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Thumb tip injuries
Abstracts
89
was fixed with a pin, then the arteries were anastomosed, then the nerves and lastly the veins. An arteriogram taken two months after the accident shows one digital artery patent. Five months after operation the patient has a mobile finger with sensation. CORRY, R. J. (1972), ‘ Finger replacement surgery proves successful ‘, J. Am. med. Ass., 222, 529. Silicone rubber spacers A survey of 62 patients treated from 1966 to 1971 by a two-stage repair of severe flexor tendon injuries. The spacer is inserted at the first operation and 10 weeks later is replaced by a tendon autograft. A detailed review of the technique and results which deserves careful study in the original text. HELAL,B. (1973), ‘The use of silicone rubber spacers in flexor tendon surgery ‘, Hand, 5, 85. Alterations
in finger growth
Two patients with flexor tendons cut during early childhood and never repaired were reviewed several years later when abnormal growth and shortening of the affected fingers was shown clinically and proved by X-ray examination. Experimental work on baby chicks confirmed that growth was regularly affected when their flexor tendons were injured and not repaired in early life. GAISMIRD, J. C., and FLEEOLER, E. J. (1973), ‘ Alterations in finger growth following flexor tendon injuries. A clinical and laboratory study ‘, Plastic reconstr. Surg., 51, 164. Radiation injuries of the hand In 1971, two patients,
a man and a woman working for a flrm manufacturing parts for surgical instruments, received severe acute radiation burns of the hands from an industrial fluoroscope. They received a dose of radiation ranging from 19,500 to 250,000 rad. Adequate excision and resurfacing of the damaged areas with skin grafts and flaps produced immediate relief from pain, increased the range of function and, at least for the time being, avoided the drastic amputations that had been suggested as a ‘ prophylactic measure ‘. KRIZEK, T. J., and ARNAN, S. (1973), ‘ Severe acute radiation injuries of the hands ‘, Plastic reconstr. Surg., 51, 14. Radiodermatitis A 25-year experience
of this condition seen almost exclusively in medical and allied professional workers has confirmed the value of excision and split-skin grafting of the affected areas. The paper reminds us very forcibly that even at the end of the twentieth century many workers in the health services can still be at risk from conventional sources of diagnostic and therapeutic radiation. LAOROT, F., GRECD, J., MICHEAU, P., and CASTAGLIOLA,M. (1973). ‘Study of a series of 104 patients with radiodermatitis of the hands treated by surgery ‘, Ann. chir. plast., 18, 233.
Thumb tip injuries
The volar advancement flap is a useful method of restoring normal sensation to an unsatisfactory or insensitive thumb tip following infection or trauma. The operation is probably better done as a secondary procedure, but can in certain cases be used for the acute injury. The flap is obviously only feasible if there is adequate unscarred volar skin available. The maximum advancement achieved in this series of 11 cases was 1.5 cm. Postoperative internal fixation was not required to hold the interphalangeal joint in a flexed position. MILLENDER,L. H., ALBIN, R. E., and NALEBUFF, E. A. (1973), ‘Delayed volar advancement flap for thumb tip injuries ‘, Plastic reconstr. Surg., 52, 635. Assessment of hand function
This is the first part of a study of the assessment of hand function, with particular reference to the surgery of the rheumatoid hand but with obvious implications in the measurement of results of all types of hand injury and hand surgery. Subjective methods of assessment have been found to lack de&ition or precision and are very di&ult to quantify. The objective assessment of hand function, particularly the study of individual tiger function, can be made using a cybcmometer. The measurements can be compared before and after surgery and the early results show that this new device promises to be a very useful tool in the accurate assessment of finger and hand function. DICKSON, R. A., and NICOLLE,F. V. (1972), ‘ The assessment of hand function ‘, Hand, 4, 207. Thumb web contracture An excellent
review of the measures that may be required to correct contractures affecting the web space between the thumb and the index finger. It pays special attention to the release or excision of fibrosed or shortened muscles and capsular ligaments so that an optimal angle of 40” can be. obtained between the metacarpals of the thumb and index finger. Proper retention of the thumb in its new position is absolutely essential and can be achieved by: 1. A ‘ lively ’ splint. 2. A transversely placed K-wire retained for six weeks. 3. K-wires placed separately in the thumb and index metacarpals and connected together by elastic bands in exactly the same way as used in the wnstruction of jaw-exercisers. 4. Bone-graft. MUTZ, S. B. (1972), ‘Thumb web wntracture ‘, Hand, 4,236.
