Techniques for Vascularised Bone Grafting in Scaphoid Nonunion.

Nonunion of the scaphoid remains a significant problem in the management of scaphoid fractures. Recurrent persistent nonunion following attempts at internal fixation, and nonunions with sclerosis or avascular necrosis of the proximal pole of the scaphoid are particularly challenging. However, the aims of restoration of scaphoid anatomy and the achievement of union of the scaphoid remain the foundation pillars of scaphoid treatment.

Vein implantation for treatment of painful cutaneous neuromas. A preliminary report.

Based on the theory that recurrent neuroma formation can be prevented if the cut nerve end is implanted into the lumen of a vein, 14 patients have been treated by neuroma excision followed by proximal vein implantation over the last 5 years. Thirteen patients reported dramatic pain relief following surgery, and this was sustained in all but one case. Both failures were re-explored, when it was found that the nerve had pulled out of the vein, leading to recurrent neuroma formation.

Splinting in the management of proximal interphalangeal joint flexion contracture.

Proximal interphalangeal (PIP) flexion contracture is a common complication following hand injuries and conditions. This study investigated the treatment outcome of 20 subjects with PIP flexion contracture who followed a dynamic splinting program using either a Capener or low-profile outrigger. The splint applied a 250-g force to the distal end of the middle phalanx.

Complications following surgical treatment for Dupuytren's contracture.

Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively.

Total wrist fusion. A functional assessment.

Twenty cases of total wrist fusion, performed for post-traumatic conditions, were reviewed objectively, subjectively and radiologically. All patients were satisfied with the position of the fused wrist and had good pain relief. All patients would have had the procedure sooner, having had an average of three operations on the wrist before the fusion.

The effect of workers' or third-party compensation on return to work after hand surgery.

Objectives: To investigate the role of compensation in recovery from scaphoid internal fixation.

Design: Retrospective review of patients who had had scaphoid internal fixations performed by one surgeon between 1 September 1981 and 31 December 1994 with a minimum follow-up of six months.

Setting: Private practice of a specialist hand surgeon.

Avascular necrosis of the proximal scaphoid after fracture union.

We report four cases of late avascular necrosis (AVN) of the proximal part of the scaphoid following apparent healing of acute scaphoid fractures. One patient had been treated conservatively, by plaster immobilization, and the other three had undergone internal fixation of their acute fractures. The onset of symptoms associated with AVN varied, being as late as 2 years in one patient.

Idiopathic avascular necrosis of the scaphoid.

Idiopathic avascular necrosis of the scaphoid is a rare condition. A review of the literature shows a variety of conditions labelled as spontaneous avascular necrosis or Preiser's disease. In this paper we report on a study of eight patients with idiopathic avascular necrosis affecting only the proximal pole of the scaphoid.

Spontaneous correction of dorsal intercalated segment instability deformity with scaphoid malunion in the skeletally immature.

This is a report on two children with dorsal intercalated segment instability deformity of the carpus associated with malunited fracture of the scaphoid. The patients were observed over 4 years, and spontaneous improvement was noted in association with growth.