The death of the Byzantine Emperor John II Komnenos (1087-1143).

INTRODUCTION: The purpose of this study is to give a brief account of the life of John II Komnenos, his reign and to clarify the events and causes surrounding his death. METHODS: A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in history books through the internet and in History and Medical University libraries. RESULTS: The death of the king cannot be attributed to poisoning from an injured hand by arrow poison. The long period of time before the presentation of symptoms should be attributed to their being caused by an infection. The failure of both conservative anti-inflammatory treatment and surgical drainage point towards an anaerobic infection or a septic inflammation. CONCLUSION: The death of the emperor John Komnenos was caused by a severe infection of the hand of unknown agent leading to septicaemia. This conclusion is based on the fact that death came a week or more after the injury of the hand and it was not caused by the poison of the arrow which would have been fatal within several hours.

Recuerdo histórico de la evolución de la cirugía de la mano dentro de la Cirugía Plástica y Reparadora / No disponible

No disponible

More with less: A comparative kinematical analysis of Django Reinhardt's adaptations to hand injury.

BACKGROUND: At the age of 18 years, jazz guitarist Django Reinhardt (1910-1953) sustained significant burns to his left-hand ring and little fingers; yet, subsequently, he relearned to play and achieved international fame, despite his injuries. CASE DESCRIPTION AND METHODS: Archive film footage and novel motion analysis software were used to compare movements of Django's fretting hand with that of six other guitarists of the same genre. FINDINGS AND OUTCOMES: Django employed greater abduction of index and middle fingers (-9.11 ± 6.52° vs -5.78 ± 2.41°; p < 0.001) and more parallel alignment of fingers to the guitar neck (157.7 ± 3.37° vs 150.59 ± 2.67°; p < 0.001) compared to controls. CONCLUSION: In response to debilitating hand injury, Django developed quantifiable compensatory adaptation of function of his remaining functional fingers by developing an original playing technique. CLINICAL RELEVANCE: Hand function following injury may be optimized by maximizing latent degrees of freedom in remaining digits, rather than through extensive surgical reconstruction or complex prostheses. Further study of adaptation strategies may inform prosthesis design.

A surgeon's historical perspective: Dr. Leonard Furlow on the early years of human composite flexor tendon allografts.

"I think that probably convenience is what did in the flexor mechanism allograft," Dr. Leonard Furlow explained in response to why tendon allografts in the 1960s were overshadowed by the Hunter rod, which is still routinely used for flexor tendon reconstruction today. At 83 years old, Dr. Furlow had graciously made the trip from his home in Gainesville, FL up to Charlottesville, VA for a special interview with the Department of Plastic Surgery at the University of Virginia. Furlow is perhaps better known for developing the double-opposing Z-plasty for cleft palate repair, but his interest in hand surgery led to a year in Chapel Hill, NC where he trained with the creator of the flexor mechanism allograft, Dr. Erle E. Peacock, Jr. Through innovative experimental work on flexor tendon reconstruction, Peacock had pioneered the use of fresh composite tendon allografts, which transplant the unscarred synovial space between the tendon and its sheath such that scar formation only occurs outside the sheath. Inspired by our recent research interest in this subject, we asked Dr. Furlow to reflect on his experience with the tendon allograft in the 1960s with the late Dr. Peacock. The picture he painted was of a simple, elegant, and astonishingly successful solution for flexor tendon reconstruction that suffered from a lack of practicality at the time.

The French initiated FESUM - historical development, experience and perspectives.

FESUM is an association dedicated to management, research and education of hand trauma. Created by surgeons in 1979, it is now accepted by the national and regional health administrations. The first goal of FESUM is to apply strict guidelines for specialized hand trauma centers. These guidelines are verified on site by 2 FESUM surgeons, and re-checked every 3 years. Patients are selected to be directed to the FESUM cen-ters following very simple recommendations: every severe trauma must be addressed to and accepted by FESUM centers, 24/7. Seemingly less severe lesions such as deep palmar lacerations must also be systematically explored in FESUM centers to ensure patients have the best opportunity for treatment. Prevention is also a very important part of FESUM activities. The FESUM prevention campaigns are currently focused more specifically on daily life trauma, that represents 2/3 of the total injuries and is very poorly managed by authorities.

