Use of an internal fixator device to treat comminuted fractures of the distal radius: report of a technique.

An internal fixator technique for stabilizing comminuted Colles fractures has been developed in the anatomy laboratory and used in 35 clinical cases. The Colles Fracture Plate (Biomet, Inc, Warsaw, Indiana) can be used to treat any comminuted Colles fracture for which an external fixator is considered proper management. We have determined, based on our surgical experience with both the internal and external fixator techniques, that internal fixation using the Colles Fracture Plate is technically just as simple as external fixation. In addition to requiring a significantly less expensive device, internal fixation using this technique offers the advantages of better patient acceptance and fewer complications. This report will be followed by a more comprehensive analysis of the technical outcome of this procedure to further substantiate the initial results presented here. The process of compiling and analyzing these data is under way.

Fibrous dysplasia of a metacarpal: a case report.

Monostotic fibrous dysplasia limited to the hand has not been described previously. We report a case of fibrous dysplasia of a thumb metacarpal in a black man.

Foreign bodies in the hand in children.

Foreign bodies in the hand in children are best managed when the surgeon has a well-organized approach to the total problem. The procedure of restraining a child, infiltrating the wound with local anesthetic, and probing the wound deep in the hand on the day of injury to remove the foreign body is discouraged. A detailed examination of the hand for cut tendons and nerves should be done. The initial treatment should be thorough cleaning of the skin, application of compresses wet with Bunnell's hand solution, systemic antibiotics, and tetanus prophylaxis. The foreign body is removed, as an elective surgical procedure, only if there is evidence of infection or persistent pain or both. Six weeks after all evidence of infection has cleared appropriate reconstructive procedures can be done.

A simplified technique for treating the complex dislocation of the index metacarpophalangeal joint.

The volar approach to open reduction of the complex dislocation of the index metacarpophalangeal joint as described by Kaplan proved to have certain disadvantages. Digital nerves are easily damaged during exposure and there is a limited view of the entrapped fibrocartilaginous volar plate dorsal to the metarcarpal head. A direct dorsal longitudinal incision through the skin and extensor tendon gives full exposure. The volar plate attached to the proximal phalanx and trapped over the dorsal aspect of the metacarpal head is in full view. The volar plate is split longitudinally and the dislocation reduces spontaneously as the flexor tendons and lumbrical muscle slip by the metacarpal head. The advantages of this approach as compared with the volar approach are: (1) there is full exposure of the fibrocartilaginous volar plate, the main structure blocking reduction; (2) digital nerves are not as apt to be damaged; and (3) accurate reduction and fixation of the osteochondral fracture of the metacarpal head, frequently seen with this dislocation, is possible.