Acute fingertip and nail injuries in the hand.

A correct diagnosis and treatment of fingertip- and nail injuries, commonly seen in the emergency room, is crucial. Insufficient treatment can result in long-term complications, including finger dysfunction and dysaesthesia, nail deformity, infection, or pain. These remaining problems may induce severe impairment of the quality of life of the patient. This review summarises the diagnosis and treatment.

Cystic soft tissue tumours of the dorsal aspect of the wrist have two distinct histological subtypes.

In total, 38 patients with cystic dorsal wrist tumours managed with surgical excision were prospectively followed up for 2 years. Tissue was examined histologically after primary surgery and at recurrence. Two distinct tissue types were found: ganglion cyst and synovial cyst.

[Ganglion cysts on wrists and hands].

The ganglion cyst is the most common soft-tissue tumour of the hand and wrist. 60-70% are found dorsally on the wrist. Ultrasound and MRI-imaging can distinguish whether the tumour is cystic or solid and may be helpful in making a diagnosis. This article reviews the different treatment techniques and rates of recurrence. Arthroscopic excision has shown promising results, but open excision remains the gold standard. The aetiology and pathogenesis of the condition is still unknown and further research is needed especially in reducing the risk of recurrence.

[Ulnar collateral ligament injury to the thumb].

Instability of the ulnar collateral ligament (UCL) is disabling and can occur at any age as an acute or chronic condition. A medical history and objective examination together with the radiological findings are sufficient to make the diagnosis in the majority of cases. Otherwise, an ultrasound or MRI scan should be considered for the acute and chronic injuries, respectively. The partial injuries are treated non-surgically with immobilisation of the metacarpophalangeal joint, while the complete ruptures require surgery, which is summarised in this review. Chronic UCL injuries with symptomatic osteoarthritis are treated with arthrodesis.

[Metacarpalfractures].

Metacarpal fractures are common. Stable, extra-articular fractures can often be treated non-operatively with or without closed reduction, splinting and then mobilisation with buddy taping. Unstable or displaced extra-articular fractures, where adequate reduction cannot be maintained, and most intra-articular fractures require osteosynthesis. The goal for any treatment is early mobilisation. Intra-articular fractures, open fractures and certain paediatric fractures can lead to poor functional outcome; hence, referral to a hand surgeon is recommended in this review.

[Phalangeal fractures of the hand].

Phalangeal fractures are common in all ages. Stable, extra-articular fractures can be treated non-operatively by closed reduction and buddy taping, while surgical fixation should be considered for unstable and displaced extra-articular fractures and most intra-articular fractures. The treatment should aim at early, active mobilisation in order to achieve the optimal functional outcome. Since intra-articular frac-tures, proximal interphalangeal joint fracture dislocations, open fractures and certain paediatric fractures can lead to poor functional outcome, referral to a hand surgeon is recommended.

[Deformities of the finger joints].

Extension of the fingers is a complex act. Boutonnière deformity is defined by flexion at the proximal inter-phalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint due to disruption of the central slip of the extensor tendon. Swan neck deformity is defined by hyperextension at the PIP joint and flexion at the DIP joint, and the pathology is divided into intrinsic, extrinsic, and articular. The deformities are a result of imbalance of the tendons and ligaments in the fingers. Treatment is depending on the underlying cause and includes surgery and non-operative treatment. Functional gain and risk must be realistically assessed.

[Rheumatoid arthritis and hand surgery].

Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery, for which the main goals are pain relief and improved function. Surgical interventions can be divided into prophylactic and therapeutic procedures. The treatment strategy is individual and depends on close collaboration between rheumatologists, hand surgeons and patients.

[Malignant tumours of the hand]. / Håndens maligne tumorer.

Malignant tumours of the hand are rare and are often misdiagnosed. A painful swelling of the hand or digits are often diagnosed with an infection, benign tumours such as ganglion cysts, or arthritis. Wounds that do not heal despite adequate treatment should be biopsied to rule out malignancy. A correct diagnosis without delay is important because the life expectancy, due to a metastasis on the hand or fingers is approximately six months.