The Journal of hand surgery
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We describe a rare case of atypical pyoderma gangrenosum of the dorsal hand in a patient who presented with the histopathologic diagnosis of squamous cell carcinoma (SCC). Atypical pyoderma gangrenosum is a rare variant of pyoderma gangrenosum that occurs on the upper extremities, presenting as a cutaneous ulcer. ⋯ Histologic and clinical presentation 1 month after onset of symptoms in the patient reported here mimicked SCC. Awareness by hand surgeons of the possible histologic misdiagnosis of SCC at an early stage in the disease evolution and a high index of suspicion in the face of biopsy-proven SCC may prevent unnecessary digit amputation.
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Perilunate injuries are complex and occasionally go unrecognized acutely. Open reduction and internal fixation is a valid treatment option for these injuries. The purpose of this study was to evaluate the functional outcome of treating chronic perilunate injuries with open reduction and internal fixation. ⋯ Despite late presentation, patients with chronic perilunate injuries can be treated with open reduction internal fixation, with satisfactory results. Patients with lesser arc injuries have less successful outcome. Patients with irreducible dislocations or major articular damage may require wrist salvage procedures.
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Patients with inflammatory arthritis frequently develop destructive shoulder arthritis and rotator cuff tearing. Reconstruction with anatomical shoulder replacement produces lesser results than for other etiologies such as osteoarthritis. We postulated that reconstruction with reverse shoulder prostheses would lead to early satisfactory results for these patients. ⋯ At early follow-up, reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients.
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Ulnar-sided carpometacarpal injuries can be difficult to diagnose radiographically. We hypothesized that the resting position of the normal hand during lateral radiography provides a consistent relationship between the rays and that dorsal subluxation of the metacarpal base in fracture-dislocations increases the angle between the uninjured index and long metacarpals and the injured small metacarpal. ⋯ Both the I-S IMA and the L-S IMA were useful screening measurements on lateral hand radiographs for detection of ulnar-sided carpometacarpal fracture-dislocations. When evaluating posttraumatic ulnar-sided hand pain, advanced imaging should be considered if the I-S IMA or the L-S IMA is greater than 10°.