Embryology of the upper limb.

An increased understanding of embryogenesis has advanced our fundamental knowledge of limb anomalies. Animal models with similar limb patterning have been used to dissect and manipulate crucial signaling centers that affect limb development and orientation. Experimental embryologists can produce limb anomalies that are similar to the human phenotype encountered in clinical practice.

Z-plasty for Tanzer type IIb constricted ears.

This article describes the Z-plasty technique for Tanzer type IIb constricted ears. The technique was used in 6 patients to lengthen the upper pole of the ear with simultaneous unfurling of the cupping deformity. All patients also underwent creation of an antihelix with Mustarde sutures as well as a "mastoid hitch" (sutures between the upper pole of the ear and the mastoid fascia) to prevent recurrence.

Long-term results of low rotation humeral osteotomy in children with Erb's obstetric brachial plexus palsy.

Seventeen children with Erb's (C5/6 and C5/6/7 types) obstetric brachial plexus palsy who underwent low rotation humeral osteotomy to treat internal rotation contracture of the shoulder were recalled back to the clinic at a mean of 10 (range 8-14) years after surgery. Eight were male and nine female with mean age of 16 (range 13-20) years. The osteotomy procedure was done at a mean age of 6 (range 5-8) years.

Campfire burns of the palms in crawling infants in Saudi Arabia: results following release and graft of contractures.

In Saudi Arabia, camping in the desert is commonly practiced by families. A campfire is usually lit and unsupervised crawling infants are at risk of burns from these campfires. During a 12-year period, a total of 53 children with hand contractures related to campfire burns were treated.

An obstetric brachial plexus data sheet.

Background: Several reputed obstetric brachial plexus clinics use their own protocols and indications for surgery. This study is to present and explain the obstetric brachial plexus data sheet used at our institution.

Methods: The data sheet is composed of 5 main parts: (1) the basic database which includes the name, age, type and side of palsy, maternal history, birth history and other complications of the traumatic delivery; (2) motor assessment of the limb; (3) preoperative investigations; (4) description of intraoperative brachial plexus findings and type of nerve procedure performed; and (5) secondary surgery to the shoulder, elbow, forearm, wrist and hand.

Flexor tendon repair in zone 2 using a six-strand 'figure of eight' suture.

The tensile strength of three different flexor tendon repair techniques were tested in vitro: the modified Kessler technique (a two-strand repair), two 'figure of eight' sutures (a four-strand repair) and three 'figure of eight' sutures (a six-strand repair). The mean breaking forces for the three techniques were 48.0 N, 73.

Congenital duplication of the palm syndrome: gene analysis and the molecular basis of its clinical features.

Congenital duplication of the palm is a rare syndrome with the following features: the dorsal aspects of both hands have thick palmar skin with no hair or nails; bilateral ulnar ray deficiency; short hypoplastic upper limbs; and severe lower limb abnormalities. In this paper, we report a new case of congenital duplication of the palm syndrome, provide its gene analysis identifying the responsible gene mutation in exon 4 of the WNT7a gene, and detail the molecular basis of its clinical features.

A review of burns related to traditions, social habits, religious activities, festivals and traditional medical practices.

This paper reviews burns that occur because of specific social habits and traditions; religious beliefs and activities; social events and festivals; and traditional medical practices. A literature review did not reveal any article that specifically reviews such burns. These injuries are not only interesting (being nation-specific) but are also important with regards to implementation of preventive measures in various countries around the world.

The bifid median nerve re-visited.

This report presents a venous malformation arising from the persistent median vessels associated with a bifid median nerve. The literature on bifid median nerve is reviewed and a classification of its associated abnormalities is offered.

Localized hand burns with or without concurrent blast injuries from fireworks.

This is a retrospective study of 32 cases with localized hand burns from fireworks. All cases occurred during two national festivals of our country. The majority (54%) were children between 5 and 14 years, and 94% were males.

The relative incidence of fractures at the base of the proximal phalanx of the thumb in children.

