Zakir Shariff

Dupuytren's contracture of the distal interphalangeal joint: a rare presentation.

aesthetic outcome at 18 months. Mycobacterium avium is commonly associated with pulmonary infection (Sachs et al., 1992), while isolated primary skin infection is very rare (Hide et al., 1997). This infection often follows an indolent and chronic course, making early diagnosis and treatment difficult (Hoyen et al., 1998). The deep infections of the hand may cause considerable damage to the underlying tissues, particularly synovium-lined structures (Hoyen et al., 1998; Walter et al., 1995). Such infections affecting the hand have direct implications on its function. There is no established method of management of this resistant infection of the skin and soft tissues. Conservative treatment, or minimal surgical activity, has often been reported to achieve control of the infection. This approach has been adopted mainly because of concern about the possible effect of the infection on the outcome of any early reconstruction. However, this conservative attitude can result in unpredictable scarring, length of recovery and functional outcome (Hellinger et al., 1995). Treatment by aggressive, radical, early debridement and reconstruction, as illustrated in this report, reduces the total bulk of tissue requiring drug control and allows early hand mobilisation. A wellperfused flap may even help bring the drugs to the site. Successful Rifampicin and Ethambutol treatment within a period of 2 months is considerably shorter than previously reported anti-mycobacterial treatments for an average of 1 year (Hellinger et al., 1995).

Botulinum toxin type A injections for cold intolerance following finger revascularization

iliac crest bone autograft and fixation of the scaphoid at age 16. One year later there was complete resolution of symptoms with an equal range of movement in both wrists and bony union was confirmed by radiographs (Figure 1(c)). It is unclear whether AVN or the fracture occurred first. Idiopathic AVN of the scaphoid (Preiser’s disease) is rare in children, with one case reported involving both poles (Jensen and Leicht, 1995). AVN of both poles in a child’s scaphoid after fracture is also rare, with two cases reported. After treatment by immobilization, one child had painless limitation of dorsiflexion 1.5 years later (Iqbal et al., 2007). The other skeletally immature patient had a chronic scaphoid non-union with total AVN (Ben-Amotz et al., 2015). A free vascularized medial femoral condylar graft was carried out at age 17, 6 years after the original injury, with good results. The patient had returned to normal activity at 8 months, with complete resolution of pain. In the case we report, there appeared to be no negative effect from delaying surgery until the scaphoid had ossified and there was an obvious and symptomatic non-union. A non-vascularized bone autograft was effective.

A Rare Case of Primary Tuberculous Tenosynovitis in a Young Patient with an Acute History

We present a rare case of primary tuberculous tenosynovitis in a young patient with an acute history of non-penetrating traumatic injury. The patient had recently visited Pakistan and presented with sudden onset pain at the base of their right fifth digit after trying to catch a cricket ball. A provisional diagnosis of haematoma was made; however, ultrasonography revealed a mass attached to the A2 pulley. Surgical excision followed by histological examination and culture identified Mycobacterium Tuberculosis infection. This case serves to raise clinical awareness of this rare condition and highlight the importance of obtaining a travel history.