Microsurgical management of acute traumatic injuries of the hand and fingers.

Traumatic injuries of the hand and fingers may be devastating and can result in irreversible functional and psychological problems in individuals who sustain them. They occur in all age groups, ranging from the elderly to young children. The management of these injuries can be challenging and onerous. As a result, it is imperative that the surgeon be both knowledgeable and meticulous in order to afford the best possible outcomes. This review focuses on the anatomy, initial evaluation, and acute management of these injuries. A variety of treatment algorithms are discussed as well, including primary closure, grafting, commonly utilized flaps, and replantation.

The Italian CUMI.

The purpose of this review is to evaluate the historical development, growth and evolution in the past decade of the Italian network for emergencies of the hand. The complete story from its roots to model of efficiency that required so many efforts and fatigue to be created and tuned up.

Otto Hilgenfeldt (1900-1983): tribute to an important pioneer of European hand surgery.

The German surgeon Otto Hilgenfeldt (1900-1983) was a great innovator in European hand surgery in the 20th century, particularly in respect of the tactile (sensate) thumb and grip reconstruction in amputation injuries. His experience, beginning in the 1930s, helped him to treat hundreds of soldiers with mutilating hand injuries from 1941 to 1945 during World War II. While totally isolated and without any access to international publications, he devised many innovative ideas such as a neurovascular middle finger transposition for pollicization (first case done in July 1943) and a sensory dorsoradial first metacarpal flap for thumb resurfacing. His book Operative thumb replacement and substitution of finger losses published in 1950 is regarded as one of the most important German contributions to modern hand surgery. Hilgenfeldt's life and work remain fascinating and exemplary from a historical and surgical point of view. Many of his pragmatic surgical solutions remain valid despite the advent of microsurgery.

[Rendering surgical care for the wounded presenting with injuries to limb vessels].

The proffered paper provides the information about rendering surgical care for the wounded presenting with vascular injuries inflicted and sustained during wars Russia was engaged in, to be followed by a detailed description of the haemorrhage-arresting methods and techniques used in N. I. Pirogov's time, during World War I, the Great Patriotic War, as well as in local military conflicts and combat operations. Also depicted herein is the role surgeons of Russia have played in the development of vascular surgery, and, finally, due coverage is given to the statistical data concerning the methods of rendering care for those having suffered firearm wounds and injuries involving vascular lesions.

The history of fracture fixation of the hand and wrist.

UNLABELLED: The treatment of fractures of the hand and wrist has evolved over the centuries from one of rest and immobilization to internal fixation and early motion. Although today's technology (anesthesia, antibiotics, metal implants) has allowed us more freedom in treating these injuries, a number of our patients continue to experience stiffness, nonunion, malunion, and chronic pain. We explore the techniques used to treat hand and wrist fractures throughout the centuries and determine what beneficial aspects of fracture care have been maintained and those that have changed as a result of new technology. We are now realizing that rigid immobilization of fractures at the expense of the soft tissues can be just as damaging as the ancient physician's techniques of prolonged immobilization with frequent dressing changes. New implants and lighter cast materials have allowed improved digital motion and early functional use of the extremity. This has become especially important in the treatment of the aging population, which demands improved function and a quicker return to activities. The optimal treatment of these fractures for each patient remains elusive, however, and there remains a tendency to rely on technology at the expense of sound clinical care. We must not loose sight of the goals of fracture treatment and should heed the lessons learned throughout centuries of treating these injuries. LEVEL OF EVIDENCE: Level V (expert opinion).

History of flexor tendon repair.

The first issue of Hand Clinics published 20 years ago was devoted to flexor tendon injuries. This was most appropriate, because no subject in hand surgery has sparked more interest or discussion. That inaugural issue included excellent presentations on the basic science of tendon injuries (anatomy, biomechanics, nutrition, healing, adhesions) and the clinical practice of tendon repair. Of interest, there was no presentation on the fascinating history of flexor tendon surgery. It is most appropriate, therefore, that this current update of the flexor tendon begins with a historical review of the evolution of flexor tendon repair.