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The Belgian Hand Group
PROCEEDINGS The Belgian Hand Group J. Fissette , Liege, Belgium
The most recent meeting of the Belgian Hand Group
was held in Nancy, France . The following is a summary of the seven papers presented at that meeting. Phalangeal fracture treated by the "tumbler" (Biloquet) osteosynthesis. H. EVRARD (Charleroi) presented a series of 14 cases with a minimal follow-up period of 6 months . The author used either smooth pins or pins with a screw at the end. The functional result was satisfactory. The presence of the cement delayed the radiological uniting , but not the clinical consolidation. This method can be used for fractures of the epiphyses. A secondary angulation is frequently encountered in the thumb. Spontaneous rupture of the superficiaJis and profundus flexor tendons of the index finger due to tuberculous synovitis. D. LECLERCQ, A . CARLIER, G . LEJEUNE , M. VAN LANCKER, and G . ALEXANDRE (Liege) reported on a case of tuberculous tenosynovitis of the hand . The patient had developed a carpal tunnel syndrome associated with a spontaneous rupture of the flexor tendons of the index finger. A specific antituberculosis treatment was started, and a synovectomy of the wrist and the palm and an amputation of the index finger were necessary. Translocation of the fifth finger for metacarpophalangeal amputation of the fourth finger. In a presentation of five cases , 1. BITAR and 1. 1. ROM BOUTS (Lou vain) reported that the fifth metacarpal bone is completely transferred on the proximal stump of the third metacarpal bone, or inserted between the two stumps previously cut obliquely. Three of the five patients reported on had amputations of the ring finger because of a malignant tumor; the fourth amputation was due to angioma; and the fifth patient's finger was amputated as a result of a post-traumatic problem. The functional and esthetic results were satisfactory, although there was a slight stiffness of the metacarpophalangeal joint of the little finger in all patients . False aneurysm of the ulnar artery. A. DECONINCK, L. BILTERYS, R. GRANT, and W. LOKITEK (Louvain) reported that, although rare in the hand, false aneurysm may occur where the ulnar artery arises from the Guyon tunnel and where it is covered only by the
skin and the palmaris longus. One of the patients on whom they reported , a young butcher, had superficially cut his left hand in the hypothenar eminence area . Three weeks later he developed a 1.5 cm in diameter fluctuating tumor. Doppler ultrasound, thermography, and angiography demonstrated a false aneurysm of the ulnar artery. Vascularization of the ring and little fingers was poor. The aneurysm was excised , and a 3 cm venous graft was used to repair the artery. The authors emphasized the reestablishment of vascular continuity in the hand with microvascular techniques . Sensitive potentials measurement for early diagnosis of peripheral nerve involvement. A . DEMEY (Brussels) discussed the fact that it is sometimes difficult to make a differential diagnosis of the involvement of the peripheral nerves. In addition to using electrophysiological motor measurements, the author measured the latency of the F wave in order to evaluate the status of the roots of the ulnar and median nerves. He then measured the sensory potentials, as their desynchronization is the best sign of nerve involvement and the best way to evaluate postoperative recovery. Carpal tunnel syndrome in burns. 1. FISSETTE and N. FANDI (Liege) studied a series of 14 patients with bums of the upper extremities (24 wrists) both clinically and with electromyography. A significantly high incidence of carpal tunnel syndrome and sensory involvement of the unlar nerve in the Guyon tunnel was demonstrated. Of the 24 wrists explored, 12 had electromyographic and/or clinical signs of carpal tunnel syndrome, and 14 had signs of ulnar nerve compression (sensibility) . Those findings suggest that more attention should be paid to median and ulnar nerves at the wrist level in the bum patient. Toward that end, the authors will carry out additional studies. Free flaps from the first web space of the foot. G. FOUCHER (Strasbourg) presented 12 cases of reconstruction of the pulp of the fingers . This reconstruction was accomplished by the use of the pulp of the first toe in eight of the patients, and the use of the pulp of the first web space, and a part of the two pulps in two patients. In the final two patients, the author reported adding a part of the nail and the bone .
