The Trapezium is Not Necessary: Logical Implications in Treating Basal Joint Arthritis and Pollicization.

It has long been thought that the surgical treatment of osteoarthritis of the first carpometacarpal joint must replicate the normal anatomy. Common sense argues that biomechanical stability can be achieved by a simple ball-and-socket joint obviating complicated ligament reconstructions and trapezium replacements. Our argument is presented and the conclusions are based on the results of a very large series over a long period.

Pollicisation: The Myth about Creating a Pseudo-Trapezium.

We have performed 14 pollicisations without creating a "pseudo-trapezium" from the metacarpal head. The entire metacarpal of the intended finger to be pollicised is removed and the proximal phalanx of the finger is inserted into the space left by the base of the excised metacarpal. The results are good to excellent in all 14 cases followed for 2-9 years.

Extensor Digitorum Communis (EDC) Anchor and Interposition Arthroplasty for the Metacarpo-Phalangeal Joint (MCPJ).

Replacing a destroyed MCPJ has always been a challenge. Few operations have resulted in consistent satisfactory results. Also, anchoring a subluxed EDC tendon from the metacarpal head has produced numerous corrective procedures, again indicating the difficulty to keep the extensor tendon aligned.

The Liebenberg syndrome: in depth analysis of the original family.

The Liebenberg syndrome was first described in 1973 in a five- generation family. A sixth generation was added in 2001, and in 2009 a hitherto unknown branch of the same family with similar anomalies extended the family tree significantly. This article describes the clinical findings and illustrates the abnormalities with radiographs and three-dimensional computed tomography scans.

Homeotic arm-to-leg transformation associated with genomic rearrangements at the PITX1 locus.

The study of homeotic-transformation mutants in model organisms such as Drosophila revolutionized the field of developmental biology, but how these mutants relate to human developmental defects remains to be elucidated. Here, we show that Liebenberg syndrome, an autosomal-dominant upper-limb malformation, shows features of a homeotic limb transformation in which the arms have acquired morphological characteristics of a leg. Using high-resolution array comparative genomic hybridization and paired-end whole-genome sequencing, we identified two deletions and a translocation 5' of PITX1.

A working classification for the management of scapho-trapezium-trapezoidosteo-arthritis.

Osteo-arthritis (OA) of the scapho-trapezium-trapezoid joint (STT) is the second most common involved joint after trapezium-metacarpal I OA in the wrist. The possible aetiology causing or contributing to the development of STT OA is shortly discussed. A working classification is then proposed, which assists in the management of STT OA.

The incidence of asymptomatic Kienböck's disease.

The aim of this study was to determine the incidence of asymptomatic Kienböck's disease in patients who attended the Dr George Mukhari Hospital (formerly Ga-Rankuwa Hospital), as well as the relevance of ulnar variance on the disease. This was a retrospective study. In a 12 month period we reviewed postero-anterior radiographs of 1287 patients seen at our radiology department, with complaints unrelated to the upper limb including the wrist and hand.

End-to-side nerve coaptation: a qualitative and quantitative assessment in the primate.

There are several reasons why end-to-side nerve coaptation has not been widely adopted clinically. Among these are the putative damage inflicted on the donor nerve and the variable quality of the regeneration in the recipient nerve. So far experiments on end-to-side nerve repair have been short term and mostly carried out on rats.

Arthrogryposis multiplex congenita.

Since much confusion exists regarding arthrogryposis multiplex congenita (AMC), the President of the IFSSH commissioned the AMC Committee to compile a report on the various aspects of this condition. This report discusses all the facets of AMC, including definition, terminology, dermographics, aetiology, classification, clinical features, management, prognosis and further studies. Manipulation of the deformities starting soon after birth improves the range of motion, which, if surgery needs to be done, makes the operation less extensive.

Arthrogryposis multiplex congenita: functional classification and the AMC disc-o-gram.

The arthrogryposis multiplex congenita (AMC) disc-o-gram is presented as a way to measure the effect of hand therapy, splinting and/or surgery on the AMC patient. It also allows comparative measurement of passive motion (in the baby), active motion (in the young child) and function (in the older child and adult). These measurements are related to a new classification system which, as movement and function improves, indicates the efficacy of management.

End-to-side nerve suture in clinical practice.

The phenomenon of lateral sprouting of axons into an end-to-side sutured recipient nerve is well documented. The exact nature, however, still needs further investigation. Since 1996, we have been continuously involved in primate research as well as using this end-to-side nerve suture (ETSNS) method in clinical practice.

Re-innervation of M. biceps by end-to-side nerve suture.

End-to-side nerve suture (ETSNS) is a viable option to re-innervate a paralysed biceps muscle. The host or donor nerve could be any of the adjacent large nerves including the brachial plexus. It is important to adhere to certain principles when performing ETSNS, e.

The evaluation of function of the flail upper limb classification system: its application to unilateral brachial plexus injuries.

The evaluation of function of the flail upper limb (EFFUL) classification system measures in numerical terms the improvement achieved through hand surgery and hand therapy in patients with peripheral nerve injuries. To research the effectiveness of the EFFUL system a study was conducted that included 103 adult traumatic brachial plexus palsies. The measurement of upper limb function has 2 distinct phases: function without adaptation and function with adaptation.

Variations of the posterior interosseous nerve.

The posterior interosseous nerves of 58 cadaver forearms of black South Africans were dissected to study their order of branching. In 43 specimens (74%), the most common order of branching was: extensor carpi radialis brevis; supinator; extensor digitorum; extensor carpi ulnaris; extensor digiti minimi; abductor pollicis longus; extensor pollicis brevis; extensor pollicis longus and extensor indicis. In 15 specimens (26%) different variations of the nerve were observed, some of which are reported for the first time.

End-to-side nerve suture--a technique to repair peripheral nerve injury.

End-to-side nerve suture (ETSNS) has until recently been extensively researched in the laboratory animal (rat and baboon). Lateral sprouting from an intact nerve into an attached nerve does occur, and functional recovery (sensory and motor) has been demonstrated. We have demonstrated conclusively that ETSNS in the human is a viable option in treating peripheral nerve injuries, including injuries to the brachial plexus.

Triplication of the thumb.

A child with triplication of the thumb is presented. Each thumb was fully developed with neurovascular bundles, flexor and extensor tendons. Although all three thumbs were triphalangeal, they shared a common metacarpal and two shared a common proximal phalanx.

Side-effects of rinsing fluids on the rat femoral artery. A histological and electron microscopic study.

Rinsing rat femoral arteries with various fluids in experimental conditions similar to those in clinical practice was found to have deleterious effects on the intimal and medial layers of the vessels. No statistically significant difference was found between the effects of Ringer's lactate and normal saline. Heparinized saline produced significantly less damage to the medial layer and less platelet cell deposition.

The EFFUL (Evaluation of Function in the Flail Upper Limb) system. A ranking score system to measure improvement achieved by surgical reconstruction and rehabilitation.

The EFFUL (Evaluation of Function of the Flail Upper Limb) system measures in numerical terms the improvement, achieved through reconstructive surgery and hand therapy, in patients with brachial plexus injuries. The EFFUL system measures practical, everyday activities performed with the shoulder, elbow, forearm, wrist and hand. The ranking system is based upon a classification of function, with a hierarchy of increasing functional demands until normal function has been achieved.

Upper limb triplication with radial dimelia.

We report a very unusual case of upper limb triplication. The fused upper two limbs present as a duplicated mirror hand, joined along the ulnar side from the small finger up to the humerus. This exceptional abnormality further corroborates the theory that the development of the more distal segments of the limb is determined by the more proximal segments.