Comparison of Lag Versus Nonlag Screw Fixation for Long Oblique Proximal Phalanx Fractures: A Biomechanical Study.

Purpose: To compare lag versus nonlag screw fixation for long oblique proximal phalanx (P1) fractures in a cadaveric model of finger motion via the flexor and extensor tendons.

Methods: We simulated long oblique P1 fractures with a 45° oblique cut in the index, middle, and ring fingers of 4 matched pairs of cadaveric hands for a total of 24 simulated fractures. Fractures were stabilized using 1 of 3 techniques: two 1.

Measurement of Outlet Pressures Favors Rib Resection for Decompression of Thoracic Outlet Syndrome.

Background: When conservative therapy for thoracic outlet syndrome fails, scalenectomy with or without first-rib resection (FRR) is the treatment of choice. We measured pressure in the costoclavicular space before and after FRR at time of neurogenic thoracic outlet syndrome release to evaluate whether FRR is required to completely decompress the costoclavicular space.

Methods: Using a supraclavicular exposure for anterior-middle scalenectomy with FRR, costoclavicular space pressures were measured using a balloon catheter with the patient's arm in neutral anatomic position, secondarily, the arm abducted and externally rotated.

Suture-Button Reconstruction of the Interosseous Membrane.

Background: Reconstruction of the interosseous membrane (IOM) may play a role in the treatment of acute and chronic longitudinal forearm instability. Several reconstruction techniques have been proposed. Suture-button reconstruction is attractive because it obviates donor site morbidity and is relatively easy to perform.

Effect of anterior versus posterior in situ decompression on ulnar nerve subluxation.

We sought to determine the effect anterior versus posterior in situ decompression with 360° external neurolysis on ulnar nerve subluxation. Ten cadaveric specimens were used, with anterior release performed on 5 specimens and posterior release the other 5 specimens. Each specimen was released for 4 cm centered over the cubital tunnel followed by 12 cm, 20 cm, and 20 cm with 360° external neurolysis.

Unusual case of cutaneous and synovial Paecilomyces lilacinus infection of hand successfully treated with voriconazole and review of published literature.

Paecilomyces lilacinus infection is rare and is found worldwide. The majority of infections occur in immunocompromised people. Among immunocompetent patients, cutaneous infections are the second most common site of infection but are difficult to treat because of antifungal resistance.

Restoration of longitudinal forearm stability using a suture button construct.

Purpose: This study proposed a method of restoring the longitudinal stability of the forearm provided by the central band of the interosseous membrane (IOM) by using a percutaneously placed suture button construct. We hypothesized that supporting the forearm IOM with a suture button construct would restore longitudinal stability in a cadaveric model of the Essex-Lopresti lesion.

Methods: We assessed 7 adult cadaver upper extremities radiographically for evidence of previous elbow, forearm, or wrist fracture.

Complications of small joint arthroplasty.

Arthritis in the small joints of the hand can be treated with arthrodesis or arthroplasty. Arthrodesis has known risks of infection, pain, and nonunion. Distal interphalangeal (DIP) arthroplasty has been successful in preserving motion and alleviating pain for distal DIP, proximal interphalangeal, and metacarpophalangeal joints.

Carpal tunnel volume changes of the wrist under distraction.

This study attempts to determine changes in carpal canal volume with distraction across the wrist. Uniform longitudinal distraction was maintained with two external fixators on the radial and ulnar aspects of the forearm axis of five cadaver specimens. After CT scanning, volume determinations were made at 5 mm increments beginning at the lunocapitate joint to a point 1.

Release of the transverse carpal ligament alone is associated with elevated pressure beneath the distal volar forearm fascia in a cadaver model of carpal tunnel syndrome.

Purpose: The purpose of this study is to determine whether release of the distal volar forearm fascia (DVFF) is necessary at the time of median nerve decompression for carpal tunnel syndrome.

Methods: Five fresh-frozen cadaver specimens were mounted vertically with the hand dependent and a 2.27-kg weight suspended from the fingers.

Biomechanical stability of a volar locking-screw plate versus fragment-specific fixation in a distal radius fracture model.

Eight matched pairs of cadaveric radii were osteotomized by removing a 4-mm dorsal wedge of bone at the level of the sigmoid notch designed to simulate dorsal comminution. They were then fixed with either a volar locking-screw plate or fragment-specific fixation. All constructs underwent biomechanical testing in a custom-designed, custom-fabricated 4-point bending device.

Lateral approach to proximal interphalangeal joint implant arthroplasty.

Arthroplasty of the proximal interphalangeal joint is indicated for arthritic conditions that fail to respond to conservative treatment. This article describes the lateral approach for the insertion of a proximal interphalangeal joint implant arthroplasty. Clinical experience has confirmed good results in the nonlaborer with arthroplasty of all the digits.

Lesions and tumors of the carpus.

Lesions and tumors of the carpus are usually identified radiographically during a routine workup for wrist pain. Although most of these entities are benign, a failure to appreciate their presence may delay diagnosis and treatment. More importantly, a small subset of these tumors may be quite aggressive, and early recognition can spare the patient the morbidity of late sequelae such as pathologic fracture, progressive wrist arthrosis, or even tumor metastasis.