There is disagreement in the literature about the most common fracture type at the base of the proximal phalanx of the thumb in children below the age of adolescence. In this prospective study, 58 consecutive children aged 10 years or less with isolated fractures of the base of the proximal phalanx of the thumb were included and their radiographs were reviewed. The study included 38 boys and 20 girls with a mean age of 8 (range 1-10) years.

Phalangeal neck fractures with concurrent vascular injury.

The outcome in 16 consecutive paediatric cases of phalangeal neck fractures with concurrent vascular injury was investigated. The study group had a mean age of 5 (range 3-11) years. At final follow-up, the outcome was assessed according to Al-Qattan's grading system.

Juvenile mammary hypertrophy: is reduction mammaplasty always feasible?

Juvenile mammary hypertrophy is a rare disorder, and till date only 21 cases have been reported in the literature. The management of this condition includes screening for hormonal imbalance and reduction mammaplasty. However, we believe that the following case is worth reporting not only because of the rarity of the condition but also because it is the only case in which a bilateral subcutaneous mastectomy was performed instead of a reduction mammaplasty procedure because of massive intraoperative bleeding.

The relative incidence of fractures at the base of the proximal phalanx of the fingers in children.

There is debate regarding the most common fracture type at the base of the proximal phalanx of the fingers in children prior to closure of the epiphysis. In total, 100 consecutive children presenting with 103 fractures were included in a prospective study and their X-rays were reviewed by a consultant musculoskeletal radiologist. The study included 61 boys and 39 girls with a mean age of 10 (range 4-14) years.

Outcome of conservative management of spiral/long oblique fractures of the metacarpal shaft of the fingers using a palmar wrist splint and immediate mobilisation of the fingers.

Conservative management of spiral/long oblique fractures of the shaft of the metacarpal almost always results in shortening and hence these fractures have the reputation of ending up with an extension lag and reduced grip strength. In a prospective study, 42 patients with 54 fractures were treated with a palmar wrist splint and immediate mobilisation of all finger joints. All fractures united.

K-wire fixation for extraarticular transverse/short oblique fractures of the shaft of the middle phalanx associated with extensor tendon injury.

In a prospective study, 22 cases of extraarticular transverse/short oblique fractures of the shaft of the middle phalanx associated with extensor tendon injury had fixation of the fracture as well as immobilisation of the distal interphalangeal joint using a K-wire. Mobilisation of the proximal interphalangeal and metacarpophalangeal joints was started immediately after surgery. The wires were removed after 6 weeks.

The use of a combination of cerclage and unicortical interosseous loop dental wires for long oblique/spiral metacarpal shaft fractures.

A literature review of metacarpal fracture fixation techniques revealed that the use of a combination of interosseous and cerclage dental loop wires has not been previously described. In this report, we review the results of 24 patients with long oblique/spiral metacarpal shaft fractures of the fingers treated by this combined technique of internal fixation, followed by immediate postoperative finger mobilisation in a wrist splint. The study included 20 men and four women with a mean age of 32 (range 20-48) years.

Closed reduction and percutaneous K-wires versus open reduction and interosseous loop wires for displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers.

Seventy-eight male industrial workers with displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers were divided into two groups: Group 1 (n = 40 men, mean age = 34 years, range = 22-46 years) was treated with closed reduction and percutaneous K-wires, and Group 2 (n = 38 men, mean age = 33 years, range = 20-48 years) was treated with open reduction and interosseous loop wire fixation. At final follow-up, the total active motion (TAM) score of the injured finger was graded as excellent, good, fair or poor if it was greater than 240 degrees , 220 degrees , 180 degrees or less than 180 degrees , respectively. Group 2 had significantly better overall TAM scores than Group 1 (P = 0.

The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling and clinical evidence of acute median nerve dysfunction.

Twenty-five cases of crush injury to the hand resulting in the triad of multiple finger metacarpal fractures/dislocations of the fingers, a balloon hand appearance due to severe swelling and clinical evidence of acute median nerve dysfunction were retrospectively reviewed. All were men with a mean age of 33 (range 20-45) years. All injuries occurred following industrial or major car accidents.