Biomedical subjects
Publications and source records attributed to G L Lucas.
Fowler's central slip tenotomy for old mallet deformity is a well-known, but apparently seldom used procedure. Although the vast majority of patients with mallet finger can be successfully treated by well-known conservative techniques, occasional patients, such as the 11 reported here, will have enough difficulty with a chronic mallet finger to warrant rebalancing of the extensor apparatus by means of central slip tenotomy.
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The propensity for digital pigmented villonodular tenosynovitis to recur is well-known. A patient who has had 11 consecutive recurrences of the tumor over a 14-year period has retained a functional finger.
A case of synovial chondrometaplasia of the hand is described. Histologic differentiation from chondrosarcoma may be difficult. Recurrences are common, but no instance of malignant change is known. Nonetheless, adequate surgical excision of the lesion is recommended.
The transosseous injection of colored latex through 36 fingers demonstrated that the venous system consists of a series of arcades on the dorsal and palmar surface of the digit with connecting oblique and transverse anastomotic veins. The caliber of the palmar veins was smaller than that of the dorsal and their route did not consistently run with the digital artery and nerve. Venous channels were also found in the vincula. The anastomotic veins and especially the commissural veins provide a venous return for the digit if the major dorsal system has been divided.
Although sites of ulnar nerve compression or disruption are generally apparent in a detailed physical examination, ulnar nerve involvement that is confined to the dorsal sensory branch of the ulnar nerve is unusual. Three patients presented with pain over the dorsal ulnar aspect of the hand associated with a cystic mass on the ulnar border of the wrist and hand. Stretching of the dorsal cutaneous branch from an underlying ganglion or proliferative synovium was present in all three of the patients.
We have discussed 13 patients with Pasteurella multocida infection of the hand, six of whom developed chronic hand impairment as a result of the infection. It is thus apparent that chronic morbidity following Pasteurella infection of the hand is nearly 50 percent. Despite a fairly wide antibiotic susceptibility pattern of this organism, the infection may have long-term consequences such as osteomyelitis, or small joint stiffness due to paraarticular infection. We wish to emphasize the rapid evolution of the clinical picture following inoculation and the need for vigorous antibiotic therapy supplemented by rest, elevation immobilization, and occasional surgical decompression or drainage. At this time, the preferred antibiotic for initial care would appear to be on of the cephalosporins changed to penicillin for the culture-proven infection.
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An open dislocation of the shoulder is a very uncommon and serious injury. The sequelae of open glenohumeral dislocation include infection, avascular necrosis, and limited motion. The patient with such complications will have serious compromise in shoulder function, as illustrated in this case report and reference to another report in the literature.
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