Hand and upper extremity trauma in high-level instrumentalists: epidemiology and outcomes.

Hand and upper extremity injuries to the professional or serious amateur musician may cause significant disability and time away from one's instrument. This article reviewed 222 instrumentalists; 201 were followed to an end result of their injuries. 80% played strings or keyboard instruments. Sports or a direct fall were the most common causes of injury. The spectrum of diagnoses made was typical of hand trauma in general; fractures, sprains, muscle strains and lacerations were the most numerous. Final results after treatment in 201 patients included complete relief of symptoms in 137 (68.2%) and improvement in another 61 (30.3%). Return to performance was complete in 155 patients (77.1%) and in a modified fashion in 42 (20.9%). Only three performers had to stop playing as a result of trauma or it's sequelae. The 46 patients presenting with late sequelae of injury were less likely to achieve full restoration of function and complete return to musical activity than those who suffered acute trauma. Division of nerves or tendons, seen in 13 of 28 patients who sustained lacerations, was more likely to result in very long-term disability and/or incomplete recovery.

Elective hand surgery in the breast cancer patient with prior ipsilateral axillary dissection.

BACKGROUND: We wished to determine if complications after elective hand surgery were greater in women with previous mastectomy and axillary dissection than in those without. METHODS: We surveyed records of all women undergoing carpal tunnel release by the senior author (W.J.D.) from 1983 to 1993. The postaxillary dissection group (group A) was made up of 15 women; seven had some postdissection lymphedema. Group B was made up of 302 other patients who had not undergone breast surgery or axillary dissection. Anesthetic and surgical techniques were identical for both groups, with i.v. regional anesthesia used most commonly. RESULTS: No patient in the axillary dissection group developed any postoperative infection or had any worsening of preexisting lymphedema or onset of new arm swelling after ipsilateral carpal tunnel release. The nonaxillary dissection group had a postoperative infection rate of 3.6%; all infections were superficial and resolved with conservative therapy. In addition, 31 women experienced other complications, including 13 with hand/finger stiffness and four with reflex dystrophy. Fifteen required formal hand therapy. CONCLUSIONS: Women with prior ipsilateral axillary dissection can safely undergo elective upper extremity surgery, provided strict sterile technique and appropriate anesthetic and surgical precautions are observed. Patients having undergone previous axillary dissection should not be prohibited from future limb manipulations, including venepunctures, blood pressure measurements, or elective surgery.

The spectrum of sports-related interphalangeal joint injuries.

Sports participation places the fingers at risk for injury, especially from end-on contact with many kinds of balls and other objects. Certain sports are likely to produce specific injuries. Joint sprains and dislocations are especially common, whether or not accompanied by articular fractures. Tendon ruptures in the digit may not be recognized until many days or weeks later. The athlete must be aware of the need for early, accurate diagnosis, precise treatment, and complete rehabilitation for these often apparently innocuous injuries.

Sports-induced spontaneous rupture of the extensor pollicis longus tendon.

Two cases of spontaneous extensor pollicis longus tendon rupture are presented. One occurred in a 17-year-old diver and the other in a 69-year-old physician tennis player. Neither patient experienced pain, and only the diver had premonitory wrist discomfort. The diver was treated by an extensor indicis proprius transfer. The physician denied any disability and elected to have no treatment.

Radius fracture after total wrist arthroplasty.

Four cases of radius fracture are presented; each was caused by a fall and happened at least 18 months after total wrist arthroplasty. One patient had bilateral fractures occurring 12 months apart. All injuries were initially treated nonoperatively. Nonunion or healing with deformity occurred in three fractures. Revision arthroplasty was done in two cases with satisfactory results, and is being considered for a third.

Baseball injuries to the hand.

We conducted an epidemiological and etiological study of softball injuries to the hand in order to inform emergency medicine personnel of the high frequency and causative factors of these injuries. Injuries to the hand and fingers from baseball and softball comprised 2.2% of emergency department visits during this study. Most frequent injuries were: 1) sprain and sprain-fracture of the proximal IP joint (31.6%); and 2) the so-called "mallet" or "baseball finger" injury to the distal joint (18.9%). The 16-inch softball was the cause of more than two-thirds of all these injuries, most of which occurred in patients between the ages of 11 and 30. Treatment recommendations are beyond the scope of this article.

Onlay fibular bone grafting in treatment of tibial fracture non-union.

Twenty-nine patients with tibial non-union or delayed union were treated by onlay grafting, using long struts from the ipsilateral fibula and without disturbing the non-union site. Internal fixation and excessive dissection can be avoided. Follow-up in 28 patients showed solid healing in all; 20/28 patients united the fracture within 7 months. Removal of the fibula as a distracting force, combined with the principles of onlay grafting advocated by Phemister, is effective surgical treatment.