Journal of Hand Surgery (European Volume)

The authors have investigated the immunological rejection responses against allogeneic tendon tissue using two strains of inbred rats.

A complement dependent cytotoxicity test and an absorbing test were used. The results indicate that the rat tendon tissue contained major histo-compatibility antigens, that this was largely present in tendon cell components, and that collagen showed little or no response.

Twenty three cases of thumb reconstruction were analysed. Functional results of different methods of reconstruction are compared and discussed. Different injuries and different patients call for different types of reconstruction.

For replantation surgery, continuous brachial plexus block was employed using supraclavicular or axillary approach. Of a total of fifty blocks, forty-seven (94%) gave adequate surgical analgesia throughout the operations. No serious complication appeared in this series. Pneumothorax was detected in one supraclavicular block, but no surgical drainage was required. One patient had paraesthesia in the blocked arm, but it subsided within a month. No toxic reaction was recognised in spite of high dose of anaesthetic agents. Thus continuous brachial plexus block has been ascertained to be safe, reliable, and useful for the replantation and other prolonged operations in the upper extremity.

Solid bone fixation constitutes one of the important factors in obtaining good function after replantation of amputated digits. Comparison has been made of various methods of bone fixation including a newly designed ceramic intramedullary screw which we have found useful for cases of amputation of a middle or proximal phalanx around its middle.

Six different techniques of Kirschner wire fixation are compared in experimental transverse diaphyseal fractures of metacarpals and phalanges. Open retrograde cross-pinning provides a relatively simple means of obtaining consistently accurate pin placement with maximal stability. The technique is described, and the use of a preview pin and hypodermic needle guide are introduced. The indications, advantages, potential complications and clinical application are discussed.

A retrospective series of forty-three finger joint arthrodesis is presented. The failure rate was seven per cent. A new method of introducing a cerclage wire into bone is demonstrated. Septic arthritis of finger joints is considered to be an indication for acute arthrodesis.

The patency of a microarterial anastomosis was tested both in the antegrade and retrograde directions. Experimental and clinical observations showed that if patency was achieved in both directions, the subsequent result was much better than in those where patency was demonstrated only in the antegrade, but not in the retrograde direction.

A farm labourer suffered a high pressure injection injury to the palm of his right hand when the hydraulic drive of his tractor developed a leak. On the basis of the type of fluid injected, the clinical findings and the relatively favourable site of the injection, the patient was able to return to work in four weeks with a functional hand. It is suggested this type of management should-be considered only in suitable cases where experienced care is available.

A child was born with ischaemic damage to the skin and muscles of the left upper limb. Repeated surgery of the soft tissues resulted in a functional limb. Recent röentgenograms show extensive metaphyseal and epiphyseal damage. This case is reported for its uniqueness and to stress the necessity of long term follow-up.

Acute carpal tunnel syndrome is rare and usually is secondary to trauma, burns, infection or acute rheumatoid arthritis. A case is presented in which the acute syndrome was produced by Chondrocalcinosis (pseudogout or calcium pyrophosphate disease) of the wrist.

A prospective controlled trial of mallet-finger injuries treated by internal fixation or external splintage of the distal interphalangeal joint showed no particular advantages for either method, but suggested that patients presenting after some delay may achieve better results after internal fixation.

Recurrent and chronic mallet fingers were treated by tenodermodesis. The results of this simple and reliable technique are reviewed over a period of two and a half years in twenty-seven patients.

This paper reviews five cases of partial arterial division illustrating various stages in the evolution of false traumatic aneurysms.

A case is presented of Kienböck's Disease of the left wrist in a seventy-one year old lady, believed to be the oldest reported patient with this condition.

Coalition between the capitate and trapezoid is extremely rare and is reported here because of an unusual association with Kienböck's disease of the lunate in the nondominant wrist.

A case of mirror hand in which there were four supernumerary fingers but in which the lateral forearm bone exhibited many of the features of a radius is described. Observation showed that, in this case, the supernumary index finger was the most suitable for thumb construction. Rotation osteotomy of the metacarpal of this finger combined with opposition tendon transfer resulted in the creation of an efficient, opposable thumb, but transfer of a finger extensor tendon to the dorsum of the wrist did not produce lasting benefit.

A patient with actinomycosis of the wrist and hand with marked involvement of the carpal bones is recorded. The delay in diagnosis and difficulties of cultural isolation of the organism are discussed.

Synovial sarcoma is a rare tumour in the hand. We report an unusual case of such a tumour that was located in the distal phalanx of a finger of an elderly woman. A synovial tumour in this location and at such an age seems to be unique.

A case of clear cell sarcoma of the extensor tendons of the hand is reported. This rare tumour has never been recorded at this site before. The clinical presentation, differential diagnosis, pathological features and treatment are discussed, and the importance of distinguishing simple ganglion from more serious pathology is stressed.

An adjustable finger support has been constructed allowing the finger in question to rest in position suitable for operations on the dorsal structures.