Madelung's deformity: quantitative radiographic comparison with normal wrists.

Four measurements, ulnar tilt, lunate subsidence, lunate fossa angle and palmar carpal displacement, on wrist radiographs of 26 patients with Madelung's deformity and 48 normal subjects were compared. The range of measurements on wrists with Madelung's deformity was wider than on normal wrists, with severe deformities having very abnormal values. Some Madelung's patients had values that were within the normal range for each of the four measurements. Measurement of the lunate fossa angle demonstrated the least overlap between normal wrists and wrists of patients with Madelung's deformity with only two in the normal range. A lunate fossa angle over 29 degrees may help identify early Madelung's deformity.

The treatment of felons and paronychias.

Infections of the distal finger have a varied presentation, course, and treatment. As in other hand infections, initial treatment should always include elevation of the extremity and the avoidance of snug clothing or constricting jewelry. Immunosuppressive states and systemic diseases such as diabetes must be considered, for they will alter the action of the causative organisms as well as the intensity of treatment that a patient will require. Appropriate, specific antibiotic treatment can be part of the initial treatment of acute felons and paronychias, but it should never replace adequate incision and drainage. Finally, "minor" finger infections are only minor when diagnosed and treated properly. If mistreated, their consequences can have long-term implications for both the individual and for society. It is important to understand the natural history, bacteriology, and anatomy of the distal finger if we are to return patients to their jobs with expedience and minimal long-term sequelae.

Management of sea urchin spines in the hand.

The left palm of a 43-year-old woman was penetrated by sea urchin spines. Localization of the spines by soft tissue technique x-ray films proved to be the key to their easy removal. A review of the literature shows this to be an uncommon problem and that spine removal may be important to avoid long-term sequelae of pain and loss of function.

Pseudotendon formation after flexor tendon injury.

The biologic reconstitution of a divided flexor tendon by scar tissue forming a "pseudotendon" is described in three cases. With close inspection, one is able to differentiate a pseudotendon from a normal tendon intraoperatively by its relatively light gray color and the lack of a glistening surface. A pseudotendon lacks the tensile strength of a normal tendon and should be replaced by tendon grafting or transfer if function is to be restored.

Tumorous lesions of the hand.

A retrospective study was conducted of 543 tumorous lesions of the hand seen in a busy office practice for a 5-year period from April 1976 to April 1981. The lesions were grouped as benign lesions, of either the soft tissue or skeletal type, or as malignant lesions. The overall chance that a hand tumor was malignant was 2% (11 of 543). There was significant association of palmar radial ganglion and carpal tunnel syndrome (15%). Ganglions recur more often after aspiration than after surgery. Certain lesions, particularly a mucous cyst, have a high postoperative complication rate. A few of these unique lesions are described.

Treatment of painful hand neuromas by their transfer into bone.

Painful neuromas in the hand are not only very disabling for the patient, but difficult to treat. We present the results of 20 painful neuromas treated by burying the neuroma in the bone. Eighteen of the 20 neuromas operated on had acceptable results, according to the criteria of Herndon et al. We present our technique and compare our results with other treatments in the literature.

Diagnosis and treatment of retained foreign bodies in the hand.

A retrospective review was conducted of 200 consecutive patients with foreign bodies in the hand seen between 1976 and 1982. Wood, glass, and metal accounted for 95 percent of the foreign bodies seen. The duration of follow-up ranged from 1 week to 3 years (average 6 weeks). Approximately 70 percent of the foreign bodies could be removed in either the office or the emergency room. The foreign bodies were removed anywhere from the day of injury to 20 years later. In 38 percent of the patients the diagnosis was missed by the initial treating physician, in many cases because a roentgenography of the injured area was not taken. Metal was visible in all of the radiographic studies obtained, glass in 96 percent, and wood in just 15 percent.

Rupture of digital extensor tendons following distal ulnar resection.

We have treated four patients with rupture of one or more digital extensor tendons following a distal ulnar resection for a traumatic problem. The rupture was caused by the abrasive effect of the distal part of the ulna at the site of resection during pronation and supination. Two patients were treated with a silicone-rubber prosthesis ad tendon grafts and two, with resection of an ulnar bone spike and local tendon transfers. Tendon rupture is best avoided by strict adherence to the surgical technique described by Darrach. If rupture of the tendon occurs, reconstructive procedures must be devised to repair the individual lesion found at operation.

Peripartum pseudomalignant myositis ossificans of the finger.

Two cases of pseudomalignant peripartum myositis ossificans of the finger are reported. The benign diagnosis is confirmed by the histologically characteristic zone phenomenon, consisting of a transition from an inner zone of proliferating spindle cells to a middle zone of well-oriented osteoid and finally to an outer zone of mature bone. In Case No. 1, because of the question of malignancy, a ray amputation was performed. In Case No. 2, the patient was observed during the peripartum period to show diminution in the size of the tumor. The lesion was eventually treated by local excision.

"Seal finger".

Two young women developed septic arthritis in an interphalangeal joint following a seal bite. One patient was cured with tetracycline: the other required joint arthrodesis. This entity known as "seal finger" is common among sealers. Although the infection may be cured with tetracycline, in late treated or untreated cases joint destruction may occur. No causative organism has been isolated.

Common injuries of the fingernail and nail bed.

The most common injury to the dorsal distal finger is a subungual hematoma. Relief of pain is promptly achieved by draining the hematoma. If a heated paper clip is used, however, the underlying fluid may be seared and the hole plugged. Local anesthetic block followed by puncture with an 18-guage needle is advocated. When nail avulsion occurs, the free-floating proximal portion should be removed so that it will not serve as an irritant or hide any underlying pathology.