Management of Pincer Nail Deformity by Realignment of Nailbed Using a Dermofascial Graft.

Pincer nail deformity is an uncommon entity which can be painful and cosmetically unappealing. We describe our technique of correcting this deformity by realignment of the nailbed using a dermofascial graft. Pain relief as well as a cosmetically good result have been obtained in all patients, and this has been maintained over the long term.

Management of Highly Comminuted Intra-articular Fracture Subluxations at the Proximal Interphalangeal Joint by Subchondral Buttress Fixation and Early Mobilization.

This article describes our technique of managing highly comminuted intra-articular fracture subluxations at the proximal interphalangeal joint by subchondral buttress fixation followed by early mobilization. This technique has proven to be reliable and all patients have been able to return to their preinjury level of activity.

The Story of the Hand.

This review describes the Story of the Human Hand. It traces the functional needs that led to evolution of the human hand as well as its embryological development. The various in utero stages of formation of the human hand are covered along with a description of the various molecular and genetic factors that control this process.

Outcomes of the glove-gauze regimen for managing burn injuries of the hand.

We studied the efficacy of the glove-gauze regimen in treating superficial, partial-thickness and small full-thickness hand burns. Outcome measures included healing time, need for surgical intervention, need for formal physical therapy, restoration of range of motion, return to function and incidence of infection. All patients ( = 123) successfully completed the regimen with an average healing time of 3.

Small Finger Abduction Test to Evaluate the Flexor Carpi Ulnaris Tendon.

We describe a simple and effective method to assess the integrity of the flexor carpi ulnaris muscle and tendon. This method is called the Small Finger Abduction Test. The study also evaluates the efficacy and practicality of the test.

Interlocking K Wires Followed by Immediate Mobilization for Fractures of the Hand.

We describe a technique of interlocking Kirschner wires to improve stability after fixation of fractures of the hand. This enables immediate mobilization of the injured fingers thus reducing the need for prolonged postoperative physical therapy and consequently diminishing chances of posttraumatic stiffness. This study analyzes outcomes in 83 fractures in 70 patients including 26 metacarpal and 57 phalangeal fractures.

Aneurysmal Bone Cyst Involving the Pisiform: A Case Report.

Background: Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare.

Methods: A rigorous review of the literature showed that this type of tumor has not previously been described in the pisiform. In this article, we report the occurrence of an aneurysmal bone tumor in the pisiform of the left hand of a 19-year-old male.

A Technique for Treating Dorsal Instability of the Distal Radioulnar Joint.

We describe a technique for the treatment of chronic dorsal instability of the distal radioulnar joint by creating a strong dorsal radioulnar restraint using opposing flaps from the extensor retinaculum and dorsal capsule of the radioulnar joint. This technique has been used in 18 patients and has proven to be very easy and reliable with all patients demonstrating good stability of the distal radioulnar joint at final follow-up.

Internal Bone Grafting for the Treatment of Scaphoid Nonunions.

Scaphoid fracture is the most common carpal fracture of the upper extremity and a significant proportion of these can eventually progress to nonunion. Excision of pseudoarthrosis and fibrous scar tissue at the nonunion site is regarded as one of the important steps in management of scaphoid nonunions. We describe a technique of internal bone grafting, where curettage of the nonunion site was performed through a drill hole in the scaphoid and bone graft was packed through this same hole before fixation with a headless compression screw.

Mutilating Hand Injuries in Children.

Mutilating hand injuries in children are injuries that are significant not only because of the actual injury caused to tissue but also owing to the significant psychological impact they have on the patient and family alike. Management of these injuries requires significant surgical skill as well as a well-planned and well-executed treatment protocol. This article discusses the etiology, incidence as well as treatment of mutilating hand injuries in a child.

Distal Radius Bone Graft From the Second Extensor Compartment: A Safe and Effective Technique.

We describe a technique for harvesting cancellous bone graft from the floor of the second extensor compartment that is both easy and effective. It confines surgery to a single operative field under the same regional anesthesia and tourniquet as the primary hand surgical procedure while at the same time allowing wide visualization for harvesting bone graft. It provides cancellous bone of sufficient quality and quantity for use in most hand surgical cases.

Parsonage-Turner Syndrome: Clinical and Epidemiological Features From a Hand Surgeon's Perspective.