0363-5023 /80/010091 +01$00.10/0 © 1980 American Society for Surgery of the Hand
THE JOURNAL OF HAND SURGERY 91
The most recent meeting of the Belgian Hand Group
was held in Nancy, France . The following is a summary of the seven papers presented at that meeting. Phalangeal fracture treated by the "tumbler" (Biloquet) osteosynthesis. H. EVRARD (Charleroi) presented a series of 14 cases with a minimal follow-up period of 6 months . The author used either smooth pins or pins with a screw at the end. The functional result was satisfactory. The presence of the cement delayed the radiological uniting , but not the clinical consolidation. This method can be used for fractures of the epiphyses. A secondary angulation is frequently encountered in the thumb. Spontaneous rupture of the superficiaJis and profundus flexor tendons of the index finger due to tuberculous synovitis. D. LECLERCQ, A . CARLIER, G . LEJEUNE , M. VAN LANCKER, and G . ALEXANDRE (Liege) reported on a case of tuberculous tenosynovitis of the hand . The patient had developed a carpal tunnel syndrome associated with a spontaneous rupture of the flexor tendons of the index finger. A specific antituberculosis treatment was started, and a synovectomy of the wrist and the palm and an amputation of the index finger were necessary. Translocation of the fifth finger for metacarpophalangeal amputation of the fourth finger. In a presentation of five cases , 1. BITAR and 1. 1. ROM BOUTS (Lou vain) reported that the fifth metacarpal bone is completely transferred on the proximal stump of the third metacarpal bone, or inserted between the two stumps previously cut obliquely. Three of the five patients reported on had amputations of the ring finger because of a malignant tumor; the fourth amputation was due to angioma; and the fifth patient's finger was amputated as a result of a post-traumatic problem. The functional and esthetic results were satisfactory, although there was a slight stiffness of the metacarpophalangeal joint of the little finger in all patients . False aneurysm of the ulnar artery. A. DECONINCK, L. BILTERYS, R. GRANT, and W. LOKITEK (Louvain) reported that, although rare in the hand, false aneurysm may occur where the ulnar artery arises from the Guyon tunnel and where it is covered only by the
skin and the palmaris longus. One of the patients on whom they reported , a young butcher, had superficially cut his left hand in the hypothenar eminence area . Three weeks later he developed a 1.5 cm in diameter fluctuating tumor. Doppler ultrasound, thermography, and angiography demonstrated a false aneurysm of the ulnar artery. Vascularization of the ring and little fingers was poor. The aneurysm was excised , and a 3 cm venous graft was used to repair the artery. The authors emphasized the reestablishment of vascular continuity in the hand with microvascular techniques . Sensitive potentials measurement for early diagnosis of peripheral nerve involvement. A . DEMEY (Brussels) discussed the fact that it is sometimes difficult to make a differential diagnosis of the involvement of the peripheral nerves. In addition to using electrophysiological motor measurements, the author measured the latency of the F wave in order to evaluate the status of the roots of the ulnar and median nerves. He then measured the sensory potentials, as their desynchronization is the best sign of nerve involvement and the best way to evaluate postoperative recovery. Carpal tunnel syndrome in burns. 1. FISSETTE and N. FANDI (Liege) studied a series of 14 patients with bums of the upper extremities (24 wrists) both clinically and with electromyography. A significantly high incidence of carpal tunnel syndrome and sensory involvement of the unlar nerve in the Guyon tunnel was demonstrated. Of the 24 wrists explored, 12 had electromyographic and/or clinical signs of carpal tunnel syndrome, and 14 had signs of ulnar nerve compression (sensibility) . Those findings suggest that more attention should be paid to median and ulnar nerves at the wrist level in the bum patient. Toward that end, the authors will carry out additional studies. Free flaps from the first web space of the foot. G. FOUCHER (Strasbourg) presented 12 cases of reconstruction of the pulp of the fingers . This reconstruction was accomplished by the use of the pulp of the first toe in eight of the patients, and the use of the pulp of the first web space, and a part of the two pulps in two patients. In the final two patients, the author reported adding a part of the nail and the bone .
0363-5023 /80/010091 +01$00.10/0 © 1980 American Society for Surgery of the Hand
THE JOURNAL OF HAND SURGERY 91