A comparison of patients with different types of syndactyly.

We performed a retrospective review of finger syndactyly releases at Shriners Hospital for Children, Houston Unit, between January 1983 and January 1993. This study was performed in an attempt to compare the long-term postoperative function in patients after release of syndactyly resulting from Poland's syndrome with that in patients with idiopathic forms of syndactyly. Only patients with one involved hand were included in this study. The contralateral hand was used as a control. Twenty-seven patients with only one hand involved underwent syndactyly release during this period. Of these, 13 patients who underwent a total of 30 syndactyly releases were available for evaluation. For each patient, the type of syndactyly was determined. Each patient was subjected to a detailed physical examination and participated in occupational-therapy modalities. We noted statistically significant differences in function between operated-on and control hands in the Poland's group, whereas operated-on hands affected with idiopathic forms of syndactyly did not demonstrate significantly different function compared with contralateral controls. These data suggest that functional deficits in hands affected by Poland's syndrome are attributable to more than the syndactyly alone. Hands affected by idiopathic forms of syndactyly are likely to have little postoperative functional deficit.

Silicone implant arthroplasty of the great toe. A review of single stem and flexible hinge implants.

One hundred sixty-five feet were reconstructed with the single stem silicone implant, including patients with hallux regidus, hallux valgus due to degenerative and osteoarthritic joint changes, hallux valgus secondary to rheumatoid arthritis and patients with previous unsuccessful "bunion" procedures. Preoperative pain and intolerance to shoe wear were relieved in the great majority of patients. The amount of correction of the hallux valgus angle was directly related to the preoperative deformity. Infection occurred in 2 patients, and inflammatory reaction to the implant occurred in one patient. One hundred five feet were reconstructed with a flexible hinge implant; 94 of the feet had joints destroyed by rheumatoid arthritis. Dramatic improvement in the hallux valgus angle resulted in these feet which had relatively severe preoperative deformities. No implant fractures were recorded. The present survey of our cases, and experiences reported by others, encourage the use of these implants by surgeons who follow the suggested indications, surgical technique, and follow up care.

The prevention and treatment of amputation neuromata by silicone capping.

A technique of silicone capping of amputated sciatic or tibial nerves was evaluated in a single litter of ten New Zealand white rabbits (eight experimental, two control). All nerves and caps were evaluated 12 and 4 weeks after operation. Neuroma formation was prevented when a lengh:diameter ratio of 5:1 (minimum) to 10:1 (maximum) of the cap was observed and a smooth, filmy, nonreactive capsule around all nerve ends and caps was noted. Eighteen patients with 38 traumatic neuromata in the upper extremity were treated by silicone capping and were evaluated an average of 41 months after operation. Of these 18 patients, 17 underwent revision surgery for the specific purpose of relieving disabling neuroma pain. Two patients developed a causalgic state. One patient had recurrence of symptoms in one of four nerves capped and was relieved by reoperation and recapping. The remaining 15 patients were relieved of their preoperative complaints.