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Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.
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Since November 1984, lengthening of metacarpals and digital phalanges by a distraction apparatus has been performed in six metacarpal bones and four phalangeal bones in nine patients (four females, five males). The age ranged from 14 to 59 years (average 36). The follow-up period was from two to 28 months (average 16). Lengthening was performed by two kinds of external distraction devices, the Ikuta external fixateur for metacarpals and the mini-Hoffmann-device for phalanges. The achieved elongation of the metacarpal bones varied from 26 mm to 30 mm (average 28.8 mm), and of the digital phalanges from 10 mm to 17 mm (average 13.5 mm). During the operation, the bone was distracted primarily about 5 mm and thereafter it was gradually distracted at a rate of 0.5 to 1 mm per day. Blood supply and subjective complaints were examined carefully. During distraction, following complications were observed: Fracture of grafted bone, necrosis of free grafted skin, rupture of a tendon with neglected lesion and delayed spontaneous bone union between the fragments. It is emphasized that skin, tendons, and other soft tissues around the thumb and fingers to be elongated should be intact and that the gap should be filled with an en-bloc bone graft. This facilitates early union in spite of a relatively short period of immobilization. Because of the relative simplicity of the method, no microsurgical technique is required. The main advantage of the procedure is that the lengthened digit retains its original sensation, vascular supply and some mobility. It is a useful procedure especially when a patient does not want to sacrifice another digit.
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Leprosy deformities have been considered as the main reason for dehabilitation and social ostracism. Prevention of deformities is considered as one of the most important objectives of leprosy control programme. In present work based on deformity status, efforts have been made to evolve new parameters and their possible application in assessment of leprosy control programme.
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Correct acute care is critical in the treatment of burns of the hand, particularly in the younger patient in order to avoid complications that may interfere with the patient's quality of life and ability to be self-sufficient and self-supportive. Objectives of management are to prevent edema, prevent prolonged immobilization and poor position and prevent infection and preserve viable tissue. The various modalities that are used to achieve these objectives and how they may be individualized to meet the patient's specific needs are described and discussed.
The conventional angiography using a serial film changer is the gold standard in hand arteriography. Since Digital Subtraction Angiography (DSA) is available, this method may substitute the conventional technique because of several advantages. This paper offers practical advice on intraarterial DSA-techniques and indications for hand arteriography additionally. Furthermore, differential diagnosis of arteriographic findings and the validity of DSA is discussed.
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An unusual case of Bardet-Biedl syndrome which presented with sudden total visual loss in both eyes is documented. The fundus picture and angiographic findings were consistent with the diagnosis of bilateral disc oedema with retinitis pigmentosa. The various etiological possibilities resulting in the manifestation of bilateral disc oedema in this case of retinitis pigmentosa are considered. Inflammatory disc oedema secondary to photoreceptor degeneration as a possible cause of acute loss of vision in retinitis pigmentosa is discussed.
A case is presented illustrating some of the basic principles in the development of deformity in the rheumatoid hand. Swanson flexible implant arthroplasties of the second through the fifth metacarpophalangeal joints are described and postoperative care and follow-up discussed. The authors conclude that surgery plays a crucial role in the early treatment of the rheumatoid hand.
Injuries to the small joints in the hand can lead to stiffness, pain, instability, and arthrosis. Careful evaluation and an understanding of possible complications may prevent serious difficulties from occurring.