Single-stage distraction correction for neglected dorsal fracture dislocations of the proximal interphalangeal joint: a report of eight cases.

We present the outcome of treatment of eight chronic neglected dorsal fracture dislocations of the proximal interphalangeal joint treated with a single-stage ligamentous distraction using the Penning mini-external fixator and a closed reduction. The distraction correction and 2 to 3 mm over distraction was performed acutely at the time of operation in all eight cases at an average injury-to-surgery time of 6 weeks. Satisfactory results with an average range of motion of 79 degrees were obtained at an average follow-up of 20 months. This technique is simple, effective and offers the advantage of being minimally invasive. We recommend this single-stage distraction correction technique for the treatment of chronic neglected dorsal dislocations of the proximal interphalangeal joint, which are no more than 10 weeks-old.

Aneurysmal bone cyst of the terminal phalanx of the thumb in a child.

We report a case of aneurysmal bone cyst (ABC) of the terminal phalanx of the thumb in a young boy, which was treated successfully with complete curettage with preservation of the growth plate. Three years later he was asymptomatic, with normal growth of the thumb, full range of movement and no evidence of recurrence. For this rare benign cyst in a child's hand, we recommend simple surgery to preserve the growth plate.

Absent superficial abdominal reflexes in children with scoliosis. An early indicator of syringomyelia.

We describe 12 children with idiopathic scoliosis who had a persistent absent superficial abdominal reflex (SAR) on routine neurological examination. MRI showed syringomyelia to be present in ten. The average age at detection of the scoliosis was 4.3 years and at diagnosis of syringomyelia 6.6 years. In all ten children the SAR was consistently absent on the same side as the convexity of the curve. In two it was the only abnormal neurological sign. An absent SAR in patients with scoliosis is an indication for investigation for underlying syringomyelia. In the children with syringomyelia, six had thoracic and four thoracolumbar curves. The clinical features differed in the two groups. Patients with thoracic curves were generally asymptomatic. Their neurological signs were subtle and none had any motor signs. By contrast, patients with thoracolumbar curves had symptoms and neurological signs. Abnormal gait was present in all four patients with thoracolumbar curves. In three this was due to considerable motor weakness. In eight children syringomyelia was associated with a Chiari-I malformation. In seven the syrinx was treated surgically by decompression of the foramen magnum.

Skin closure in hip surgery: subcuticular versus transdermal. A prospective randomized study.

A randomized parallel-group clinical trial was conducted between March 1991 and December 1993 to compare the effectiveness of subcuticular suture using absorbable material (Dexon) and continuous transdermal blanket suture using nonabsorbable material (silk) in hip surgery. Eighty patients (48 females and 32 males) aged between 19 and 94 years (average 71.4 years) who underwent 97 hip operations were studied. Patients were followed up between 2 and 20 months. The two groups were evaluated with respect to infection rate, patient satisfaction with the scar, extra time and cost in removal of suture and the cosmetic appearance assessed by a plastic surgeon evaluating photos of patients' wounds using a specific scoring method without knowledge of the suturing method used. Five patients died during the study. There was no significant difference in superficial infection rate between the two groups (5% with positive bacteriological swab and 16% requiring extra antibiotics on clinical grounds). No deep infection was suspected in either group. The average score of patient satisfaction with the scar was 9.6/10 in the subcuticular group and 8.68/10 in the continuous mattress with a significant difference between the two groups (p < 0.05). Cosmetic evaluation by the plastic surgeon using a 6-category scoring system showed a better cosmetic result in the subcuticular group with a significant difference (p < 0.01). An average of 17 minutes of extra nursing time was needed for removal of suture material in the nonabsorbable group in addition to the cost of the suture removal set. We conclude that absorbable subcuticular skin closure is an effective method and offers some advantages over the traditional transdermal suturing method in hip surgery.

[Primary hydatid cyst in the thigh with pain manifestation at the hip level]. / Kyste hydatique primitif de la cuisse à manifestation douloureuse au niveau de la hanche.

Hydatid cyst has been reported in various unusual anatomical sites. Primary limb and muscular hydatid cyst remains extremely rare. We report a case of hydatid cyst in the thigh presenting with referred hip pain 40 years after leaving an endemic region, and review the literature.