"Postpartum/newborn" de Quervain's tenosynovitis of the wrist.

De Quervain's tenosynovitis is a common wrist ailment involving the abductor pollicis longus and extensor pollicis brevis tendons of the first dorsal compartment. Etiology is thought to be overuse or trauma. The specific entity of "postpartum/newborn" de Quervain's tenosynovitis has not been described in the orthopedic literature. Affected individuals in the setting of infant care tend to be younger (33 years) and to have bilateral involvement; they may or may not be the birth mothers. Nonoperative treatment was successful in most (77%) of the postpartum/newborn cases reviewed here; operative treatment was successful in the rest.

The role of the abductor pollicis brevis in opposition.

The abductor pollicis brevis muscle is the most significant of the thenar intrinsics with respect to providing palmar abduction and pronation of the thumb. While limited, even clinically acceptable, function may be exhibited in its absence, the abductor pollicis brevis is required for full opposition (thumb tip to base of small finger).

Late infection of hand implant after a dental procedure: a case report.

A 78-year-old woman with a silicone implant in her first carpometacarpal joint had acute inflammation and lymphangitis beginning 24 hours after a dental root canal procedure. The infection resolved after implant removal and debridement of the residual carpometacarpal space. Although this is a rare event, the use of prophylactic antibiotics to protect implants in the hand should be reviewed.

Conservative open acromioplasty.

Chronic rotator-cuff syndrome with impingement is satisfactorily treated by acromioplasty by both open and arthroscopic techniques, but the Neer operation with deltoid detachment requires a prolonged rehabilitation. Arthroscopic acromioplasty reduces recovery time but is a difficult procedure. McShane, Leinberry and Fenlin (1987) described a conservative open anterior technique with good results and shortened rehabilitation. A similar technique has been used in 25 patients with an average age of 46 years. After a mean follow-up of 24 months, 80% were very satisfied and none was dissatisfied. The average recovery times were 2.7 weeks for activities of daily living, 1.9 months for return to work and 3.7 months for all activities including overhead manual labour.

Bone suture anchors in hand surgery.

The recent development of small bone suture anchors has created potential applications in reconstructive surgery of the hand and wrist. A combined laboratory and clinical study was devised to evaluate their use. 16 paired fingers (32 in all) from eight cadaveric hands were disarticulated at the MP joint with a 10 cm tail of FDP tendon. The FDP insertion was released in all specimens. In 16 fingers reinsertion was performed with the classic Bunnell technique; in the paired 16 fingers, the repair utilized Acufex 2 mm anchors. There was no significant difference between the two groups regarding load-to-failure at approximately 40 Newtons. The mean stiffness of the anchor repairs was significantly greater than the Bunnell repairs. 19 consecutive patients were prospectively enrolled with a tendon or ligament repair of the hand or wrist using bone anchors. The average age was 41 years and the average length of follow-up was 24 months. All repairs were stable at the time of follow-up. Bone anchors were simple to insert, required less dissection and surgical time than the Bunnell technique and appeared to be reliable in both laboratory and clinical settings.

Bone marrow/allograft component therapy. A clinical trial.

Bone graft is required in clinical orthopedic situations that involve a skeletal defect. Whether the defect is the result of trauma or surgery, autogenous iliac bone graft is the gold standard of therapy. The author used autogenous bone marrow/cancellous allograft as a bone graft substitute in 19 consecutive patients with a bony defect (synthetic bone substitutes were not available commercially when the series began). In this prospective study, both clinical and radiographic outcomes were followed. Of the patients, 100% were clinically healed at the site of grafting; 95% achieved radiographic union. No patients had surgical or postoperative complications. A bone marrow/allograft is a viable alternative to an iliac bone graft.

A model for training in elevation of local skin flaps in the hand.

Appropriate skin flap design is crucial for success in surgery of the hand. Practice models are useful in acquiring surgical experience. The author describes a three-dimensional model composed of readily available materials which has been useful for practice in elevation of local skin flaps in the hand.

Endoscopic median nerve decompression: early experience.

Open median nerve decompression is the gold standard for carpal tunnel syndrome; endoscopic median nerve decompression is an alternative. We compared our first 20 consecutive endoscopic releases with our last 20 open releases. The endoscopic procedure employed the two-portal Chow technique; the open procedure employed the Taleisnik technique. Postoperative patient assessment was performed by an independent occupational therapist blinded to the technique. There was no difference between the groups with respect to both subjective and objective outcomes. The time of return to work and to all activities averaged 3 and 6 weeks, respectively, for both groups. The choice between techniques should be based on informed consent by the patient in light of available data.

Congenital adactylia.

Congenital adactylia is rare. Its precise embryogenesis is enigmatic. The adactylic hand assumes a helper function. Surgical reconstruction is an option.

Extensor tenolysis: a modern version of an old approach.

The concept of tenolysis has been in existence for at least 50 years. Its function is to free tendon from posttraumatic scar tissue. To retard the recurrence of rescarring, membrane interposition between tendon and bone has been recommended. In the setting of postfracture extensor tenolysis, I prospectively employed a 3-mm section of passive Hunter rod as an interpositional material in eight consecutive patients. After an average follow-up of 23 months, the patients maintained 92 percent of operatively attained motion; only 56 percent was maintained in six patients without membrane interposition. There was no instance of rod dislocation, rod removal, or adverse silicone reaction. Extensor tenolysis with silicone membrane (Hunter rod) interposition is more predictable and enduring than tenolysis alone.

Total hip replacement in Down's syndrome.

Hip subluxation occurs in 4% to 5% of Down's patients; adulthood coxarthrosis may result. Eight total hip replacements were performed in five Down's patients (ages 37 to 64 years) for painful coxarthrosis. The patients were followed for a mean of 4.3 years. The hip scores improved from an average of fair preoperatively to excellent postoperatively, with a Harris hip score of 92. All of the patients demonstrated clinical improvement and were cared for more easily by virtue of the procedure. There were no major complications. Total hip replacement should be considered a useful surgical option for the treatment of hip osteoarthritis in patients with Down's syndrome.

Posterior hip dislocation, a new technique for reduction.

Acute posterior hip dislocation is a common and serious orthopaedic problem. Key features of a new technique for the closed reduction of both posttraumatic and artificial posteriorly dislocated hips include the lateral decubitus position, exaggeration of the deformity (hip flexion 100 degrees, internal rotation to 45 degrees, adduction to 45 degrees), palpation of the dislocated femoral head and greater trochanter and gravity-assisted reduction, utilizing a simultaneous push-pull maneuver. The technique has been successfully employed in 18 awake but sedated patients, requiring the help of only one assistant. It has proven to be simple, effective, and complication free.

Total hip replacement in the neuromuscularly impaired.

UNLABELLED: Controversy exists over the appropriate use of total hip arthroplasty in patients with significant neuromuscular disease. This study investigated the use of THR in neuromuscular disease patients. A criterion for patient inclusion was a diagnosis of mental retardation, cerebral palsy or Down's syndrome. The study population consisted of nine patients (12 hips), average age, 42 years. Average follow-up was 3.5 years. RESULTS: (1) 100% of patients demonstrated decreased pain, expanded range of motion and improved overall function. (2) All institutionalized patients were cared for more easily. (3) There were no infections, dislocations or major complications. CONCLUSION: Total hip arthroplasty is a reasonable and safe therapeutic option for the treatment of painful osteoarthritis of the hip in select patients with neuromuscular disease.