Percutaneous Trigger Release in Non-Triggering Digits: Infiltration of Normal Saline into Tendon Substance to Induce Triggering.

Percutaneous trigger release is recognized as an effective minimally invasive procedure with a low complication rate. One prerequisite for percutaneous trigger release is a trigger of Quinnell Type II or higher; that is, a digit that is actively triggering. We describe an additional step in percutaneous trigger release, which enables the surgeon to perform the procedure in digits that are not actively triggering at the point of surgery.

Reconstruction of Extensive Soft-Tissue Defects with Concomitant Bone Defects in the Lower Extremity with the Latissimus Dorsi-Serratus Anterior-Rib Free Flap.

Background: The combined latissimus dorsi-serratus anterior-rib (LD-SA-rib) free flap provides a large soft-tissue flap with a vascularized bone flap through a solitary vascular pedicle in a one-stage reconstruction.

Methods: Seven LD-SA-rib free flaps were performed in seven patients to reconstruct concomitant bone and extensive soft-tissue defects in the lower extremity (tibia, five; femur, one; foot, one). The patients were all male, with an average age of 34 years (range, 20-48 years).

Posterior interosseous artery flap: our experience and review of modifications done.

This is a report on the 14 PIA flaps done in our centre for traumatic hand defects over both volar and dorsal aspects, as well as thumb reconstruction over a six-year period from 2000 to 2007. We were able to achieve reach to the DIPJ with the use of fascia extension and better flap survival with more perforators captured in the flap.

Mechanical failure of the distal radius volar locking plate.

Purpose: To review 9 cases of mechanical failure of the volar locking plate for distal radial fractures.

Methods: Records of 374 consecutive patients who underwent volar locking plating for distal radial fractures were reviewed. Mechanical failures of the volar locking plate were defined as plate breakage or bending, screw breakage or loosening, or collapse of articular fragments resulting in intra-articular screw extrusion.

Beware! The volar ulnar fragment in a comminuted Bartons fracture.

The purpose of this study is to highlight a cohort of patients with a comminuted volar shearing type of distal radius fractures (AO B3.3) with the volar ulnar fragment that is prone to re-displace, resulting in volar subluxation of the radiocarpal joint. We report our experience with two such patients with re-displacement of the fragment and joint requiring repeat surgery; one of whom required a third procedure to stabilize that fragment.

Safe and easy method to preserve fingertip contour in VY-plasty.

VY-plasty is a well-known technique to reconstruct fingertip defects. A simplified method combining pinning of flap and healing of donor site by secondary intention is described. These steps preserve the rounded appearance of the fingertip and restore the convexity of the hyponychium.

Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations.

Purpose: To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint.

Methods: We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes.

Results: The age range of our patients was 15 to 56 years (average, 33 y).

Volar plate and screw fixation for dorsal fracture-dislocation of the proximal interphalangeal joint: case report.

We present a case of a man who sustained a closed dorsal fracture-dislocation of his left ring finger proximal interphalangeal joint in a fall. The patient was treated surgically with plate and screw fixation via a volar approach. This method theoretically provides more secure fixation than internal fixation with screws alone, allowing early rehabilitation with active range of motion and potentially better functional outcome.

Atypical glomus tumour of the wrist: a case report.

Wrist glomus tumours are extremely rare. We report a case of an unusually large wrist glomus tumour with atypical presentation. Magnetic resonance imaging (MRI) findings correlated well to those previously described for digital glomus tumours.

Prospective randomised study of intra-articular fractures of the distal radius: comparison between external fixation and plate fixation.

Introduction: Intra-articular fractures of the distal radius represent high energy, complex, unstable injuries and the optimal method of treatment remains controversial.

Materials And Methods: The aim of the paper is to compare the outcomes of external fixation (EF) with open reduction internal fixation (ORIF) with plates and screw fixation in the treatment of intra-articular fractures of the distal radius. Thirty-five patients were enlisted from December 2003 to September 2005 after a failure of initial conservative treatment.

Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study.

Background: The most effective method for the fixation of an intra-articular distal radial fracture has not been established. Two commonly used treatment methods are external fixation combined with percutaneous pin fixation and plate fixation. We performed a prospective multicenter randomized trial to compare these two treatment strategies.

Intra-articular loop wire fixation allows joint preservation and early motion in replantation around the proximal interphalangeal joint.

Restoration of motion is an important component of success in digital replantation. This is achieved only with rigid bony fixation that allows early post-operative mobilisation. In addition, the technique used should be simple and avoid excessive soft tissue stripping.

A biomechanical comparison of four extensor tendon repair techniques in zone IV.

Background: This study was designed to evaluate the biomechanical parameters of four different suture techniques specifically designed for zone IV extensor tendon injuries: the double figure of eight, the double modified Kessler, the six-strand double-loop, and the modified Becker suturing techniques. Ease of repair, tendon shortening, strength to 1-mm gap, strength to 2-mm gap, ultimate strength, and mode of repair failure were evaluated.

Methods: Twelve fresh-frozen cadaver hand-forearm units (48 fingers) were randomly assigned to the four suture repair treatments.

An isolated ring finger metacarpal shaft fracture?--beware an associated little finger carpometacarpal joint dislocation.

Dislocations of the ulnar carpometacarpal joint are easily missed because of a low index of suspicion as well as their subtle clinical and radiological features. Often, the presence of a more obvious adjacent injury also draws attention away from the carpometacarpal joint. Two cases of ring finger metacarpal shaft fractures with associated little finger carpometacarpal joint dislocations are presented.