Long-Term Results of Surgically Treated Radial Polydactyly - An Outcome Correlation Study.

Background: Thumb polydactyly is one of the commonest congenital hand differences. Traditional surgeon-based outcome scores capture outcomes mainly on bodily structure and function. Outcomes on the long-term well-being of the patients in the domains of activity and participation are not fully studied. Methods: Forty-eight thumbs in forty-five Chinese patients with radial polydactyly underwent surgical treatment at or before 3 years old were recruited. Mean follow-up was 11.6 years. Surgical outcomes were collected and compared to the normal opposite thumb. The results were compiled into the Japanese Society for Surgery of the Hand (JSSH) score, Cheng score and Tada score. Patients' activity involving hands were assessed by both objective tools and patient-reported outcome measure while their health-related quality of life (HRQoL) was assessed by Patient- and Parent-reported Pediatric Quality of Life Inventory (PedsQL). Correlations between outcomes were analysed. Results: Overall, both parents and patients themselves reported good quality of life with mean score of 86.6% and 92.1% respectively in PedsQL. The combined surgical scores ranged from 52% good or excellent results using JSSH score to 100% good result using Cheng score. None of the outcomes on bodily structure and function showed positive correlation with patient's well-being. Negative correlation was noted in total passive range of movement, active movement and Cheng score. All patients reported no activity restriction. Writing test did not show significant slowing. The operated hands had significantly poorer fine motor dexterity than normal. No significant correlation is noted between activity outcomes and PedsQL. Conclusions: Outcomes on bodily structure, function and activity showed little correlation with patients' well-being after thumb polydactyly correction. It should be careful in using or analysing patient/parent-reported outcome measures on HRQoL as outcome assessment of surgical treatment of radial polydactyly.

Interphalangeal dislocation of toes: a retrospective case series and review of the literature.

Although not uncommon, dislocation of the toes, including that of the great toe, is not commonly reported in published studies. In the present report, we describe a series of 18 patients with toe dislocations managed by our department from January 2001 to December 2007. We considered the radiographic pattern of injury in our series of patients. Of the 18 patients, 10 (55.56%) had their toe dislocations treated by closed reduction with or without internal fixation. Seven patients (38.89%) with complex dislocation, defined as open dislocation or dislocation not amenable to (failed attempt) closed reduction, that required open reduction and internal fixation. One patient (5.56%) with a dislocated toe declined to undergo any form of treatment.

Hazmat disaster preparedness in Hong Kong: what are the hazardous materials on Lantau, Lamma, and Hong Kong Islands?

OBJECTIVE: Hazmat disaster preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study describes the identities and quantities of hazardous materials (HMs) in Hong Kong and lists what antidotes are needed for these dangerous goods (DGs). This study describes what HMs are most common in Hong Kong to prioritize disaster preparedness and training. DESIGN: A descriptive, cross-sectional study. SETTING: The Hong Kong Special Administrative Region, specifically Lantau, Lamma, and Hong Kong Islands. SAMPLE: The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). INTERVENTIONS: Descriptive statistical analyses with Stata 9.2. MAIN OUTCOME MEASURES: Identifying and quantifying HMs in the HKFSD DGD. RESULTS: Most HMs do not have antidotes. The most common HMs with recognized antidotes are carbon monoxide, methylene chloride, fluorides, cyanides, nitriles, hydrazine, methanol, and nitrates. The most common categories of DGs are substances giving off inflammable vapors, compressed gases, and corrosive and poisonous substances. CONCLUSIONS: Hazmat disaster preparedness and training should emphasize these most common categories of DGs. Disaster planning should ensure adequate antidotes for HMs with recognized antidotes, ie, oxygen for carbon monoxide and methylene chloride; calcium gluconate and calcium chloride for fluorides; hydroxocobalamin or amyl nitrite, sodium nitrite, and sodium thiosulfate for cyanides and nitriles; pyridoxine for hydrazine; fomepizole or ethanol for methanol; and methylene blue for methemoglobinemia produced by nitrates. Supportive care is essential for patients exposed to HMs because most DGs do not have antidotes.

Plate fixation for crescentic metatarsal osteotomy in the treatment of hallux valgus: an eight-year followup study.

BACKGROUND: Distal soft tissue realignment and crescentic metatarsal osteotomy is a popular procedure in the treatment of hallux valgus. The traditional technique of screw fixation for crescentic osteotomy is technically demanding, and the inferior stability of this construct has been described. We evaluated the long-term results of a modified fixation method. METHODS: Twenty-six patients (32 feet) undergoing this procedure were retrospectively reviewed. Five patients (six feet) were lost to followup. Mean age of the patients was 47 (14 to 74) years. The osteotomy was fixed with a 2.7 mm AO plate. Assessment of clinical and radiographic results was performed at a mean followup of 2.7 (1.3 to 7.2) years and 8.0 (6.1 to 12.0) years, respectively. RESULTS: The mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 57.9 to 90.5 at 2.7 years of mean followup, whereas the patient satisfaction rate was 96%. The intermetatarsal angle (IMA) and hallux valgus angle (HVA) improved from the mean preoperative values of 16.1 degrees and 34.2 degrees to 9.5 degrees and 16.3 degrees. At eight years of mean followup, the mean AOFAS score and patient satisfaction rate remained at 88.5% and 92%. The mean IMA and mean HVA were 9.7 degrees and 17.0 degrees. Complications included one case of hallux varus (4%) and two cases of recurrence (8%). The osteotomy achieved union in all cases. CONCLUSIONS: Dorsal plate fixation of crescentic metatarsal osteotomy is a technically easier procedure. Equally good results can be achieved when compared with screw fixation methods, and the results can be maintained long-term.

Injury by mittens in neonates: a report of an unusual presentation of this easily overlooked problem and literature review.

Injuries caused by mittens applied to infants' hands had been reported since the 1960s. Despite the attention brought forward, reports of injuries continued to appear. We report a case of an unusual presentation of upper limb injuries related to mittens, where the injuries involve the entire hand. The injuries fortunately recovered within 2 weeks without subsequent tissue loss.

Simultaneous rupture of the patellar tendon and the anterior cruciate ligament: a case report and literature review.

We report a case of simultaneous rupture of the patellar tendon and the anterior cruciate ligament. This condition was rarely reported in the literature and clinical diagnosis can be difficult. It is frequently associated with injuries of other knee structures. The preferred treatment is immediate primary repair of the patellar tendon and delayed reconstruction of the anterior cruciate ligament.