[Dislocation of the extensor tendons of the hand at the metacarpo-phalangeal level (zone V of Verdan)]. / Luxación de tendones extensores de la mano a nivel metacarpofalángico (zona V de Verdan).

MATERIAL AND METHODS: Traumatic dislocation of the extensor tendon over the metacarpophalangeal (MCP) joint is a rare lesion that is caused by the dysfunction or rupture of the sagittal band, which is an important stabilizing structure of the extensor tendon. This mechanical alteration presents itself as instability that affects function and may cause pain or snapping during finger motion. The diagnosis is made when ulnar dislocation of the extensor tendon is observed over the MCP joint. Nonsurgical treatment is successful and should be attempted when injuries are diagnosed within the first three weeks. Several surgical repairs have been described. We searched medical databases (Ovid, Medline) for papers on extensor tendon dislocation. We also revised our own cases of this injury. RESULTS: Our search resulted in 10 articles and four books. We found 18 patients with 21 injuries, 10 men and eight women. The most frequently affected finger was the middle one (in thirteen cases), followed by the index (in five cases), the fourth finger (in two cases) and the third one (in one case). Eight of our patients were treated conservatively and thirteen required surgical treatment. The surgical procedures performed were Wheeldons in seven cases; primary repair of the sagittal band and Wheeldon in four cases; primary repair alone in one case; and Carrolls in one case. The follow-up was between one and 34 years (average: 17.5 years). DISCUSSION: Extensor tendon dislocation in zone V is rare. When the diagnosis is made after three weeks of the lesion, the surgical treatment is recommended.

La luxación de los tendones extensores a nivel metacarpofalángico (MCF) de los dedos es una alteración mecánica poco frecuente que se caracteriza por incompetencia o ruptura de la banda sagital (BS), estructura que estabiliza dichos tendones. Se manifiesta por desplazamiento cubital del tendón extensor (en raras ocasiones, la luxación es radial o divergente), que limita su función y puede causar dolor o chasquido. El diagnóstico se hace al observar el tendón extensor del lado cubital de la articulación MCF en flexión del dedo. El tratamiento debe ser conservador cuando el diagnóstico se efectúa en las primeras tres semanas. Se recomienda tratamiento quirúrgico cuando el diagnóstico es tardío. Existen varias técnicas de reparación quirúrgica. Se revisaron bases de datos electrónicas (Ovid y Medline) en busca de artículos relacionados con esta patología. Se examinaron los casos de luxación de tendones extensores en zona V en nuestros pacientes.

[Inclusion bone cyst in the distal phalanx. Report of three cases]. / Quiste oseo de inclusión en la falange distal. Informe de tres casos.

UNLABELLED: Inclusion bone cysts are cysts of an epidermal lineage containing keratin. They are commonly found in the subcutaneous tissue, occasionally in intratendinous, subungueal or intraosseous tissue. The diagnosis is usually clinical. The most frequent symptom is pain, which may be associated with ungueal deformity. Plain X-rays in two views allow identifying the bone location. The treatment recommended for all cases of epidermoid cyst of the distal phalanx is curettage of the lesion. MATERIAL AND METHODS: The clinical charts of patients with inclusion cysts of the distal phalanx from 1983 to 2010 were reviewed. RESULTS: Three cases were found; 2 males and one female, ages 23, 28 and 47 years. The most frequent symptom was pain with ungueal deformity in 2 cases. In 2 cases the X-rays show the characteristics of the epidermoid cyst. Curettage was performed in the 3 cases; a bone graft was used in 2 cases. The follow-up ranged between 120 and 324 months (mean of 222 months). No relapses or complications were reported. DISCUSSION: Inclusion bone cysts are infrequent tumors of the distal phalanx and have particular characteristics that the orthopedist surgeon should be familiar with.

[Enchondroma of the distal phalanx]. / Encondroma de la falange distal.

Enchondroma is the most frequent benign tumor in hand bones. It occasionally occurs in the distal phalanx of the fingers; it is usually an asymptomatic lesion, but pain may occur when it is associated with a fracture. The most recommended treatment is lesion curettage and application of a bone graft, besides fixation as needed. Five cases with location in the distal phalanx are reported, as well as treatment results from January 1978 to May 2010. Of the 5 patients, 4 were females and one was male. The most frequently affected digit was the middle finger followed by the little finger. The most frequent symptom at the time of diagnosis was pain. Lesion curettage was performed in all cases, with the use of an autologous distal radius bone graft in 4 and coralline graft in one. Mean follow-up was 193 months (2-384 months). No complications or relapses were reported.

[Glomus tumor of the hand]. / Tumor glomus en la mano.

BACKGROUND: Glomus type of tumors are benign tumors of the hand phalanges. Their most frequent location is the nail bed. The diagnosis requires a certain index of suspicion and is usually a clinical one. The recommended approach is surgery. MATERIAL AND METHODS: The clinical files of patients with glomus of the hand were reviewed from June 1978 to May 2010, analyzing the characteristics of their management. RESULTS: Twelve patients with a glomus type of tumor were found; 4 females and 8 males, ages 31-55 years. The distal phalanx and the little finger were the most frequent sites. The diagnosis was mostly clinical and treatment in all cases was surgical. Mean follow-up was 8 years. CONCLUSIONS: The glomus type of tumor is a lesion often involving the distal phalanx, with unique clinical and pathologic characteristics that the orthopedic surgeon should know to determine management.