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Operative correction of posttraumatic and congenital swanneck deformity--a new technique.

Volar plate reconstruction by using a part of the slip of the superficialis tendon is a new technique in the treatment of posttraumatic and congenital swanneck deformity. This small series represents two patients with a posttraumatic swanneck deformity due to volar plate rupture and one patient with a congenital swanneck deformity in six fingers. The results of the operation with a two years follow-up show seven fingers with a normal flexion-extension range without hyperextension. Only one finger has an extension lag of five degrees. All fingers have a normal grip strength and normal fine movements without pain. There were no complications.

Adolescent↗

Silastic implant arthroplasty for post-traumatic stiffness of the finger joints.

In the years 1981 to 1987, 50 patients had 59 replacements of the finger joints. Of these, 41 patients with 49 joint operations were reviewed, with follow-up ranging from two to eight years (average 32 months). About 80% of these patients were satisfied that silastic implant arthroplasty had relieved their pain and stiffness and improved function of the finger and hand. They were satisfied that this procedure was preferable to amputation or fusion. Success or failure was assessed not only on the range of movement of the joint being replaced, but on relief of pain, correction of deformity, stability and overall finger function. The seven patients regarded as failures are analysed in detail.

Adolescent↗

Results of primary repair of digital nerves.

Recovery of sensitivity following repair of 54 digital nerves was evaluated after one to seven years. Normal two-point discrimination has been regained in only seven cases (13%), two-point discrimination between 6 and 10 mm in 20 (37%), between 11 and 15 mm in 13 (24%) and protective sensation in 14 (26%). A close correlation between age and recovery of sensation after repair has been confirmed by statistical analysis. Microsurgical repair of digital nerves gives satisfactory results, since a normal or good two-point discrimination can be obtained in one-half of cases while sensation improves in the others. However a high rate of complete recovery of sensation is to be expected only in children.

Adolescent↗

Double dislocations of digits.

We report eight patients who sustained simultaneous dislocations of two joints in a digit. The little finger was involved in five patients.

Adult↗

Reconstruction of the distal phalanx of the fingers by free toe-to-hand transfer.

Anatomical examination of the blood-vessels in the distal phalanges of the foot show that the arteries and veins of this region are thick enough to be anastomosed by microsurgical means. This makes it possible to perform free toe-to-hand transfer, reconstructing defects of the distal phalanx and suturing arteries and veins at the level of the middle or even distal phalanxes. Eleven distal parts of the fingers have been reconstructed. All the transfers were successful, and good cosmetic and functional results were obtained.

Adolescent↗

External fixation of unstable metacarpal and phalangeal fractures.

A prospective study of the management of 30 patients with 37 unstable or complex metacarpal or phalangeal fractures treated with the "Shearer" micro-external fixator was carried out over an 18-month period. The stability achieved, with minimal soft-tissue tethering, allowed early joint mobilisation with good or excellent function in 94% of metacarpal and 85% of phalangeal fractures by nine weeks. There were no cases of non-union and few complications.

Equipment Design↗

The "S" Quattro in the management of fractures in the hand.

The "S" Quattro has shown its value in the management of displaced comminuted intra-articular phalangeal fracture dislocations. Since then the system has been used as a dynamic flexible external fixator in the treatment of five maluniting phalangeal fractures, five comminuted condylar and four severe compound fractures. These challenging fractures have been dealt with by easy operations, taking full advantage of the versatility of the "S" Quattro to achieve good results.

Adult↗

Arterial spasticity and cold intolerance in relation to time after digital replantation.

Cold induced arterial vasospasm was studied in ten patients with single digit replantation, by measuring finger systolic pressure at different finger temperatures. Each patient was examined three times; within 2 weeks of surgery, after 1 year and after 3 years. The replantations were performed using long arterial and venous grafts. Cold-related vasospasm is established during the first year after trauma, and thereafter seems to be persistent. It is concluded that the subjective cold tolerance, which affects all patients after digital amputation regardless of whether replantation is performed or not, is partly due to vasospasm. It is less pronounced in patients without pathological vasospasm in the replanted digit. Cold intolerance is likely to decrease during the first 2 years after replantation, but not to disappear completely.

Adult↗

Interphalangeal joint arthrodesis with oblique placement of an AO lag screw.

A damaged interphalangeal (IP) joint may be treated by fusion. Arthrodesis should leave the joint at the most functional angle and give sound bony union in the shortest possible time, maintaining maximum proximal and distal joint motion. The lateral oblique placement of a single AO lag screw, proximal to distal, achieves these aims. This method gives sufficient proximal bone for screw purchase and better control of the desired angle of fusion. This technique has led to fusion in 22 of 23 joints (96%), taking an average of 8.2 weeks.

Adult↗