Dynamic lumbrical muscle transfer for correction of posttraumatic extensor tendon subluxation.

Posttraumatic ulnar subluxation of the extensor tendon over the metacarpal head results from rupture of the radial sagittal fibers. The patient will complain of limited digital extension and pain. Various techniques have been described to correct the disorder by either reefing the sagittal fibers or using a slip of extensor tendon around the radial collateral ligament.

Biomechanical stability of a fixed-angle volar plate versus fragment-specific fixation system: cyclic testing in a C2-type distal radius cadaver fracture model.

Purpose: To compare the biomechanical stability of 2 recently introduced fixation systems in an intra-articular, dorsal comminution distal radius fracture model.

Methods: AO/ASIF type C2 fractures were simulated in 10 matched pairs of fresh-frozen cadaveric arms randomized between fixed-angle volar plate and fragment-specific fixation systems. Specimens were loaded in extension cyclically for 2,000 repetitions followed by a single cycle to failure.

Radiographic parameters of increased carpal tunnel pressure with progressive wrist distraction: a cadaveric study.

Purpose: Increased carpal canal pressure associated with external fixation has been noted as a potential source of complications but no correlated clinical observation has been identified. We hypothesized that there would be a significant change in midcarpal distance and modified carpal height index with increasing distraction across the wrist joint and that these changes would correlate with pressure increases.

Methods: Thirteen cadaveric upper extremities were mounted vertically using 2 half pins in the midradius.

Carpal canal pressure of the distracted wrist.

Purpose: This study was conducted to study the effect of distraction across the wrist joint on carpal canal pressure.

Methods: Ten cadaver specimens were mounted vertically in neutral forearm rotation by 2 half pins that transfixed the radius and ulna. The wrist joint was distracted by suspending weights from the middle finger.

Kienböck's disease in an elderly patient treated with proximal row carpectomy.

Kienböck's disease most often occurs in the dominant hand of young men with a history of manual labor. We report an atypical presentation of stage III Kienböck's disease in the nondominant hand of a 70-year-old woman. The patient was managed successfully by proximal row carpectomy.

Long-term results of surgical management of proximal interphalangeal joint contracture.

To evaluate the long-term results of surgical treatment of proximal interphalangeal (PIP) joint contractures, 68 PIP joints were retrospectively reviewed with a minimum follow-up period of 24 months. Preoperative and intraoperative factors were studied for outcomes and subjected to statistical analysis. Among the total group the average improvement was 7.

Diagnosis and treatment of post-traumatic medial and lateral elbow ligament incompetence.

Elbow instability may occur secondary to soft tissue or bony injuries. Predictable patterns of instability do occur. Identification of disrupted osseous or ligamentous constraints allows for an algorithmic and predictable treatment plan.

Digital neurorrhaphy after the age of 60 years.

Fifteen patients over the age of 60 years (average age: 65 years), with 19 digital nerve lacerations, were evaluated more than 1 year after injury. Two-point discrimination, Semmes-Weinstein evaluation, and subjective return of sensibility were examined by a certified hand therapist before and after local anesthetic block of the uninjured digital nerve. Sixty-three percent of the patients regained moving two-point discrimination less than 15 mm; 100 percent regained Semmes-Weinstein values of less than 4.

Reconstruction of an ulnar-sided thumb in central deficiency: a case report.

The thumb, which is normally located on the radial border of the hand, requires adequate sensibility to perceive its environment and adequate mobility to oppose to the other digits. We present a case in which the most ulnar digit of the hand was surgically augmented to function as a thumb.

Analysis of digital pulse-volume recordings with radial and ulnar artery compression.

The vascular noninvasive studies of 289 consecutive cardiac surgery patients were reviewed to better understand hand blood-flow physiology in an older population with vascular disease. The radial artery was found to be more important to pulsatile digital blood flow than the ulnar artery. In more than 20 percent of hands, the thumb and the index and fifth fingers lost pulsatile blood flow with radial artery compression at the wrist compared with only 5 percent with ulnar artery compression.

Un-united fractures of the distal radius: a report of 12 cases.

The treatment of 12 distal radius nonunions in 11 patients over a 24-year period is presented. The average age of the patients was 55 years (range, 35-72 years). The comorbid medical conditions in the patients with these fractures included diabetes mellitus, peripheral vascular disease, psychiatric disorders, alcoholism, peripheral neuropathy, scleroderma, and morbid obesity.

Radial artery use in bypass grafting does not change digital blood flow or hand function.

Background: Patient selection criteria have not been clearly established for use of the radial artery as a bypass conduit. To help establish such criteria, we measured changes in digital blood flow and hand function after radial artery removal.

Methods: Ninety-eight patients of the first 122 consecutive patients considered for radial artery harvest met predetermined criteria by vascular noninvasive studies to undergo removal of the radial artery.

Successful treatment of primary cutaneous Aspergillus flavus infection of the hand with oral itraconazole.

Primary cutaneous Aspergillus flavus infections of the hand are exceedingly rare. Usually, these infections are present in severely immunocompromised patients suffering from lymphoreticular malignancies. The majority of cases result in invasive systemic infections and often culminate in death.