Abstract: We feel the original description of Kaplan’s cardinal line provides a more accurate reference point to the superficial palmar arterial arch. We sought to anatomically correlate the relationship of Kaplan’s cardinal line to the superficial palmar arch. Sixty hands (30 cadavers) were dissected after Kaplan’s original description was drawn on each hand. Measurements we made from K…
Abstract : Transection of the transverse carpal ligament (TCL) for carpal tunnel syndrome is commonly performed, yet actual knowledge of TCL morphology is rudimentary and the anatomical terminology is inconsistently used. The purpose of this study was to perform a morphological analysis of the TCL, to redefine the anatomical terminology concerning the TCL and surrounding structures, and to eva…
Abstract: Although carpal tunnel release is one of the most commonly performed procedures in the USA, the morphology of the carpal tunnel as determined previously in the literature has been questioned. Previous methodology has been questioned for accuracy by recent studies. The purpose of this study was to perform a morphological analysis of the carpal tunnel and correlate carpal tunnel and ha…
Abstract: Zone III flexor tendon injuries are relatively rare in comparison to other flexor tendon injuries in zones I, II, IV, and V. Often, these are open injuries resulting from an electrical device like a saw; however, closed injures are even rarer, and those mid-substance ruptures resulting from bowling with no evidence of underlying tendinopathy from diseases like gout are highly unusua…
Abstract: Anatomic variation of the trapeziometacarpal joint stabilizing structures is one of the concepts proposed to explain the pathogenesis of trapeziometacarpal arthritis. We undertook this study to test the hypothesis that septation of the first extensor compartment or variation of the abductor pollicis longus (APL) tendon (supernumerary insertions) are more frequently associated with t…
Abstract: This is a case report of a 61-year-old cardiac transplant patient who developed a disseminated infection involving the upper extremity with a rare fungus known as Aspergillus ustus. The patient was successfully treated with aggressive serial debridements, antifungal medications, and reduction of immunosuppression. With these interventions, the patient avoided amputation despite the a…
Abstract: Compartment syndrome is a condition with multiple reported etiologies, and permanent disability may ensue if not treated in a timely fashion. We report the first case, to our knowledge, of acute forearm compartment syndrome caused by intravenous autologous blood reinfusion. The patient underwent forearm fasciotomy, and hematoma was encountered deep to the superficial volar fascia, pr…
Introduction: Subungual exostosis (SE) is a solitary, commonly sessile, bony growth firmly attached to the tuft of the underlying distal phalanx. It is a benign osteocartilaginous tumor arising underneath or beside the nail bed and may disrupt nail growth. Initially described in the hand by Hutchinson in 1857 [8], Dupuytren wrote about his experience with its manifestation in the foot a decad…
Abstract: The Wide-Awake Approach to Dupuytren's contracture involves fasciectomy under local anesthetic with epinephrine and no tourniquet. The goal of this study is to show that the Wide-Awake Approach produces equivalent outcomes to fasciectomy under general anesthetic with a tourniquet, with fewer risks to the patient. A multicenter retrospective review was conducted on 111 patients with f…
Abstract: The superficial palmar arch (SPA) and its contributing arteries are highly variable. The palmar type of median artery (PMA) can be involved in the formation of the SPA by replacing the superficial palmar branch of the radial artery (RA) or the ulnar artery (UA). The present study was undertaken to investigate the presence of the PMA and its contribution in the formation of SPA in 42…
Abstract: The term “plexic hand” refers to hand and wrist involvement in traumatic brachial plexus injuries and to remaining deficits after nerve surgery has been performed. From January 2000 to March 2008, reconstructive surgery (dynamic tenodesis) was performed on seven patients with C5, 6, 7, and 8 nerve root lesions of the brachial plexus to restore wrist and finger extension. This pro…
Abstract : We are reporting on a case of an index radial collateral ligament tear repaired with a titanium Mitek bone suture anchor. The development of cystic radiographic changes and increased pain and weakness led to suture anchor removal at 10 months post-repair. Periprosthetic osteolysis due to titanium-induced osteoclastogenesis and micromotion was suspected to be the cause. This case rep…
Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause for patients to present to a physician’s office or emergency department. We observed increasing numbers of community-acquired MRSA infections in patients admitted to the hand surgery service at our suburban academic center. It is an important issue as unsuspected community-acquired MRSA hand infections can be ad…
Abstract: In the United States, the Emergency Medical Treatment and Active Labor Act (EMTALA) effectively requires Level I trauma centers to accept hand trauma transfers for higher level of care if capacity exists. However, patient transfer for non-medical reasons, such as ability to pay, is still perceived as a common practice. We hypothesized that EMTALA would cause selective transfer of han…
