Evaluation of plate luting, using an in vivo ovine osteotomy model

Bilateral, midshaft metacarpal osteotomies were performed in 11 sheep and bilateral, midshaft radial osteotomies were performed in 7 sheep. The lesions were repaired with bone plates. One of each pair of plates was luted with polymethylmethacrylate and all screws were tightened uniformly with a torque screwdriver. Sheep were allowed unrestricted exercise after surgery. At 8 weeks, 10 of 11 sheep with metacarpal osteotomies were sound and both osteotomies were healing. Seven were lame on the limb with the unluted plate during the first 3 weeks; 4 were never lame on either limb. The screws of the unluted plates were significantly (P less than 0.01) looser at 8 weeks than those in the luted plates. All of the sheep with radial osteotomies were lame in the limb with the unluted plate. Four of 7 sheep had overt loosening of the unluted plates. One sheep only had mild screw loosening with continued alignment of the osteotomy. Two of 7 sheep fractured the radius with the luted plate; these 2 sheep were lame in the limb with the unluted plate and were using the limb with the luted plate vigorously. Excluding the 2 sheep with fractures, all had substantially more screw loosening in the unluted plate. Histologically, there were no discernible differences in the vascularity or porosity of the bone under the luted vs the unluted plates. The only adverse consequence of the luting technique was introduction of a small amount of polymethylmethacrylate into the osteotomy gap in 5 bones.

Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion

Metacarpal and phalangeal malunion after fracture or replantation frequently causes rotational deformities with scissoring during digital flexion. Transverse osteotomy at the metacarpal base has been advocated for derotation, but this only partially corrects scissoring resulting from phalangeal malunion. We describe the results of rotational step-cut osteotomies at the site of malunion. There were twenty-three osteotomies in eighteen patients; seven metacarpal and sixteen in the proximal phalanx. The value of the technique is supported by the results; speedy healing of bone, satisfactory alleviation of deformity, and a useful gain in range of motion in many patients.

Metacarpal and phalangeal osteotomy with miniplate fixation

We reviewed the results of corrective oseotomies performed with power tools for symptomatic malunions of metacarpal and phalangeal fractures in 10 patients. At an average follow-up of 30 months, all patients had a healed osteotomy with correct alignment and had an average increase of 30 degrees in the flexion arc of the involved digit. We recommend a surgical technique of miniplate fixation over K-wire fixation where possible; it allows precise, intraoperative correction and rigid stabilization. A shortened immobilization time and early motion are significant advantages of plate fixation. However, plates cannot be used across open growth plates or directly over areas of tendon insertion. A careful preoperative plan should always be prepared prior to any corrective osteotomy. Problems such as post-operative tendinous adhesions did not occur, nor did nonunions or delayed unions.

Arthroscopic removal of osteochondral fragments of the palmar/plantar aspect of the metacarpo/metatarsophalangeal joints

This paper presents the results of arthroscopic surgery in 42 Standardbred trotters and three Finnish horses. Forty-five horses were operated on. The age range was one to seven years; 73 per cent of the horses were three years old or younger. Horses showed a variety of clinical signs ranging from moderate to severe lameness at slow speeds, to obscure lameness manifesting only at high speeds. Synovial effusion of the fetlock joint was rare. In this series, 44 horses that had Type I fragments and one horse that had Type III fragments were operated on. Of the 45 horses operated on, 23 (51 per cent) returned to speed training in three months and 41 (91 per cent) returned to speed training in six months. Three of 45 (6 per cent) were lame three months after the surgery when the trainer attempted to start speed training. One of those was sound six months after the operation. The remaining two (4 per cent) stayed lame due to a lesion in the affected joint. Two of 45 (4 per cent) discontinued training for other reasons. The horse with Type III fragments returned to speed training in three months.

[Osteosynthesis in hand bone fractures in children]

At 12 preparations of the upper extremities of still-born fetuses has been studied microcirculatory channel of long bones of a hand. Clinical confirmation of the experimental results is based on the analysis of data obtained in process of treatment of 54 children with instable fractures of phalanges and metacarpal bones. An arterial channel of long bones of a hand is formed by the branches of finger arteries and vessels of the surrounding tissues. Epiphysis, metaphysis and growth cartilage have common circulatory system. The types of phalanx epiphysiolysis determine the terms of the open reposition realization. Comparison of morphological data and clinical observations demonstrated that the optimal methods of fixation of instable fractures of long bones of a hand are as follows: diafixation by means of wires, intramedullary osteosynthesis and perosseous compressive-distractive osteosynthesis.

