Faculty Bibliography

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

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.

An unusual rupture of a flexor profundus tendon, previously unreported in the literature, is presented. There was avulsion and proximal displacement of a large bone fragment from the palmar base of the distal phalanx and further retraction of the tendon unattached to the bone fragment.

The locked metacarpophalangeal joint of a finger is an unusual condition frequently confused with a "trigger finger." The causes can be classified into degenerative and spontaneous groups. Ten cases are presented. The cause of locking of one patient in the degenerative group was gouty arthritis, a cause not previously reported in the literature. Although surgery is usually necessary, joint mobility was restored in 30% of the cases by distending the joint capsule with an intraarticular injection of a local anesthetic followed by gentle manipulation. In addition to routine x-ray films, arthrotomography was found to be a useful diagnostic technique in determining the cause of locking.

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.

Dorsal dislocations of the proximal interphalangeal joint are common injuries, and reduction is usually obtained by manipulation. We describe four cases of dorsal dislocation in which attempts at reduction by manipulation were not successful. Three of these injuries were open and one was closed. At surgery, the main block to reduction in all cases was the palmar plate that had ruptured from its proximal attachment and was interposed between the joint surfaces.

Fractures occurring at the base of the hook of the hamate are difficult to detect. Failure to visualize the entire hamulus on routine radiographs and conventional carpal tunnel view may contribute to a delayed diagnosis. Carpal tunnel trispiral thin-section tomography is a useful aid in the investigation of a suspected fracture of the hook of the hamate.

A case of an intraosseous ganglion arising in a phalanx is described. This condition has not been reported previously.