Abstract: Because of the thin skin envelope of the hand, especially at the dorsum, flaps are frequently required for defect reconstruction in the hand. The pedicled radial forearm flap is a time proven procedure that offers reliable coverage in this area without the need of advanced microsurgical expertise. Despite several alternatives and an increasing acceptance of free tissue transfers, the…
Abstract: Ischemia–reperfusion (I/R) injury is, in part, related to the burst of reactive oxygen species (ROS) generated after reperfusion. Vitamin E has been shown to exert its biological effects as an antioxidant, inhibiting the ROS. In this report, the effect of Vitamin E succinate (VES) on ischemia/reperfusion injury and NF-κB expression was studied in a rat skeletal muscle model during…
Abstract: Dupuytren’s disease (DD) is a familial, fibroproliferative, irreversible, and progressive disease of the palmar fascia, yet with unknown etiology. However, there is compelling evidence which has consistently suggested a genetic ethiopathogenesis given the high occurrence among the Northern European extraction, familial nature, and demonstration of concordance in twins. DD is an inc…
Abstract: Purpose To test the hypothesis that an important step in a causative mechanism for carpal tunnel syndrome (CTS) is sleeping in a lateral position (sleeping on the side), we designed a cross-sectional survey to measure the association between sleep position, age, gender, and body mass index (BMI). Methods and Findings We surveyed 247 patients in a primary care setting. Fifty percent o…
Abstract: The purpose of the study was to investigate patients with proximal interphalangeal (PIP) joint replacements regarding postoperative function, pain, complications and incidence of reoperations. From 2000 to 2007, 23 patients (11 male, 12 female) with an average age of 47 years (19–72 years) who had symptomatic posttraumatic (15) or idiopathic arthritis (nine) in 24 PIP joints underw…
Abstract: Purpose To report the surgical treatment outcome of pediatric locked trigger thumb by sequential release of the annular pulley and partial release of the oblique pulley. Materials and Methods A retrospective review was undertaken on 28 operative thumbs in 24 patients with an average follow-up of 79 months. Intraoperative observations focused on the pathology of the pulley system. Sur…
Abstract: The purpose of this study was to investigate the cutaneous nerves at risk during the posterior midline approach to the elbow and proximal ulna. Ten fresh frozen cadaver upper extremities were used for this study. A posterior midline skin incision extending from 10 cm proximal to 15 cm distal to the olecranon tip was created. All superficial nerves were identified and preserved. Nerve…
Abstract: Negative pressure wound therapy (NPWT) is commonly used as a bolster for skin grafts. The technique offers the benefit of negative pressure as well as reduced dressing changes. Skin grafting of the hand provides a unique challenge, and currently, the only commercially available NPWT hand dressings are adult-sized, precluding their use in small children. We present our custom NPWT “…
Abstract: We describe a patient who presented with dystonia of her small finger secondary to entrapment neuropathy of the ulnar nerve at the elbow. Pre operative electrophysiological studies suggested that the locus of entrapment was located proximal to the medial epicondyle. This was confirmed intraoperatively by the presence of a thickened and prominent arcade of Struthers. Surgical decompre…
Abstract: Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna sho…
Abstract: In a landmark paper published in 1973, the eminent hand surgeon J. William Littler, MD, proposed two mathematical relationships between the anatomic and functional geometry of the hand. His proposal that the motion of the tips of the fingers follow an equiangular spiral has been experimentally supported. Studies have not supported his other idea that the lengths of the phalanges foll…
Abstract: The purpose of this study was to determine if letting down the tourniquet prior to closure after carpal tunnel release decreases the amount of post-operative ecchymosis and subsequent post-operative pain. We prospectively studied 18 consecutive patients who were undergoing bilateral open carpal tunnel releases. The side done first was randomized and the tourniquet was released to obt…
Abstract: A case of chronic exertional compartment syndromeof the forearm treated with endoscopic-assistedfascial decompression is presented. The diagnosis of exertionalcompartment syndrome of the forearm was confirmed by direct measurement of intracompartmental pressures.Following endoscopic-assisted fascial decompression, the patient was able to begin rehabilitation therapy within 2 weeks. T…
Abstract Diaphyseal radius fractures without associated ulna fracture or radioulnar dislocation (isolated fracture of the radius) are recognized in adults but are rarely described in skeletally immature patients. A search of our database (1974–2002) identified 17 pediatric patients that had an isolated fracture of the radius. Among the 13 patients with at least 1 year follow-up, ten wer…
Abstract: The purpose of this case series is to identify and illustrate the phenomenon of scaphoid remodeling in skeletally mature subjects following bone grafting for scaphoid nonunion. Nine patients with scaphoid nonunions were treated with interpositional bone grafting (with iliac crest bone graft) and K-wire fixation. The mean length of follow-up was 28.6±9 months. Radiographs and CT scan…
