Mallet finger deformity: treatment reconsidered

Two hundred patients with traumatic mallet finger deformities are treated according to the pathological nature of the lesion. Incomplete lesions are treated by master neglect i.e. simple observation. Complete freshtears are treated with custom made splints; recent avulsion fractures are treated by barbed wire fixation. In old injuries the fragment is excised and direct repair to the periosteum is made and supplemented with krischner wire fixation of the distal joint. Tightening of the expansion opposite the middle phalanx is done in old complete tears. This proposed classification and plan of management is found effective

Our experience on neglected cases of congenital dislocation of hip

It is well known that at the age 3 to 5 years better results are obtained by open reduction and salter's innominate osteotomies. Which gives the best results when done at the age of three years. But in our cases of neglected hips the situation is different. In unilateral cases: always better to reduce the hip. Since subsequently even a stiff hip can be treated by total Hip replacement arthroplasty in later adult life. In unilateral involvement we aim at restoring the normal anatomy which is attained by open reduction, and shortening of the femur, derotation osteotomy and shelf procedure. In bilateral cases: open reduction by surgery can produce bilateral stiff hip and hence only osteotomies are preferred aiming at change of weight transmission and to obtain moderately stable hip. Frequently neglected bilateral cases do generally well. However in older patients as in our cases there is usually limb length discripancy with or without pain in the gluteal region. In such cases we test the feasibility of reduction and the possibility of the descend of the femoral head by adductor tenotomy, psoas tenotomy and skeletal traction, if both heads descend reasonably, then one may think of open reduction on both sides. But in our cases it was impossible so, we aimed at correcting the limb length discripancy to prevent the low back pain by Schanz osteotomy on the shorter side. Even though the cases may be bilateral, one side is more hypoplastic than the other and the operation may have to be done on one side only. If the head is painful we excise it and proceed with Schanz osteotomy. Before concluding we wish to emphasise on the following points we are aware of the fact that the study confines only to a very small number of cases. But we felt it is significant since it constitutes 25% of all C.D.H. cases treated surgically in our department. Hence it is apparent that the problem facing the orthopaedic surgeons in this country is of grave nature. Attention has to be focused to early detection, prompt diagnosis and treatment before they fall under the group neglected C.D.H.