Radiographic evaluation of the hook of the hamate: a new technique.

Radiographic confirmation in cases of suspected hook of hamate fractures can be very difficult. Films, including the carpal tunnel view, may be difficult to interpret. We describe a new semisupine oblique radiographic view of the carpus that permits excellent visualization of the hamate hook, is cost efficient, and allows for patient comfort during the study.

Complex dorsal dislocation of the second carpometacarpal joint.

Isolated dislocation of the carpometacarpal joint of the index finger is a rare injury. This paper reports a case of an isolated dorsal dislocation of the second carpometacarpal joint not reducible by closed means. At open reduction, the extensor carpi radialis brevis was found to be interposed in the joint, blocking reduction.

Fracture-dislocations of all five carpometacarpal joints: a case report.

Injuries to all five carpometacarpal joints are rare. Only four cases have been reported in the English literature. A case of fracture-dislocations of all five carpometacarpal joints is presented. An excellent result has been obtained 2 years after open reduction and internal fixation. This case is the only one in the English literature so treated and with prolonged follow-up.

Digital ischemia secondary to thrombosis of a persistent median artery.

Digital ischemia secondary to either ulnar arterial or digital arterial thrombosis has been well described. To our knowledge, digital ischemia secondary to thrombosis of a persistent median artery has not been previously reported in the English literature.

Computed tomography in the diagnosis of a herniated disk at the L5-S1 level.

Six patients with a normal myelogram were found to have evidence of a herniated nucleus pulposus (HNP) at the L5-S1 level on computed tomography (CT) scan. In all six patients, the presence of the herniated disk was confirmed at surgery. Five of the six herniations were lateral. The authors found no patients with an abnormal myelogram and a normal CT at the L5-S1 level in a technically good study. The sensitivity of the CT in diagnosing an HNP at the L5-S1 interspace is greater than with myelography if images in the exact plane of the disk can be obtained.

Osteochondromas of the hand in hereditary multiple exostosis: report of a case presenting as a blocked proximal interphalangeal joint.

Blocking of motion of an interphalangeal joint in the hand by an osteochondroma has not been reported previously. Osteochondromas, which are uncommon in the hand, are encountered most frequently in patients with hereditary multiple exostosis. They can occur away from the epiphyseal plate region at the distal end of the proximal and middle phalanges. Osteochondromas that occur in these locations characteristically cause angular and rotational deformities. Early recognition and prompt surgical treatment in this child resulted in full motion with minimal angular deformity.

Surgical stabilization of thoracic and lumbar spine fractures: a retrospective study in a military population.

Twenty-two patients underwent surgical stabilization of thoracic and lumbar spine fractures. Twenty patients were operated on within 4 weeks of the injury and two patients more than 1 year following injury. Harrington rods were used in 21 and Dwyer instrumentation in one. The presenting neurological deficits were: four complete, five incomplete, and 13 intact. Clinical failure was noted in four patients, two of whom underwent posterior instrumentation more than 1 year following the initial injury. The most important contributing factor to failure was use of instrumentation in deviation from standard practice. The aim of operative treatment to maintain fracture reduction, decompress neural elements, promote fracture healing, and shorten hospitalization was achieved.

Upper extremity gangrene of the newborn infant.

Ischemia of a limb occurring in the first week of life is uncommon. Gangrene presenting at birth in the upper extremity is fortunately rare. The result in this case and a review of the literature of the last 40 years shows that prompt recognition, early arteriography, and aggressive surgical treatment are necessary.

Bifid median nerve with three thenar branches--case report.

A case of a high division of the median nerve associated with a persistent median artery and three transligamentous thenar motor branches is presented. To our knowledge, three transligamentous motor branches have not been previously reported in the literature.

Laceration of the ulnar nerve with a closed fracture of the distal radius and ulna: a case report.

Injury to the ulnar nerve with closed fractures at the wrist are rare. A case of an ulnar nerve laceration as a result of a closed Colles' fracture is presented. Rationale for early exploration of the ulnar nerve due to persistent palsy following fracture reduction is discussed.