Background: Parsonage-Turner Syndrome (PTS) is a rare but serious condition characterized by spontaneous paresis of the upper extremity, typically lasting several months with variable recovery. With little literature on the behavior of PTS from a hand surgeon's perspective, accurate diagnosis and subsequent counseling of patients with PTS can be challenging.

Methods: This study is a retrospective evaluation of the clinical features of all PTS patients seen over a 9-year period.

Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients.

We wanted to determine whether 1 of 3 brachial plexus blocks was best for one of our most common surgeries, the cubital tunnel release with or without transposition of the ulnar nerve. Brachial plexus blocks can provide excellent results for upper extremity surgery, but we noticed inexplicable block failure for cubital tunnel releases with an incision in the proximal arm. In this case series, we initially reviewed 90 patients receiving axillary, infraclavicular, or supraclavicular blocks to determine if one block performed better for a surgical procedure that proceeds up the inner aspect of the arm.

Intraosseous xanthoma of the distal radius - a case report.

An intraosseous xanthoma is a very rare condition. It has an aggressive appearance on radiographs mimicking primary or metastatic malignant bone tumors. We report a case of intraosseous xanthoma of the distal radius in a 51-year-old male with no history of hyperlipidaemia.

Intraneural malignant granular cell tumor - report of an extremely rare tumor in a child.

We report a case of intraneural malignant granular cell tumor of the upper extremity occurring in a child. This is an exceedingly rare tumor and the incidence has so far been reported only in adults. The tumor was successfully treated surgically and the patient has remained tumor free to date.

Resurfacing glabrous skin defects in the hand: the thenar base donor site.

Defects of the glabrous skin surfaces of the palm and fingers result from numerous causes including larger fingertip injuries, unhealed burns, and after surgery for diverse pathologies. The qualities of glabrous skin are specifically tailored to the functional requirements of high-shear strength and robustness. Despite these unique properties, graft reconstruction of defects in the glabrous regions of the hand is frequently achieved with skin from nonglabrous donor sites such as the medial forearm.

Isolated abductor digiti minimi palsy--an unusual case of Guyon's canal compression.

We present a case of isolated Abductor Digiti Minimi (ADM) palsy caused by an anomalous branch from the ulnar artery. Electrophysiology suggested selective involvement of the motor branch to the ADM in the Guyon's canal. Surgical exploration revealed an anomalous branch of the ulnar artery causing a pincer effect on the nerve to the ADM.

Nonunion of the scaphoid distal pole.

This study was undertaken to determine the incidence of and assess factors affecting nonunion of scaphoid distal pole fractures. A total of 193 established scaphoid nonunions were treated in our clinics between the years 1999 and 2004; of which, eight cases involved the distal pole of the scaphoid. These were further analyzed to determine factors that may have contributed to the development of nonunion.

The recall DASH score--a novel research tool.

The DASH score is a universally accepted method for assessment of hand function. However, there are occasions when a pre-treatment DASH score is unavailable. This study provides a solution to this situation.

Size discrepancy in vessels during microvascular anastomosis: two techniques to overcome this problem.

The problem of size discrepancy between vessels during microvascular procedures is well known. Inability to successfully overcome this problem can lead to turbulent flow at the anastomotic site with consequent thrombosis. Various techniques have been described to overcome this problem.

Combination V-Y advancement flap and composite graft for reconstruction of an amputated fingertip.

Fingertip amputations can lead to both functional and aesthetic problems. We present the results of our preferred technique to address fingertip amputations in zone 1 and zone 2 which have been deemed non-replantable by microsurgery. It is based on the "reposition technique" described by Dubert et al.

Focal hand dystonia in a patient with ulnar nerve neuropathy at the elbow.

We describe a patient who presented with dystonia of her small finger secondary to entrapment neuropathy of the ulnar nerve at the elbow. Pre operative electrophysiological studies suggested that the locus of entrapment was located proximal to the medial epicondyle. This was confirmed intraoperatively by the presence of a thickened and prominent arcade of Struthers.

A classification system for anomalies of the extensor pollicis longus.

Introduction: Variations of the long extensor tendon to the thumb are very rare.

Materials And Methods: We present three cases in which there was a supernumerary long extensor tendon to the thumb. In all three cases, the supernumerary tendon emerged from the fourth dorsal compartment and had a parallel course to the extensor pollicis longus.