Journal of Hand Surgery (European Volume)

Two cases of microvascular great toe transfer for congenital absence of the thumb in children are reported. A rationale and operative details are discussed. A long term follow up is needed, but at this stage the results are most encouraging. There has been no interference with gait.

An analysis of 130 cases of digital revascularisation and replantation with an attempt to correlate case selection and management to survival and results.

An assessment of the results of three techniques of nerve repair. Epineurial repair, Funicular repair with resection of epineurium and Combined Funicular and Epineurial repair. The results were essentially similar.

Resin casts of the fine vasculature of human digits in normal and some abnormal states were studied by scanning electron microscopy. The palmar skin contained terminal loops aligned with the finger-print, while the dorsal skin vasculature consisted of a coarse meshwork. Fine vessels in the nail bed had a parallel orientation as far as the lunula in adults, but were straight right up to the nail roots in young children. A deeper meshwork of capillaries (corresponding to the rete subpapillare and the rete cutaneum), vessels of the glomus bodies, and the dense meshwork of sweat glands were visible on the sagittal cut surface of the samples. A severely scarred index finger showed a coarse meshwork of surface capillaries. A skin-grafted index finger showed repaired terminal loops resembling normal skin in the area of grafted skin. The fine architecture of the digital vessels observed was discussed in terms of the physiology of blood circulation to the skin.

Twenty-six rabbits were subjected to various types of forepaw flexor tendon laceration. After two weeks the tendons were examined. Fibrosis was densest around the proximal stump of the divided profundus tendon. Double partial transverse nicks, designed to induce local ischaemia, caused no more fibrosis than a single longitudinal slit of the same length. Rendering the proximal stump ischaemic with a snare caused no increase in fibrosis. It was concluded that movement and tissue trauma are more important than ischaemia in determining the degree of fibrosis around the injured flexor tendon in the rabbit forepaw.

The results of primary repair of the flexor tendons within the digital theca of the hand in twenty-three fingers have been very encouraging. Eighty-seven percent of the fingers had excellent to good results. Primary tenorrhapy by the technique described in selected cases offers the patient a shorter period of disablement with functional results as good or even better than those after a free tendon graft.

During the period 1966–75 operation to restore thumb opposition was performed in thirty four patients.

Out of twenty seven patients who could be traced, twenty one had obtained a satisfactory result, five had considerably improved, while one had to be classified as a failure.

Complications from the operation and the motor tendon are discussed.

Among 147 cases with injury to the median nerve treated during the same period, operation to obtain opposition was indicated in 14%.

This paper presents two anatomical variants as possible causes of peripheral nerve compression — the median nerve by a persisting median artery and the ulnar nerve by the muscle anconeous epitrochlearis.

A case of palsy of the distal part of the deep palmar branch of the ulnar nerve is described.

The possibility of an entrapment by the arch of the adductor poilicis is discussed. Anatomical features of this arch are reported.

This case report of a fracture of the hook of the hamate presenting as carpal tunnel syndrome emphasizes the importance of a careful physical examination, the necessity for a carpal tunnel roentgenogram and a high degree of suspicion by the surgeon in patients with symptoms of median nerve compression following trauma to the wrist.

Bone density was studied in ten patients before and after release of an idiopathic carpal tunnel syndrome. A corticomedullary ratio was measured at the mid-point of the metacarpals and proximal phalanges of both hands. There was a significant increase in the mean bone density over the period of observation in the thumb and middle finger metacarpals and in the index, middle, and ring finger proximal phalanges of the operated hand. Ther was no significant increase in the density of either metacarpal or proximal phalanx on the non-operated side.

Release of the carpal tunnel syndrome provides not only symptomatic relief but also leads to increased bone density.

The effect of excising fifty sural nerves from the legs of forty-five patients undergoing nerve grafting are described. Forty-two per cent of patients complained of tenderness in the calf, likely to be due to neuroma formation. Ten per cent of patients had other minor complaints. One wound haematoma and one deep vein thrombosis occurred. Overall patient satisfaction was high when the functional result of the nerve grafting was taken into account.

Four different types of Brachydactyly are presented and the incidence of Crooked Finger investigated.

A case of Psoriatic Arthritis with disabling flexion deformities at the metacarpophalangeal joints of the fingers is described. Skeletal shortening decreased the deformity and improved the function.

In the present series, the author studied anomalies of the hand associated with a pectoral muscle anomaly.

Gonococcal infection of tendon synovial sheath is discussed. A case of acute gonococcal flexor tenosynovitis without joint involvement is presented.

A patient with septic arthritis and a retained tooth fragment in a metacarpophalangeal joint is described. The case illustrates the mechanism of the initial injury.