Biomedical subjects
Publications and source records attributed to V E Wood.
Keloid formation on the palms of the hands and soles of the feet is rare. A keloid developed 2 months after release of simple syndactyly in a young black child. The process of keloid formation is not completely understood, and surgical correction is not effective.
Release of the sheath of the flexor tendon is the accepted solution for the problem of congenital trigger digits in children. A series of 27 patients with 37 trigger digits were observed over a period of 18 years: the average follow-up on these patients was 46.9 months. Thirty-two thumbs, three long fingers, and two ring fingers showed locking and a degree of triggering. Thirty-three digits required surgery. The surgical treatment is simple and effective. The outcome in most cases shows that this is a conservative approach.
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We present a case of a child born with metacarpal synostosis of the index, long, and ring fingers associated with a simple syndactyly of the small finger and an absent thumb. At age 7 months, a syndactyly release with skin grafting to the small finger was accomplished so that it became the new thumb. At age 4 years, one of the muscles on the radical border of the hand was transferred to the small finger to act as an opposition transfer. At follow-up, the transfer contracted well and the functional capability of the hand was improved. This operation will not often be used but should be considered for the occasional patient with congenital anomalies.
To assess the efficacy of paradoxical directives, levels of challenging behaviour during 2 weeks of paradox, reprimand and extinction were compared with baseline levels in four adults with mental handicaps attending a day centre. Paradox was the most effective procedure for reducing the frequency and severity of challenging behaviour by an average of over 70% by the end of 2 weeks and up to 90% in certain subjects; extinction was least effective. Paradox was most effective with more defiant subjects, when staff rated treatment success as low, when improvement using extinction and reprimand was poorest, and in reducing aggressive behaviour. The present authors suggest the overjustification effect offers an explanation for the effects of paradox.
This article describes a clinical entity under the new name "super digit." The anomaly represents a conglomerate of several different malformations and syndromes. Twenty patients with 24 super digits are presented. The two main types of super digits are discussed: Type I, which has two metacarpals that support a single oversized digit; and Type II, which has a single metacarpal that supports two or more digits distally. These digits, with growth, display several complications such as enlargement, deviation, angulation, loss of motion, and undergrowth. The anomalies singly and collectively present problems that require similar surgical procedures for correction.
Two patients with hamartomas of the median nerve and one with hamartoma of the ulnar nerve associated with macrodactyly are described. Nineteen similar cases of this association have been found in the literature. There is evidence that these two conditions are part of a localized regional growth disturbance. This type of macrodactyly should be differentiated from neurofibromatosis.
Polydactyly associated with triphalangeal thumb is not rare, as among the records of 1,269 patients with congenital deformation of the upper extremity at the University of Iowa there were 21 patients with 32 hands with such involvement. More detailed classification based on Wassel's work was made. Treatment should be early, with removal of the radial digit if equal in size, excision of all accessory parts including delta bone when present, reconstruction of joint ligaments or joint fusion and osteotomy for correction of deviations. Care should be taken to avoid leaving a narrow first web space.
Eleven patients were treated for rollover injuries of the upper extremities from 1971 to 1976 resulting from the rollover accidents of off-road vehicles in rough terrain. Injuries to the volar surfaces of the extremity were most common, but injury to the extensor surfaces seemed to be more severe. Soft-tissue injuries predominated as did injury to the nondominant hand. The majority of patients returned to their original jobs after sometimes prolonged recovery and rehabilitation. A redesign of the rollover cage with interior hand holds could reduce the frequency and severity of these novel injuries.
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A case of hyperphalangism is presented with a review of the literature. Ninety-one cases of this deformity have been recorded now in the literature. This abnormality is inherited as an autosomal dominant. The index and middle fingers show hyperphalangism, which is confused occasionally with nonunion of a fracture. The anatomical features of this unusual duplication are presented along with a simple plan of treatment for the cosmetic aspects of this rare congenital defect.
From the literature we found reports of 105 patients whom we judged had a triangular deformity of one of the bones of the hand or foot. We found 49 patients of our own with 84 delta-shaped phalanges limited strictly to the hand. This represents an incidence of 3.5% of our congenital abnormalities of the upper extremity. The deformity is associated with many abnormalities: syndactyly, polydactyly, symphalangism, triphalangeal thumb, cleft hand, and hypoplastic hand are the most frequent Triangular deformity of the bone of the index finger usually is associated with Apert's syndrome. Triangular deformity of the proximal phalanx of the ring finger often is found with central polydactyly. Our average follow-up time on these 49 patients was 14 years, giving us a chance to establish some guidelines and general rules about the natural history and treatment of the delta bone.
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The triphalangeal thumb is a rare congenital malformation, but not as rare as the literature would imply. Forty-two patients with 68 triphalangeal thumbs, represent an incidence of about 3 per cent of a population of upper extremity abnormalities. Although little is written about the details of treatment, surgery is frequently necessary. Age makes a great difference as to hom the extra phalanx should be treated. The associated abnormalities present major surgical problems that must be treated early.
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