Tendons
and Ligaments
Rupture of rectus femoris with scarring
Rupture of the rectus femoris with resultant painless gap in the muscle belly is a common and well rewgnixed condition. This paper records fibrosis as a
89
was fixed with a pin, then the arteries were anastomosed, then the nerves and lastly the veins. An arteriogram taken two months after the accident shows one digital artery patent. Five months after operation the patient has a mobile finger with sensation. CORRY, R. J. (1972), ‘ Finger replacement surgery proves successful ‘, J. Am. med. Ass., 222, 529. Silicone rubber spacers A survey of 62 patients treated from 1966 to 1971 by a two-stage repair of severe flexor tendon injuries. The spacer is inserted at the first operation and 10 weeks later is replaced by a tendon autograft. A detailed review of the technique and results which deserves careful study in the original text. HELAL,B. (1973), ‘The use of silicone rubber spacers in flexor tendon surgery ‘, Hand, 5, 85. Alterations
in finger growth
Two patients with flexor tendons cut during early childhood and never repaired were reviewed several years later when abnormal growth and shortening of the affected fingers was shown clinically and proved by X-ray examination. Experimental work on baby chicks confirmed that growth was regularly affected when their flexor tendons were injured and not repaired in early life. GAISMIRD, J. C., and FLEEOLER, E. J. (1973), ‘ Alterations in finger growth following flexor tendon injuries. A clinical and laboratory study ‘, Plastic reconstr. Surg., 51, 164. Radiation injuries of the hand In 1971, two patients,
a man and a woman working for a flrm manufacturing parts for surgical instruments, received severe acute radiation burns of the hands from an industrial fluoroscope. They received a dose of radiation ranging from 19,500 to 250,000 rad. Adequate excision and resurfacing of the damaged areas with skin grafts and flaps produced immediate relief from pain, increased the range of function and, at least for the time being, avoided the drastic amputations that had been suggested as a ‘ prophylactic measure ‘. KRIZEK, T. J., and ARNAN, S. (1973), ‘ Severe acute radiation injuries of the hands ‘, Plastic reconstr. Surg., 51, 14. Radiodermatitis A 25-year experience
of this condition seen almost exclusively in medical and allied professional workers has confirmed the value of excision and split-skin grafting of the affected areas. The paper reminds us very forcibly that even at the end of the twentieth century many workers in the health services can still be at risk from conventional sources of diagnostic and therapeutic radiation. LAOROT, F., GRECD, J., MICHEAU, P., and CASTAGLIOLA,M. (1973). ‘Study of a series of 104 patients with radiodermatitis of the hands treated by surgery ‘, Ann. chir. plast., 18, 233.
Thumb tip injuries
The volar advancement flap is a useful method of restoring normal sensation to an unsatisfactory or insensitive thumb tip following infection or trauma. The operation is probably better done as a secondary procedure, but can in certain cases be used for the acute injury. The flap is obviously only feasible if there is adequate unscarred volar skin available. The maximum advancement achieved in this series of 11 cases was 1.5 cm. Postoperative internal fixation was not required to hold the interphalangeal joint in a flexed position. MILLENDER,L. H., ALBIN, R. E., and NALEBUFF, E. A. (1973), ‘Delayed volar advancement flap for thumb tip injuries ‘, Plastic reconstr. Surg., 52, 635. Assessment of hand function
This is the first part of a study of the assessment of hand function, with particular reference to the surgery of the rheumatoid hand but with obvious implications in the measurement of results of all types of hand injury and hand surgery. Subjective methods of assessment have been found to lack de&ition or precision and are very di&ult to quantify. The objective assessment of hand function, particularly the study of individual tiger function, can be made using a cybcmometer. The measurements can be compared before and after surgery and the early results show that this new device promises to be a very useful tool in the accurate assessment of finger and hand function. DICKSON, R. A., and NICOLLE,F. V. (1972), ‘ The assessment of hand function ‘, Hand, 4, 207. Thumb web contracture An excellent
review of the measures that may be required to correct contractures affecting the web space between the thumb and the index finger. It pays special attention to the release or excision of fibrosed or shortened muscles and capsular ligaments so that an optimal angle of 40” can be. obtained between the metacarpals of the thumb and index finger. Proper retention of the thumb in its new position is absolutely essential and can be achieved by: 1. A ‘ lively ’ splint. 2. A transversely placed K-wire retained for six weeks. 3. K-wires placed separately in the thumb and index metacarpals and connected together by elastic bands in exactly the same way as used in the wnstruction of jaw-exercisers. 4. Bone-graft. MUTZ, S. B. (1972), ‘Thumb web wntracture ‘, Hand, 4,236.
Tendons
and Ligaments
Rupture of rectus femoris with scarring
Rupture of the rectus femoris with resultant painless gap in the muscle belly is a common and well rewgnixed condition. This paper records fibrosis as a