[The Foucher's "kite-flap" (12 cases)]

The "kite-flap" is a cutaneous island flap containing a triple pedicle. It is harvested from the dorsum of the index and is intended to cover skin-loss on the thumb. The purpose of our study was to evaluate 12 "kite-flaps" performed over the course of 11 years. The skin defects were on the dorsum of the distal phalanx of the thumb in 3 cases, on the dorsum of both the distal and proximal phalanges in 4 cases and on the volar aspect of the thumb in 5 cases. The associated lesions consisted of combined bone and skin in one case treated by bone graft with external fixation, and one case of septic arthritis of the interphalangeal joint treated by arthrodesis. The results of our series are very good after an average of 2 years follow-up. We have however had 4 cases of cold intolerance, 2 cases of superficial sepsis and one case of shrinkage of the first commissure. It appears that the "kite-flap" is the best solution for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover.

Band saw injury in a butcher

BACKGROUND

While treating an unusual amputation caused by a meat band saw in a 35-year-old butcher, we sought information from the medical literature that would be useful to other physicians who might encounter similar occupational injuries.

METHODS

Using the Medline database and relevant search terms, we reviewed the literature concerning occupational saw blade injuries and porcine microbiology as they related to this injury.

RESULTS

Among meat workers using powered cutting equipment, hand injuries and distal fingertip amputations appear to be common. The greatest risk for a wound infection after open exposure to raw pork meat appears primarily related to environmental flora rather than enteric-borne porcine pathogens.

CONCLUSIONS

Decision-making strategy when formulating a treatment plan for debridement or reconstruction of saw blade amputations should rely on a detailed understanding of the injury and occupational environment to achieve an optimal patient outcome. When considering operative and antibiotic treatment for porcine meat-related amputation injury, surgeons should adhere to open fracture-related guidelines, since porcine-borne illnesses are most often caused by ingestion rather than transcutaneous inoculation.

Infektiöse Arthritis der Fingergelenke

BACKGROUND AND PURPOSE

Septic arthritis of finger joints is rare and its management not standardized. The outcome of all consecutive patients with finger joint arthritis was analyzed in terms of risk factors, surgical technique, antimicrobial therapy and hand therapy.

PATIENTS AND METHODS

Data of 31 patients with surgical treatment between 1993 and 2005 were screened and those from 29 patients with > 1 year of follow-up were retrospectively analyzed. Surgical techniques were debridement, primary, secondary arthrodesis or temporary joint distraction with external fixation. In addition, all patients were treated with antibiotics and hand physiotherapy. The median follow-up of the 29 patients was 5.7 years.

RESULTS

The most frequent cause was work injury (19/29), the leading causing agent Staphylococcus aureus (9/29). Overall 16/29 (55 %) of the patients with follow-up had a good result regarding healing of infection, lack of pain and fair function. Primary arthrodesis was performed in 3, secondary arthrodesis in 4 patients. 3 patients were treated with temporary external fixation for three weeks. Cartilage damage detected during surgery (p = 0.01) was the significant risk factor for a bad outcome. The median delay to treatment was 4 days (1 - 550 days). Antibiotics were given for a median of 2 days by the iv-route and 17 days orally.

CONCLUSIONS

Septic arthritis of finger joints should be early recognized and immediately treated with surgery and antibiotics, in order to avoid cartilage damage. If cartilage is already damaged, primary arthrodesis with the use of an external fixation is indicated.

Handgun injuries with metacarpal and proximal phalangeal fractures: early definitive treatment

Most gunshot injuries to the hand involve a combination of tissue types. The goal of this study is to report the results of early definitive treatment in extra-articular metacarpal and proximal phalangeal fractures due to low velocity gunshot wounds and to analyse their outcomes. A retrospective analysis of 51 metacarpal and 41 proximal phalangeal fractures of 76 patients due to low velocity gunshot wounds treated between January 2001 and December 2004 was carried out. We applied acute fixation in the first 24 hours. The patients were evaluated with total active motion scores, radiographic control, complication rate and the need for revision surgery. The infection frequency was 10.5% and the need for a revision surgery was 7%. The plate fixation group had significantly higher total active motion scores than the external fixation group. The K wire group had the highest revision rate. The bone grafting group was associated with good total active motion scores and low complication rates. The majority of the low velocity gunshot injuries are surgically clean wounds which allow not only early fracture fixation, but also early bone grafting and soft tissue reconstruction. Plate and screw fixation is associated with significantly better functional outcomes than the minimal fixation group.

