Scapholunate ligament disruption in a skeletally immature patient: a case report.

Scapholunate ligament tears are rare in skeletally immature people because the force of impact is absorbed by the cartilaginous carpus. We present a case of a boy who ruptured this ligament after a fall.

Metastatic renal carcinoma in the hand: treatment with preoperative irradiation and ray resection.

Isolated metastatic renal-cell carcinoma of the hand is a rare disorder that requires aggressive management for pain relief, improvement of hand function, and prevention of further spread of disease. An unusual presentation of isolated, advanced metastatic renal-cell carcinoma in the left third metacarpal of the nondominant hand is presented. Localized preoperative radiation therapy was used prior to ray resection to decrease tumor bulk and vascularity. The patient is alive and disease free at 1 year postoperatively with a functional but impaired hand.

Superficialis finger reconstruction: a new look at a last-resort procedure.

The anatomic two-tendon, three-joint finger cannot always be restored to normal after a severe flexor tendon injury. An effective alternative to consider is reconstruction of superficialis finger function or one-tendon to two-joint function. This principle has been applied to two-stage flexor tendon reconstruction in severe salvage situations to provide a good working arc of digital flexion. The surgical procedure, postoperative considerations, and biomechanical principles are discussed.

Wrist arthrodesis for treatment of rheumatoid arthritis.

Eighty-seven wrist fusions using the technique of Millender and Nalebuff were reviewed in 79 patients with rheumatoid arthritis. Follow-up averaged 6 years and 97% of all patients had an excellent or good result. Pain was absent or mild in all patients after operation, and 95% of this patient population had improved hand function after wrist fusion. Wrist position averaged neutral in the lateral plane and 6 degrees ulnar deviation. Time to clinical fusion averaged 10.8 weeks. Complications were present in 23% of all cases, with half of these a result of symptomatic hardware. Carpal tunnel syndrome was seen after operation in five patients, all of whom had significant palmar carpal dislocation before surgery. A neutral position of the wrist with slight ulnar deviation is very functional and cosmetically acceptable for the patient with rheumatoid arthritis, even in bilateral fusions. Wrist arthrodesis for the patient with rheumatoid arthritis is a dependable procedure with a high degree of success and patient satisfaction.

Connective tissue nevus and osteopoikilosis in the hand: the Buschke-Ollendorff syndrome.

The Buschke-Ollendorff syndrome is a rare disorder of uncertain etiology characterized by osteopoikilosis and connective tissue nevi. An unusual presentation of this syndrome is described that involves both the cutaneous and skeletal manifestations affecting the hand. The bones of the hand and carpus are a common site for osteopoikilosis. Connective tissue nevi of the hand may require excision for diagnosis or mechanical impingement. Special elastin stains must be done on these cutaneous lesions to confirm the diagnosis. Routine hematoxylin-eosin stains may fail to show any pathologic change in mild cases.