Abstract: The need for soft tissue coverage of large defects in the hand and the wrist following trauma is a common problem for hand surgeons. Flap coverage of these defects can be either in the form of distant or regional flaps. The posterior interosseous artery flap recently has emerged as a front runner in these situations by its virtue to preserve both the major arteries to the hand. Thirt…
Abstract : Osteoid osteoma is a rare occurrence in the hand, and only a small percentage affects the thumb and distal phalanges. An 18-year-old right hand-dominant man presented to our office with an approximately 1-year history of left thumb pain without any history of trauma. He had seen several doctors previously and undergone multiple diagnostic tests with no definitive diagnosis. Plain ra…
Abstract: Soft tissue fixation of ligaments and tendons in the hand can be achieved by the use of metal or bioabsorbable suture anchors. Advantages of bioabsorbable suture anchors include lack of interference in magnetic resonance imaging, resorption of anchor, replacement by bone, and no need for hardware removal. However, complications of these bioabsorbable implants include inflammatory res…
Abstract: Current military conflicts in Iraq and Afghanistan have produced a significant number of complex injury patterns. Multiple extremity trauma and wide zones of injury andate a flexible approach to these problems. We report our experience with periarticular elbow injuries with large soft tissue defects. Acute vascular reconstruction and multiple wound debridements throughout the evacuat…
We report a case of a 27-year-old man who presented with a progressive painful swelling at the base of his left index finger, with radiographs and a computed tomography scan revealing a lytic lesion of the proximal phalanx. Following further investigation, the patient underwent a bone biopsy that revealed a florid noncaseating granulomatous chronic inflammatory infiltrate, compatible with sarco…
Abstract : Hand surgeons rely on referrals from general providers. Appropriate referral is dependent upon referring physicians having an understanding of the problem and available treatments. This study evaluates the referring physicians’ knowledge and perceptions of basic hand problems and their treatment. This study also evaluates the impact of a brief lecture on our referring physicians�…
Abstract : Cubital tunnel syndrome is the second most common nerve entrapment in the upper extremity. There are no current publications concerning the recurrence rates after endoscopic cubital tunnel release. The purpose of this study is to evaluate the recurrence rate of endoscopic cubital tunnel release compared to published reports of recurrence following open cubital tunnel procedures. We…
Abstract: Dislocation of the either the trapezium or the trapezoid are both rare injuries, even among carpal dislocations. We report a case of combined volar trapezium dislocation and dorsal trapezoid dislocation with other concomitant injuries. A review of the literature regarding trapezium and trapezoid dislocations as well as the treatment of these injuries is presented.
Abstract : Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare cartilaginous neoplasm that often presents in the long bones of the hands and feet. BPOP is a benign but locally aggressive fibro-osseous mass that has striking clinical, radiographic, and histologic similarities with osteochondroma. Differentiating between the two lesions is important as BPOP often requires more ex…
Abstract: Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of sev…
Abstract: Carpal dislocations commonly occur as the result of high-energy axial loading of the forearm with the wrist extended. There exists several variants of carpal dislocations with the most commonly observed being those about the lunate. Perilunate dislocations and fracture dislocations were first characterized by Mayfield in 1980 and represent a spectrum of traumatic carpal dislocation b…
Abstract Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) wit…
Abstract: Background The purpose of this study was to determine current practice patterns and examine the influence of recent evidence in the surgical treatment of advanced thumb carpometacarpal (CMC) osteoarthrosis. Methods A survey was sent to 2,536 American Society for Surgery of the Hand members. Information regarding specialty training, years of experience, annual cases performed, treatme…
Abstract : The objective of this study is to demonstrate the utility of the scratch collapse test (SCT) in localizing the point of maximal compression in cubital tunnel syndrome. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Cubital tunnel syndrome was diagnosed based upon symptoms of numbness, tingling, and/or pain…
Abstract: A latissimus dorsi muscle flap was used to simultaneously resurface the dorsal index, middle, and ring fingers of a 10-year-old child who had sustained a severe abrasion burn from a go-kart injury. Rather than performing multiple individual flaps, or a single flap in which a secondary division procedure would have been needed, the flap was divided into three vascular territories, pe…
Abstract : Burns to the hand are common in burn victims. These burns often leave complex wounds that require local flaps for coverage. Local flaps are often excluded because they lie within the zone of thermal injury. The purpose of this case report is to report the successful use of a Quaba flap harvested from a previously burned and skin-grafted area. The patient's medical record including p…