The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Feb 1985
Case ReportsIrreducible buttonhole dislocation of the proximal interphalangeal joint of the finger (a case report).
Dislocations of the proximal interphalangeal joints of the finger rarely present a problem in reduction. However, reduction may be prevented by buttonholing of the joint capsule and volar plate by the head of the proximal phalanx.
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The value of isotope scanning in patients with clinical signs of fracture of the carpal scaphoid bone and negative or non-diagnostic initial radiographs was examined. 30 patients were examined using both radiography and isotope scanning. A normal scan excludes a fracture. Increased activity localized to the scaphoid bone indicates a fracture. 9 patients had fracture of the scaphoid evident on bone scans within 2 weeks of the injury. It took 2-6 weeks before these fractures showed up on radiographs.
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Peripheral damage is immediately assessed by the central nervous system by way of a gate control system so that the sensory outcome depends not only on the fact of the injury and the injury signals but also on other convergent impulses from the periphery and on descending controls from brain to spinal cord. However peripheral injury, particularly when nerves are affected, sets off a chain of slow reactions which start in the area of damage but spread centrally. ⋯ The arrival of injury produced impulses in the spinal cord triggers changes with a latency of many minutes which persist for hours even if no further impulses arrive. These increases of excitability and expansion of receptive fields which are triggered by C fibres may be the basis of the secondary hyperalgesias and reflex changes associated with injury.