Faculty Bibliography

An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities

Although arthrodesis of an arthritic proximal interphalangeal joint provides excellent relief of pain, it does so at the expense of mobility. Silicone rubber implant arthroplasty also provides predictable relief of pain and approximately 60 degrees of motion. Insertion of the implant through a dorsal extensor-splitting approach is preferred when a tendon reconstruction is necessary, as in cases of boutonniere deformity. If tendon reconstruction is not necessary, the lateral approach is an excellent alternative because it does not disturb the extensor mechanism and therefore permits earlier rehabilitation exercises. The following article outlines the dorsal and lateral techniques and postoperative rehabilitation of silicone rubber arthroplasty.

An injury to the dorsal aspect of the metacarpophalangeal joint of a finger usually damages the sagittal fibers of the extensor tendon mechanism. Rupture of the underlying joint capsule, a far more serious injury, has received scant attention in the medical literature. The problem is often unrecognized because the extensor tendon may remain in its normal midline position. Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. Most of the injuries occurred in professional boxers.

We investigated whether cortico-cancellous allograft obtained from cadaveric banked bone is effective in the treatment of enchondroma of the hand. Twelve patients had 15 operations on 19 enchondromas using allograft bone. These patients were compared with 16 patients with enchondroma treated with autogenous iliac cancellous bone. The distribution of tumors was similar in both groups. There was no significant difference in the patient's age, their occupations, or whether the operation involved the dominant hand. In both groups, immobilization was maintained until clinical union was obtained. The duration of immobilization for both groups was identical. There were no recurrences, refractures, or complications in patients treated with allograft bone. The grafts incorporated and remodeled in all patients. We concluded that a allograft cortico-cancellous bone can be used effectively in the treatment of enchondromas of the hand. It is especially useful in the treatment of patients with multiple tumors

Juvenile aponeurotic fibroma is a distinctive fibroblastic tumor usually found in young children. The tumor has a predilection for the palms and soles, although it can occur elsewhere, either superficially in subcutaneous tissues or in deeper musculofascial and paraskeletal tissues. In this case the tumor occurred in an adult within the substance of the flexor pollicis longus tendon, a location not previously reported in the literature. Because of the unique location of the tumor, it was excised without sacrificing the tendon. Since recurrence of these lesions is common, continued observation was necessary. Magnetic resonance imaging in this patient 26 months after the operation showed restoration of the normal tendon contour

Trispiral tomography is an x-ray technique that is essential in the diagnosis and management of a wide variety of problems involving the carpal bones and their joints. It facilitates the visualization of acute fractures, particularly those of the scaphoid and hook of the hamate, as well as cysts, sclerosis, and erosive lesions. It is useful in differentiating between acute and chronic changes, and it is often indispensable in evaluating healing after acute fractures or bone grafts to treat nonunions.

Chronic palmar instability of the metacarpophalangeal joint of the thumb can result in a significant disability. Grasp, particularly pinch, is painful and weak because the thumb goes into hyperextension. Stabilization of the metacarpophalangeal joint can be achieved by distal advancement of the conjoined tendon of the abductor pollicis brevis and lateral fibers of the flexor pollicis brevis.

Two cases of lipofibroma of the median nerve are described. The literature is reviewed and the clinical and treatment aspects of this unusual condition are discussed.

Seven patients with chronic palmar dislocations of proximal interphalangeal joints are described. The duration of the dislocation ranged from 4 weeks to 19 months. Satisfactory mobility was restored in each patient after operative reduction and reconstruction of the extensor mechanism. Motion of the proximal interphalangeal joint averaged 57.1 degrees and 29.3 degrees at the distal interphalangeal joint. This method of treatment is preferable to an arthrodesis in selected patients.