Extensor indicis proprius syndrome secondary to an anomalous extensor indicis proprius muscle belly

The complaint of dorsal hand pain is common among patients seen in a primary care practice. The differential diagnosis includes tenosynovial disease, ganglion, trauma, and soft-tissue tumors. Rarely is an anomalous muscle an etiologic factor. Reported here is an anomalous indicis proprius muscle that was manifested as a painful dorsal hand mass. Also discussed are the anatomic variations of the extensor indicis proprius syndrome.

Mechanical and biological effects of plate luting

Plate luting, a technique that uses polymethylmethacrylate (PMMA) interposed between the plate and the bone, as well as between the screw heads and the plate, to improve the stability of internal fixation was tested in vitro using 20 paired equine third metacarpal bones with mid-diaphyseal osteotomies plated with six-hole broad ASIF compression plates. One of each pair was luted and all specimens were tested in static overload or cyclic loading at 75% of the ultimate breaking strength using four-point bending. Although no differences were measured in static overload tests between luted and nonluted plates, a three to 12-fold increase in the number of cycles to failure was noted with the luted specimens. In vivo studies of the biological reaction to plate luting were performed in seven horses using identical plates fixed to the intact radius. One side was luted while the opposite side was plated without luting. The horses were killed at 1, 2, 6, and 15 months after surgery. Quantitative histomorphometry showed no increase in porosity under the luted plate when compared with the nonluted side.

Cleft hand

Definition, incidence, genetics, and etiology of typical cleft hand are discussed in this paper. Cleft hand, central polydactyly, and osseous syndactyly were induced experimentally when the same teratogenic factors acted on the embryos at the same developmental stage. Typical cleft hand, central polydactyly, and syndactyly should be classified together as manifestations of the same entity, that is, failure of induction of finger rays. Typical cleft hand may be further subdivided into five types on the basis of the number of defective finger rays. Treatment of the typical cleft hand involves cosmetic and functional considerations. Reduction of the wide interdigital space is performed primarily for cosmetic reasons, while separation of syndactyly between thumb and index finger and correction of deviation of the thumb is performed for functional improvement. A zigzag incision with a small triangular flap is recommended for reduction of the interdigital space. If metacarpal remnants or cross bones prevent drawing the metacarpals together, they should be removed. The deep transverse metacarpal ligament should be reconstructed by ligamentous flap made out of the flexor tendon sheaths of the index and ring fingers to prevent later spreading of the fingers. A dorsal-based rotation flap fashioned from the skin of the cleft is recommended for the treatment of cleft hand with partial syndactyly of the thumb and index finger. Deviation of the thumb is often caused by a delta phalanx by a trapezoidal-shaped extra phalanx. Deviation of the thumb is corrected by removing the delta phalanx or osteotomy of the trapezoidal phalanx. When the cleft is closed at approximately 1 year of age, spontaneous correction of the flexion deformity of the ring finger is sometimes observed.

Keratoacanthoma necessitating metacarpal amputation

Keratoacanthoma is usually considered a benign self-limiting lesion. First described in 1888 by Hutchinson, it most commonly involves the face and hands. It is usually controlled by complete soft tissue excision. A variant, subungual keratoacanthoma, affects bone by pressure erosion of the distal phalangeal tip. We report a case of keratoacanthoma clinically involving a metacarpal and phalanges with a radiologic and physical appearance at variance with previous reports. After multiple recurrences following erosion and cryosurgery, as well as attempted digit salvage with Mohs' surgery, ray amputation was required. The world literature pertaining to keratoacanthoma is reviewed and discussed.

[Transpalmar transplantation of a severed hand to the opposite side: a case report]

A man of 20 got both his upper limbs badly injured by an accident on May 28, 1989. Crush of all the 4 fingers of right hand, traumatic amputation through the left arm with severe damage of soft tissue and burst fracture of bones around left elbow. And so, the chance of providing him a useful hand could only be transpalmar transplantation of the undamaged left hand to the opposite side. This was done urgently to reconstruct a new hand, a hand with its fingers in a reversed order. The wound healed up nicely, the transplanted fore-hand was well taken and the new hand functions satisfactorily, though the natural little finger of left hand takes the place of and works as index one, and the original ring finger of left hand seats the position in and acts as long one; and so on. The details of operative procedure are described and the importance of rehabilitation training is particularly emphasized.

