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CT plays a limited but distinct role in the evaluation of the hand and wrist. It is most useful in assessing bone and joint anatomy and has only a secondary role in soft tissue abnormalities. The clearest value of CT is in assessing trauma and post-traumatic complications, such as malunion, nonunion, or avascular necrosis, where careful attention to position and technique can yield important information not otherwise obtainable.
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In this report we present another family with oligosymptomatic expression of the EEC syndrome. A mother with complete absence of the permanent teeth had two children with split hand/split foot deformity, as typically seen in the EEC syndrome. Cleft lip/cleft palate was also present in one of them. The great variability in expression of this autosomal dominant syndrome is discussed and the difficulties in genetic counseling are emphasized.
The anomalies of the ADAM complex arise through amniotic strangulations, adhesions and amputations. In the face cleft formations, displacements and deformities of various structures occur. The limbs exhibit constriction grooves, secondary syndactyle or amptuations. According to observations on 8 patients and information from the literature, the presentation of Adam complexes can vary to an extraordinary degree. The anomalies result from exogenous influences. In genetic counselling phenotypically similar congenital malformations must be separated.
This article discusses the relationship between early wound treatment and late deformity in burned children. The writer believes the main causes of late deformity are as follows: to treat deep second burn wound too conservatively; to use pinch skin graft on functional position and too large ratio of mesh graft; to take skin too thick from donor area; no proper pressure dressing and rehabilitation after grafting. The better results can be obtained, if the early burn wounds are treated with some plastic surgical points of view and the deformities are corrected within half year postburn although the scar is still unstable.
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Normal and abnormal embryologic and postnatal development of the extremities, chest wall, breasts, and abdominal wall are described. Knowledge of development anatomy is helpful in forming a rational basis for planning and timing of surgical intervention. Clinical and potential clinical applications are described.
Since 1985, on the basis of anatomic study of dorsal pedal artery, thumb and radial side of palm reconstruction have been successfully performed in one stage by using opposite composite dorsal pedal flap including the second toe, the second metatarsal and the first toe web. Because they were all distributed by dorsal pedal artery and great saphenous vein, dissecting these tissues was not difficult. Good function and cosmetic appearance were achieved following reconstruction.
In a series of 157 transfer cases, 73 were carried out in 58 patients using the second toe. 55 transfer operations were performed on the long toes versus 18 on the big toe. Indications are discussed on the basis of an original classification of amputations. Among tested parameters, sensitivity and mobility statistically correlated with 17 factors. Of statistical import were age, sensitivity to cold, duration of ischemia, partial exclusion of fine pinch. Significant mobility factors were industrial accident, the surgeon's experience, the number of nutrient arteries, the reconstruction level, and the amputation score.
A case of atypical brachydactyly is reported with clinical and radiographic findings. A differential diagnosis is discussed. In light of the lack of corrective surgical techniques, conservative management is considered, including genetic consultation to prevent the deformity in future generations.
Fourteen of 52 unselected patients with systemic lupus erythematosus (SLE) (27%) had ligamentous derangement demonstrated by either Jaccoud's syndrome and/or patellar tendon elongation. Three cases had only Jaccoud's syndrome, 4 isolated patellar tendinous laxity, while the remaining 7 presented both findings. Jaccoud's syndrome and/or tendinous laxity were not associated to an increased frequency of arthritis, corticosteroid therapy or a longer disease duration, but significantly associated with increased serum PTH levels secondary to chronic renal failure. Hyperparathyroidism secondary to chronic renal failure should, therefore, be considered a potential factor contributing to the development of Jaccoud's syndrome and/or tendinous laxity in patients with SLE.
Five children developed growth disturbances following severe burns of their hands. Joint abnormalities, amputations, and periosteal reaction were seen on radiographs, and all had premature epiphyseal fusion in several phalanges or metacarpals, a finding rarely described previously.
Nine children who had growth abnormalities of their hands following frostbite were studied. In all nine there was shortening of distal phalanges and some adjacent middle phalanges. Proximal phalanges and metacarpals were rarely involved. Epiphyseal abnormalities included destruction, premature fusion, and fragmentation. Other findings included irregularity of the distal ends of phalanges, abnormal alignment, joint abnormalities, and soft tissue swelling.
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The authors report 73 cases of Behçet's disease with articular manifestations. Polyarthritis, generally considered to be rare, was found in 20.5 per cent of cases in this series. The unusual features are illustrated. Amongst them, two cases presented deforming and destructive lesions, which have been only exceptionally reported in the literature. A third case is unusual because of the association of Gougerot-Sjögren's syndrome with Behçet's disease and polyarthritis deformans. No cases of ankylosing spondylitis were observed. Lastly, the data of this series are compared with those of the literature.
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