The Journal of Hand Surgery: British & European Volume

Iliac crest bone grafts are sometimes preferred to other bone grafts for the treatment of non-unions of fractures of the scaphoid as they are claimed to have better osteogenic potential and biomechanical properties. We retrospectively studied a consecutive cohort of 68 symptomatic established scaphoid non-unions treated by bone grafting. An iliac crest graft was used in 44 cases and a distal radius graft in the other 24. The two treatment groups were comparable in terms of location of the fracture, duration of the non-union and the fixation implants used. Overall union was achieved in 45 of the 68 patients (66%) and the union rate was not influenced by the type of bone graft used. Twenty-nine of the 44 treated with iliac crest bone graft (66%) and 16 of the 24 (67%) treated with distal radial graft united. Donor site pain over the iliac crest was present in nine of the 44 patients in this group.

We describe a case of a symptomatic non-union of the scaphoid in a 19-year-old man which spontaneously healed 3 years after the injury.

A rare case of delayed posterior interosseous nerve palsy that developed 39 years after an unreduced anterior dislocation of the radial head is reported. The posterior interosseous nerve was compressed and narrowed at the arcade of Frohse. Radial head resection and release of the arcade was done. The paralysis continued to recover 6 weeks after operation. The nerve, at the arcade of Frohse, was susceptible to compression by the dislocated radial head, especially in the supinated position. Repeated supination and pronation movement over time may have led to developmental changes that caused the delayed nerve palsy.

Những đóng góp tương đối của các cơ duỗi cẳng tay vào lực kéo căng tại mỏm khuỷu bên đã được khảo sát bằng cách cấy một cảm biến lực vào gân duỗi chung của bốn khớp khuỷu tử thi mềm đã cố định và kéo căng từng cơ xuất phát từ mỏm khuỷu bên theo thứ tự. Cơ duỗi cổ tay ra ngoài ngắn và cơ duỗi ngón tay chung tạo ra sự gia tăng lớn nhất, trong khi đầu nông của cơ supinator tạo ra một sự gia tăng vừa phải về lực kéo căng trong gân duỗi chung. Cơ duỗi cổ tay ra ngoài dài và cơ duỗi cổ tay trụ không có tác động đáng kể.

Hildreth’s test is a clinical test for the diagnosis of glomus tumours. It is positive if there is a reduction in pain and tenderness on exsanguination and ischaemia of the affected part. This study assessed Hildreth’s test, and found 92% sensitivity and 91% specificity with a positive predictive value of 92% and a negative predictive value of 91%.

Ten arterialized venous toenail flaps with two venous pedicles, one of which was anastomosed to a digital artery and the other to a dorsal vein of the finger, were used in nine patients to reconstruct nail loss due to trauma. Four flaps were taken from the lateral part of the big toe and six flaps from the second toe. Four toenail flaps with pulp and three flaps with the distal half of distal phalanx were used. Nine flaps survived completely and one had partial necrosis. All showed excellent aesthetic and functional results except for one case with minimal deformity in growth of the nail. The mean operating time was 2 hours.

The purpose of this study was to evaluate the reported rate of complications after endoscopic carpal tunnel release by means of an analysis of 54 publications, reporting a total of 9516 endoscopic and 1203 open releases. Endoscopic release was comparable to open release in the rate of irreversible nerve damage (0.3% and 0.2% respectively) but case reports may indicate a small risk of unacceptable complications with endoscopy, such as transection of the median nerve. Reversible nerve problems were more common after endoscopic release. Tendon lesions were extremely rare (0.03%) and the rate of other complications (reflex sympathetic dystrophy, haematoma, wound problems, etc.) was about the same with endoscopic as with open release.

A patient is described who was stabbed in the upper arm and two years later developed a radial nerve palsy. X-rays showed that the tip of the knife had broken off in the arm. At operation this bit of blade was loose and had completely divided the radial nerve.

A case of closed rupture of the extensor mechanism associated with a fracture of the proximal phalanx of the little finger is presented. Diagnosis was made only after surgical exposure for internal bone fixation.