On the Treatment of Enchondroma

We recommend simply removing an enchondroma without filling the cavity with cancellous bone or plaster-of-Paris. This method can also be applied to other benign bone conditions, such as aseptic necrosis.

Metacarpal Fractures and the Clamp-on Plate

Since internal fixation of metacarpal fractures has a high complication rate, most fractures should be managed conservatively, with the emphasis on early mobilisation. However, some fractures do need internal stabilisation. We propose the use of the clamp-on plate, which is simple to use, has a very low complication rate and allows immediate mobilisation.

Carpometacarpal dislocation: report of three cases

The case reports of three patients with carpometacarpal dislocations are described. The diagnosis of this condition may be difficult and is often missed. Swelling, dislocation and a palpable lump are the main clinical findings. X-ray findings, the key to the diagnosis, are loss of parallelism, interruption of the so-called M-line and overlapping of articular surfaces. Additional X-rays in different planes are to be recommended if carpometacarpal dislocation is suspected.

Correction of rotary malunion of the fingers by metacarpal rotational osteotomy

Metacarpal rotational osteotomy was performed in 12 patients to correct rotary malunion following fractures of the phalanges and metacarpals. All but one patient obtained excellent correction of their preoperative deformities. The procedure is simple and gives predictable results.

[Ray amputation of the hand]

The aim of a ray amputation is to improve the cosmetic appearance and function of the hand after finger amputation. Pain, reasons of appearance and impaired function of amputation stumps are good indications. The patient's occupation, hobbies, handedness and emotional attitude regarding the amputation should be assessed when ray amputation is considered.

Osteostixis for incomplete cortical fracture of the third metacarpal bone. Results in 11 horses

Eleven horses with acute or chronic incomplete cortical fractures of the left or right third metacarpal bone (McIII) were treated with surgical puncture (osteostixis). The fractures were diagnosed by physical examination and radiography. Four to eight holes, 2.7 or 3.5 mm in diameter, were drilled in the fractured bone. Radiographically, the fractures were healed by month 3, and the drill holes were inapparent by month 7. Nine horses (82%) returned to race competition, and two horses were retired, one the result of a surgical complication. The mean time between surgery and the first race was 9.4 months. None of the bones refractured within 24 months of surgery. Osteostixis was not technically difficult and a second operation for implant removal was not necessary.

Aneurysmal bone cyst of the fifth metacarpal

An aneurysmal bone cyst of the hand occurred in a 10-year-old girl. The hand is an extremely rare location for this lesion. A case report is presented along with a review of the medical literature.

[Comparative evaluation of methods of fixation of metacarpal bone fragments]

The authors have carried out an experimental study of stability of the bone fragments of the 2-5th metacarpal bones in various hypes of fixation of the hands of fresh human cadavers. It has been established that the highest stability in all kinds of fractures in the conditions of functional loading is provided by osteosynthesis with rod apparatnses. A differential approach concerning the choice of the hype of osteosynthesis depending on the fracture plane is necessary in the treatment of the metacarpal bone injuries. An early functional loading of the fingers should be made with regard to the plane and the type of osteosynthesis.

Intraarticular osteotomy for malunion of metacarpal head fractures

Three cases of intraarticular osteotomy of malunited intraarticular fractures of the metacarpal head are described. The patients, all young males, had significant improvement in the articular anatomy and function. Rigid internal fixation was used in each case.

Composite wiring of metacarpal and phalangeal fractures

Composite wiring techniques using various configurations of Kirschner pins and stainless steel wire sutures have been applied to the treatment of 63 fractures of the long bones of the hand. The secure fixation achieved allowed active motion within 1 week of operation. Thirty-three metacarpal fractures achieved a final mean total active motion of 256 degrees (standard deviation 13.4) (normal total active motion -260 degrees). Twenty-one phalangeal fractures achieved a mean total active motion of 215 degrees (standard deviation, 46 degrees). There were no instances of infection, malunion, nonunion, loss of reduction, or tendon rupture in the 63 fractures that were treated.