A unique treatment of finger-sucking habit in children with mental retardation: report of 2 cases

Finger-sucking habit, or nonnutritive sucking, usually ceases spontaneously in childhood. If the habit is not broken, however, not only will dental occlusion be affected, but the shape of the finger may be altered as well. When the habit is broken, the threatening disturbances of digital growth and dental occlusion will resolve spontaneously. This article describes a unique type of habit-breaking appliance applied on the sucked fingers of 2 children with mental retardation. The advantages of this type of extraoral appliance are discussed.

[Primary flexor tendon ruptures of the little finger within the carpal tunnel. Proposed classification based on six clinical cases and review of the literature]

Six cases of primary flexor tendon rupture of the little finger within the carpal tunnel are presented. All of them were attritional ruptures caused by a rough hook of the hamate. These ruptures are rare. They have their place among the flexor tendon ruptures of the wrist and the palm. Ultrasound may by helpful to determine the level of rupture. The surgical treatment consists of excision of the hook of the hamate and tendon repair.

Closed rupture of the flexor tendons of the index finger caused by a pathological fracture secondary to an intraosseous ganglion in the lunate

We report a rare occurrence of attritional rupture of both flexor tendons of the right index finger in a 71 year-old man with a pathological fracture of the lunate arising from an intraosseous ganglion.

Chronic circumferential periostitis of proximal phalanges related to tight fitting rings

We present three cases of chronic erosion injuries to the phalanges seen at our institution. We review the literature regarding this uncommon injury and discuss the clinical scenarios in which these injuries may occur, the radiographic findings, treatment options, and outcomes.

Surgical treatment of skier's thumb injuries: case report and review of the literature

Inappropriate treatment of skier's thumb injuries has been reported to result in chronic painful instability, weakness of pinch, and arthritis. Therefore, surgical treatment is recommended for those fractures with 2 mm or more of displacement, or significant articular involvement with incongruency or rotation. The goal of surgery is restoration of anatomy with stable fixation. In this study we present some cases managed with internal fixation of the injury. This technique has the advantage of anatomic stable fixation with good outcome.

Thenar hammer syndrome: a case report

BACKGROUND

Raynaud's phenomenon occurs among automobile mechanics secondary to long-term use of vibrating hand-held tools. It can also occur from traumatic injury to the upper extremity.

AIM

This report describes a case of single digit Raynaud's phenomenon in an automobile mechanic due to focal arterial impact trauma.

CASE REPORT

A 38-year-old right-handed transmission mechanic complained of paraesthesia and blanching of the right index finger on exposure to cold and eventually developed a transient necrotic ulcer at the tip of the digit. He had a long history of occupational exposure to vibrating hand-held power tools. Evaluation for common causes of Raymond's phenomenon was negative. The diagnosis of hand-arm vibration syndrome (HAVS) was rejected because of the rapidity of progression and severity of the symptoms restricted only to the index finger without corresponding symptoms of the other digits of the right hand as would be expected. Angiography revealed an obstructive lesion of the distal right radial artery at the wrist and he was diagnosed with thenar hammer syndrome. This uncommon condition was due to focal injury of the distal radial artery caused by repeated slamming of transmission parts on a work table.

CONCLUSIONS

Not all cases of Raynaud's phenomenon in workers using vibrating hand-held tools are due to HAVS. Alternative aetiologies should be considered especially if symptoms are asymmetrical and unilateral.

Can sarcoidosis cause autoamputation of a finger phalanx?

Sarcoidosis is a multisystemic granulomatous disease. In the case presented, autoamputation of the distal phalanx of a little finger of the left hand was observed. The possibility of autodigital amputation as a result of sarcoidosis is discussed.

Fingertip injuries

The fingertip is a complex anatomic unit highly specialized in function and particularly prone to injury. Its complex design and the difficulty of secondary repairs demand great care in initial evaluation, diagnosis, and treatment for optimal long-term outcome. The goals of treatment should be to preserve length, maintain sensation, mobilize early, return function expediently, and be mindful of cosmesis.