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Linear nevus sebaceous syndrome is a rare neurocutaneous syndrome in which associated radiographic findings of the peripheral skeletal system are uncommon. We report a follow-up study of a patient with mainly unilateral changes of the skeletal system involving the thorax and the right arm and leg.
INTRODUCTION: In a follow-up examination 50 patients who had sustained dorsal dislocations of the proximal interphalangeal (PIP) joint, the results of two conservative therapy regimens, either immobilisation or early motion, were investigated. The patients were assigned randomly. The inclusion criteria were: adult patients over the age of 18 with isolated, acute, closed dorsolateral dislocation of the PIP joint. MATERIALS AND METHODS: In group A, 25 patients were treated by closed reduction and immobilisation with a short-arm cast including both interphalangeal joints for 4 weeks. In group B, 25 patients were treated by dorsal block splinting of the PIP joint following reduction. The finger was released in extension with daily active exercise of the PIP joint. RESULTS: In group A, 9 patients showed a normal range of motion, whereas a limitation of extension of 10 deg and more was seen in 16 patients. All PIP joints were clinically stable, and 19 patients were satisfied. Two patients complained of a limitation of extension, 3 of limitation of extension and pain, and 1 of pain and swelling. In group B, only 2 of 25 patients showed a limitation of extension of 10 deg and more, whereas 23 patients showed a normal range of motion. Instability of one collateral ligament was seen in 2 cases. Palmar instability did not occur, and 18 patients were satisfied. One patient complained of instability, pain and lack of extension during hard work, 1 of pain in combination with instability, 2 of pain and 3 of swelling of the joint. CONCLUSION: Early active motion after dorsolateral dislocation of the PIP joint produces significantly superior results regarding the active range of motion and pinch power than static splinting.
INTRODUCTION: Intra-articular fractures of the proximal interphalangeal joint are usually treated by one of many methods of external fixation, but this does not restore the articular surface. We describe a procedure where bone grafting and internal fixation are used to restore the articular surface. PATIENTS AND METHODS: A prospective study was conducted in which three patients underwent surgical treatment for this fracture. We describe a surgical procedure where bone graft harvested from the distal radius is packed through a diaphyseal window to restore the articular surface. This is followed by internal fixation with mini-screws. RESULTS: The average follow-up was 61 months. At last follow-up the average arc of movement of the proximal interphalangeal joint was 100 deg and the average Disability of the Arm, Shoulder and Hand (DASH) Score was 2. Postoperative radiographs showed restoration of the articular contour in all three patients. CONCLUSION: The surgical technique described addresses the issues of restoration of the articular surface and permits early mobilisation. The results for our group are excellent and compare favourably with those achieved using external fixators described in the literature.
INTRODUCTION: Osteochondral (OC) fractures of the trochlea of the PIP joint are rare but the treatment of these fractures can be challenging [2, 5, 6, 10]. And the therapeutic guideline is not determined. MATERIALS AND METHODS: All of the three cases were male. Two were delayed union with minimal displacement and the other was a fresh displaced fracture. All cases were treated with ORIF using small K-wires. In delayed union cases, bone grafting was added. RESULTS: Although bone union was obtained in all cases, rotation of the fragment due to the absorption of the grafted bone resulted in deformity of the trochlea in one of the delayed union cases. The functional recovery at the 2-year follow-up was satisfactory in all cases. CONCLUSION: Although OC fracture of the trochlea of PIP joint carry significant fixation implications, successful treatment could be done with ORIF using small K-wire fixation technique.
Dislocations of the proximal interphalangeal joint rarely present a problem in reduction. We report a case of dorsal dislocation in which attempts at reduction by manipulation were not successful. A probable mechanism is discussed. In most cases of such injury, the flexor tendons should be elevated by a probe to allow replacement of the head of the proximal phalanx.
Herpetic whitlow is a well-known occupational hazard for medical staff. It has been reported to affect mainly workers in intensive care units who come into close contact with oral secretions. We report herpetic whitlow infection in a general pediatrician in order to increase the awareness to this infectious occupational hazard that might occur in any health care worker who deals with oral secretions. A 35-year-old male general pediatrician sustained a minor knife cut in his finger and 5 days later he developed herpetic whitlow. He was treated with acyclovir with gradual improvement. We review the clinical course, complications and treatment of herpetic whitlow. The source of the infection in the present case was unknown, but it probably derived from oral secretions of children with unrecognized infection. Simple measures like wearing gloves during oral examination will avoid unnecessary morbidity in medical staff.
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A case of posttraumatic subacute synovitis with pseudotumor of the digit with bone lesions on plain film is reported. Arteriography showed a pattern of hypervascularity that did not appear malignant and evoked a benign tumor of the synovial. Biopsy helped establish diagnosis of common subacute synovitis. Swelling disappeared spontaneously during subsequent months. Diagnosis of villonodular synovitis is difficllt when proliferation of histiocytes is present.
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Nine toe pulp flaps based on the first dorsal metatarsal artery for reconstruction of thumb and index pulp loss are reviewed. The method is capable of giving excellent results, and particular indications are noted.
Compared with the other fingers, the little finger is more often and more severely involved by flame and flash burns. The post-burn sequelae found in this finger are described and the resulting impairment of hand function highlighted. It is suggested that more attention should be paid to the post-burn problems of this finger.
An island flap is described for fingertip reconstruction, based on one neurovascular bundle. The design incorporates the stepladder principle, which ensures the provision of ample skin with full tactile sensibility in the required position, without the risk of longitudinal volar scarring and with good nail support when necessary. Fourteen such repairs have been carried out with satisfactory results and no complications.