, and the skin defect covered with a transposed flap. She made a good recovery and eight months after operation had only 40 degrees residual flexion deformity with full flexion of the PIP joint of the little finger.

Intercostal Nerve Transfer to the Musculocutaneous Nerve in Avulsed Brachial Plexus Injuries

following peripheral nerve lesions as shown in animal experiments. Though collateral sprouting was found to reinnervate only a small proportion of the forearm sensory deficit it may have greater clinical significance in a smaller initial deficit, such as following digital nerve division. The most remarkable change detected was in the advancement of sweat gland function inwards from the sensory defect margin, commencing by 3 months and continuing up to 18 months. This has important clinical implications as it calls into question the reliance placed on the recovery of sweating as evidence of nerve regeneration.