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New splint for mallet finger.
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A versatile "lively" splint.
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Vascular factors and the localization of varicella lesions.
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Primary inoculation blastomycosis in a veterinarian.
A veterinarian cut his finger while performing an autopsy on a dog subsequently confirmed to have died of blastomycosis. A typical chancriform complex developed at the site of inoculation. Culture of the lesion grew Blastomyces dermatitidis. Healing of the lesion occurred after 7 months and a course of potassium iodide. This is the first reported case of a canine necropsy accident leading to primary inoculation blastomycosis.
Use of transcutaneous electrical nerve stimulation for fingertip analgesia: a pilot study.
STUDY OBJECTIVES: To determine if transcutaneous electrical nerve stimulation (TENS) can produce fingertip analgesia. DESIGN: Randomized, crossover trial. PARTICIPANTS: Fifteen healthy volunteers, naive to the technique of TENS. INTERVENTIONS: TENS stimulation was applied to the middle and ring fingers of each subject's hands by means of small carbon electrodes placed over the digital nerves. Patients received one fingertip puncture from a mechanically driven sterile lancet device to each digit corresponding to one of four conditions: sham, one minute of TENS, ten minutes of TENS, and 20 minutes of TENS. The TENS unit was operated in the "burst" mode, with two eight-pulse burst groups per second (pulse width, 225 mu sec; pulse frequency, 80 Hz). The order of the conditions and the finger used for each condition were assigned randomly. The pain of each puncture was rated on a 10-cm visual-analog scale. Data were analyzed using a repeated-measures analysis of variance with Duncan's multiple comparisons procedure. MEASUREMENTS AND RESULTS: Mean visual-analog scale scores decreased sequentially from sham in each experimental condition: one minute of TENS, 24.4% (P < .025); ten minutes of TENS, 28.2% (P < .025); and 20 minutes of TENS, 55.7% (P < 10(-6)). Two patients had total anesthesia of the fingertip (visual-analog scale = 0 cm) in the 20-minute TENS condition. CONCLUSION: TENS significantly reduces the pain of lancet-induced trauma to the fingertip. Further studies are warranted to determine if this technique is useful clinically as an alternative or adjunct to digital nerve block anesthesia for fingertip surgical procedures.
Dynamic external fixator for pilon fractures of the proximal interphalangeal joints: a simple fixator for a complex fracture.
We describe a very cheap, simple and effective dynamic external fixator for treatment of pilon fractures of the proximal interphalangeal joint. At final follow-up, nine such fractures had regained an average range of motion of 79 degrees (range, 65-90 degrees ). There was high patient satisfaction and there were no serious complications.
Lessons learned from the management of complex intra-articular fractures at the base of the middle phalanges of fingers.
The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7-28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74 degrees (range, 0-100 degrees ). The mean total active motion of the injured digit was 196 degrees (range, 40-275 degrees ). Refinements in the regime are suggested as a result of this investigation.
A new technique to shorten extensor tendons in the hand.
A new simple cut and fold technique is described, which allows precise shortening of extensor tendons in the hand by a few millimeters.
Swan-neck deformity as a complication of the Agee technique.
Unstable dorsal fracture dislocations of the PIP joint of a finger commonly result in joint stiffness following immobilization or open reduction and internal fixation (Green and Rowland, 1984). The Agee dynamic external fixator, or force couple splint (Agee, 1978; 1987), was introduced in an attempt to avoid this complication and maintains a concentric reduction whilst allowing a full range of joint movement. The splint is constructed from three Kirschner wires and is activated by a single rubber band. A force couple is created across the proximal interphalangeal joint levering the base of the middle phalanx towards the palm whilst simultaneously lifting the distal end of the proximal phalanx dorsally to restore joint reduction. However, this technique is not without complications (Agee, 1987). We report a swan-neck deformity resulting from this treatment.
Fractures of the base of the middle phalanx treated by a dynamic external fixation device.
Intraarticular fractures of the base of the middle phalanx are difficult to treat, especially if the fragments are comminuted. A spring dynamic traction device is described and the results in the first 14 patients presented. Patient acceptance has been high and the results comparable to other methods of treatment.
Arthroplasty of the proximal interphalangeal joint using costal cartilage grafts.
Seven intra-articular fractures in five patients with partial bone loss at the PIP joint were reconstructed using a graft of costal cartilage. In all cases there were total or partial cartilagenous defects of the proximal phalangeal side of the joint. Early treatment of two joints, using only costal cartilage grafts, resulted in bony ankylosis due to necrosis of the grafted cartilage. In five joints the grafted cartilage included osseous portions using the costo-osteochondral junction, leading to an average range of movement of 64 degrees with satisfactory clinical results. The technique is a useful alternative to other forms of arthroplasty or arthrodesis, and can provide satisfactory functional results when there is a partial defect of the head of the proximal phalanx.
Cross transposition of short amputation stumps for reconstruction of the thumb.
Cross transposition of digital rays is illustrated by a case of amputation of the thumb and the middle finger. A remnant of the stump of the middle finger was mobilised and brought on top of the first metacarpal, in order to restore a functional length to the amputated thumb. A cross transposition of the second digital ray to the third was also carried out, closing the gap left by the resection of the third metacarpal.
Irreducible buttonhole dislocation of the proximal interphalangeal joint of the finger (a case report).
Dislocations of the proximal interphalangeal joints of the finger rarely present a problem in reduction. However, reduction may be prevented by buttonholing of the joint capsule and volar plate by the head of the proximal phalanx.
Fracture of the ulnar sesamoid of the metacarpophalangeal joint of the thumb--an arthrographic study.
We report a case of fracture of the ulnar sesamoid of the metacarpophalangeal joint of the thumb. The role of arthrography and stress X-rays in delineating the pathological anatomy of this injury is discussed.
Corrective osteotomy for post-traumatic malunion of the phalanges in the hand.
Rotation, angulation, deviation, shortening or a combination of deformities can occur due to phalangeal malunion and can lead to impairment of hand function. A historical cohort study of 57 patients who had phalangeal corrective osteotomies for posttraumatic malunion between 1978 and 1990 was undertaken. 59 rotational, radial/ulnar deviation, flexion/extension, length adjustment procedures, and combinations thereof were performed, using rigid internal fixation. Concurrent tenocapsulolysis was done in 50% of the cases. Satisfactory correction was obtained in 76% of the patients. Bony union was obtained in all cases. A net gain in active range of motion was achieved in 89% of the patients. Excellent and good results were obtained in 96% of the patients who had corrective osteotomies for malunion involving only the bone and in 64% of the patients who had corrections for malunion with involvement of multiple structures (P < 0.01).
A neurovascular island flap for volar-oblique fingertip amputations. Analysis of long-term results.
A neurovascular island flap has been developed to reconstruct volar-oblique fingertip amputations. This study analyzes the data collected on 16 patients who were treated with this flap and had at least 2 years follow-up. The average active/passive range of motion was 54/55 degrees at the DIP joint, 96/98 degrees at the PIP joint, and 83/83 degrees at the MP joint. Twelve out of 16 flaps (75%) had two-point discrimination better than 10 mm. Moderate and severe problems included cold intolerance (six patients), hypersensitivity (three patients), stiffness (three patients), and numbness (two patients). Out of the 16 patients treated with this technique, 14 were satisfied with their surgical outcome. In experienced hands, this technique is a safe and reliable method with which to reconstruct volar-oblique fingertip amputations.
A method of two-dimensional measurement for evaluating finger motion impairment.
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