Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
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There is no consensus regarding the optimal mode of managing the acute traumatic subungual haematoma in the hand. In this context the medical literature was searched systematically and the results analysed. The final dataset consisted of four articles. ⋯ In conclusion the outcome in terms of nail cosmesis does not appear to be affected by the mode of treatment. The acutely painful subungual haematoma should be decompressed, whether this be done by trephining or nail removal. Future research includes the potential for a randomised controlled trial to compare nail bed repair with trephination.
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Case Reports
Clinical outcomes of hook of hamate fractures and usefulness of the hook of hamate pull test.
We report the usefulness of hook of hamate pull test (HHPT), described by Wright et al. in 2010, along with therapeutic outcomes of hook of hamate fractures. Eleven patients (two with fresh fractures and nine with nonunion) were studied. The fractures were diagnosed with HHPT for recently encountered 4 patients and a definitive diagnosis was made by a carpal canal view and a computed tomography (CT) scan. ⋯ Patients returned to work/sports two months postoperatively. HHPT was useful for diagnosing both fresh fractures and nonunion. If HHPT is positive, CT should be performed even if the fracture is obscure on a carpal canal view.
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Case Reports
Delayed repair of spontaneous rupture of both the extensor pollicis longus and brevis: a case report.
A 73-year-old female suffered spontaneous rupture of the extensor pollicis longus (EPL) and extensor pollicis brevis (EPB) tendons, for which she presented for treatment three to four weeks later. At that time there was no active metacarpophalangeal (MCP) or interphalangeal (IP) extension, leading to severe functional impairment of her hand. ⋯ After a three-month period of follow-up, the thumb motion was restored and the patient was able to resume all activities of daily living. Although concomitant spontaneous rupture of both the EPL and the EPB is rare, transfer of the EIP and the AAPL tendons, respectively, seems to be the treatment of choice for anatomic reconstruction of such injuries.
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Little finger metacarpal fractures are the most common type of metacarpal fractures and the treatment is quite variable as it is a multifactorial entity comprised of subcapital, metacarpal shaft and base fractures. These fractures are common presentations in the fracture clinics and the general orthopaedic surgeons treat them until a complex case warrants specific decision making by a hand surgeon. The management of many of these fractures is still a matter of debate and differ widely in the various parts of the United Kingdom. ⋯ We have illustrated the various permutations and combinations of these fractures with the results of our survey in this article in detail. The vast majority of metacarpal bone fractures are stable and treated conservatively. The different types of injury patterns must be recognised by the orthopaedic surgeons and appropriate treatment then should be executed to serve the patient optimally in due course.
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Comparative Study
Scaphoid non-unions, where do they come from? The epidemiology and initial presentation of 270 scaphoid non-unions.
Scaphoid injury and subsequent non-union is a well documented and researched subject. This article gives an overview of the epidemiology and results of the patients we have treated for scaphoid non-union at a University Hospital. 283 scaphoid non-unions in 268 patients (83% men) were operated upon, 230 as a primary and 47 as a secondary. The median age at time of surgery was 27 years. ⋯ The greatest potential for the reduction of scaphoid non-union is an increased awareness amongst younger men. There is also potential for improved accuracy in the diagnosis of scaphoid fractures (better clinical tests, the use of radiographs, CTs and MRIs) in order to identify the fracture and evaluate dislocation at the initial injury. Early diagnosis and treatment of fractures and non-unions will reduce the development of degenerative wrist changes.