Early motion in the treatment of fractures and dislocations in the hand and wrist.

The concept of early motion is valuable in the treatment of fractures of the hand and wrist. It is a means to an end, however, and should be employed principally when the benefits outweigh the risks. The goal is a hand that functions as near to normally as possible, considering the injury. All treatments need to be tailored to the individual patient.

Palmar ganglion producing diminished sensation in the distribution of the radial digital nerve of the thumb: a case not previously reported.

An unusual presentation of a ganglion pointing in the palm is presented. Treatment was rendered by surgical excision using an extensile incision. Studies that would have no effect on decisions regarding the need for or the method of surgery were avoided, thus minimizing unnecessary costs in the management of this patient.

Intratendinous ganglia of the hand.

We report a series of seven patients with 10 intratendinous ganglia that were treated operatively. One ganglion was in the abductor pollicis longus tendon. The rest were in tendons of the fourth extensor compartment, and all of them were associated with tenosynovitis. The average age of the patients at operation was 55 years. One patient was treated by resection of the tendon with tendon transfer. The other patients were treated by excision of the ganglion with repair of the tendon or tenosynovectomy. The mean length of postoperative follow-up time was 6 years. One patient experienced a recurrence. Three of the six patients with preoperative dorsal tenosynovitis had tenosynovitis postoperatively. We speculate that the ganglia arose secondary to tenosynovitis. When an intratendinous ganglion is diagnosed, tenosynovectomy is recommended, with resection of the intratendinous ganglion and longitudinal tendon repair when needed.

A case of Ureaplasma urealyticum septic arthritis in a patient with hypogammaglobulinemia.

Patients with hypogammaglobulinemia have an increased susceptibility to certain infections. We describe the case of a patient with common variable hypogammaglobulinemia for whom the diagnosis of destructive monoarticular arthritis caused by Ureaplasma urealyticum was established after two nondiagnostic open biopsies had been performed. Mycoplasmal infection may involve a joint in hypogammaglobulinemic patients without causing macroscopic purulence in the joint. Histological examination of the bone may be helpful in the differentiation of an infectious process from the rheumatoidlike arthritis that occurs in such patients. Culture of involved bone in addition to synovium or synovial fluid may also be helpful in establishing the diagnosis.

Intra-articular fractures of the metacarpophalangeal and proximal interphalangeal joints.

When displaced or unstable, intra-articular fractures of the metacarpophalangeal and proximal interphalangeal joints represent difficult management problems. The best results can be achieved only with near-anatomic restoration of the joint surfaces and early active motion exercises. These principles dictate the use of rigid internal fixation by means that are not compromised by the exercise program. Not all of these serious injuries, regardless of how they are treated, will do well. Salvage procedures represent considerable functional compromise. Therefore, the most reliable techniques must be used in the initial treatment of these uncommon injuries.

Small-joint arthrodesis in the hand.

Arthrodesis of selected small joints of the hand is often indicated; however, in previously reported series nonunion is not uncommon. There were 171 consecutive arthrodeses of small joints performed on 134 patients. The operative method employed was essentially the method described by Littler. Emphasis was placed on the accurate coaptation of bone surfaces, the use of cancellous bone graft when needed, maintenance of the coaptation with Kirschner wires, and the need for postoperative immobilization. This technique resulted in union of 170 out of 171 arthrodeses (a nonunion rate of 0.6%). There were no infections. There were four delayed unions.

Eosinophilic fasciitis and the carpal tunnel syndrome.

Eosinophilic fasciitis is characterised by induration and inflammation of the fascia of the extremities. It is a nosologically distinct clinical entity typified by swelling, tenderness, and stiffness of the extremities associated with peripheral eosinophilia. Six of our eight patients with eosinophilic fasciitis seen in a 3 1/2 year period have had an associated carpal tunnel syndrome. The presenting complaints in three patients were those of carpal tunnel syndrome and in the other three patients were muscle aching, swelling, and tightness. Diagnosis was made by EMG and deep fascial biopsy. Although small doses of corticosteroid medications were helpful initially in five of the six patients, two patients later required surgical decompression.

Principles of management of acute hand injuries.

The care of the severely injured hand is a complex, technically demanding specialty. The majority of hand injuries, however, can be well cared for in the emergency ward or operating room by physicians without advanced training by following basic principles of diagnosis and treatment. Hopefully, by adherence to these principles, the morbidity of "minor" hand injuries can be minimized.

Bilateral spontaneous concurrent rupture of the patellar tendon without apparent associated systemic disease: a case report.

Patella tendon ruptures are an uncommon injury. Only 5 previous cases of bilateral patellar tendon rupture have been reported. Only 3 of these cases occurred simultaneously. All 5 previously described patients had systemic disease. This paper presents the only reported case of an individual with no known systemic disease who has suffered bilateral spontaneous concurrent patella tendon rupture.