双手拇指三节指骨1例报道

患者,女性,9岁,因发现双手拇指末节指骨尺偏畸形9年入院。患者出生时即发现双手拇指末节指骨尺偏,随年龄增长,畸形无明显加重,拇示指做精细活动稍有影响,为追求美观和改善拇指功能入院治疗。查体:双手拇指末节指骨尺偏畸形达60°,指间关节屈伸正常。X线片示:双手拇指指骨间见一三角形骨块(delta骨)(图1)。1治疗指根麻醉,左手取拇指指间关节桡侧纵切口,长约2cm,切开指间关节囊,见指骨间一独立的delta骨,其远端与末节指骨部分关节面接触,近端与近节指骨形成关节且可屈伸活动。将delta骨取出(图2),紧缩缝合桡侧关节囊及皮肤。同法处理右手,不…     

带血管蒂漂浮指皮甲瓣转移矫正复拇指畸形

目的探讨带有漂浮指的先天性复拇指畸形的治疗方法。方法将带血管蒂的漂浮指皮甲瓣转移至存留拇指以矫正先天性复拇指畸形。结果2例患拇术后均存活，外形明显改善，并保持了拇指的伸屈功能及感觉。结论通过手术方法将外形基本正常但无功能的漂浮指与畸形但有功能的存留指合二为一，是矫正带漂浮指先天性复拇指畸形的一种有效途径。     

右拇指外伤性动脉瘤1例报告

右拇指外伤性动脉瘤１例报告吴江患者，女，２５岁。因右手爆炸伤术后拇指出现肿物．于１９９３年９月１３日入院。患者于入院前２６天因啤酒瓶爆炸伤及右手掌在某医院清创缝合。术后１０日拆线时发现拇指处一肿物。查体：右手拇指掌面近侧指横纹处２．５×１．５×０．５...     

拇指神经卡压症1例

<正>患者,女,39岁,因右拇指掌指关节腹尺侧包块3周,于2012年10月27日入院。2012年10月初,患者无明显诱因发现右拇指掌指关节腹尺侧有一米粒大小包块,伴有右拇指尖麻木,无红肿热痛。曾就诊于他院,考虑右拇指神经炎,予以营养神经等治疗。因麻木无减轻,且包块仍存在,遂入我院治疗。查体:右     

动脉粥样硬化的拇指再造成活1例

随着我国显微外科技术的发展,足趾游离再造拇、手指的技术已达到国际先进水平,但特殊类型如动脉粥样硬化的拇指再造成活的病例较少有报道。我院为1例术前检查未发现有动脉粥样硬化病变的患者施行拇指再造术,术后再造指成活。现报道如下。     

拇指药物注射后部分坏死1例

１病例资料患者：女，25岁，工人。因左拇指药物注射后出现胀痛18h来我院就诊。自述曾到私人诊所注射“鸡眼针”（异丙嗪），6小时后左拇指出现胀痛。入院时左拇指末节颜色暗，指温偏低，观察不到毛细血管充血反应，指背有水疱形成；尺侧甲根部有一“鸡眼”，色黑、质硬；指间关节活动尚可，末梢感觉麻木。入院后即行切开减张术，在“鸡眼”处作梭形切口，切除鸡眼，切开后见末节静脉网广泛血栓形成，但动脉供血尚可，予“三抗”治疗。2周后拇指大部分颜色转红，部分表层皮肤坏死，清除后基底红润，但拇指尖端及13甲床全层坏死。２讨论“鸡…     

罕见右拇指骨结节性滑膜炎1例

患者 ,男性 ,55岁。因右拇末节肿胀 3 . 5个月就诊。查体发现右拇末节肿胀、变粗 ,指腹呈现实质样饱满 ,无波动感 ,未触及明显肿块 ,末节肤色略显苍白 ,皮温正常 ,无触痛。同时发现左大腿中下 1/3处肿块 1个月余 ,有触痛 ,边界清 ,活动度一般。X线片示 :右拇末节指骨尺侧骨皮质断裂 ,椭圆形溶骨样破坏 ,呈虫蚀样空洞改变 ,桡侧骨皮质部分缺损。为明确诊断 ,给予右拇活检 ,发现右拇末节指骨髓腔内为红褐色质脆组织 ,并同时行左大腿肿块切除。术后病理检查 :右拇滑膜组织呈慢性炎症表现伴肉芽组织形成 ,考虑为结节性滑膜炎。左大腿结节性筋膜…     

先天性拇指滑车发育不全1例

先天性拇指滑车发育不全是一种少见的先天畸形，临床罕见报道，2003年4月我科收治1例，手术治疗效果良好。     

Treatment of a type 3B hypoplastic thumb using extra phalanges from the contralateral duplicated thumb: case report

A boy was born with a right duplicated thumb (Wassel type 6) and a left radial club hand (type 3) associated with a hypoplastic thumb (type 3B). He underwent surgical centralization of the left wrist when he was 13 months old. At age 38 months, he underwent reconstruction of the carpometacarpal joint of the hypoplastic left thumb. This procedure involved transplantation of the radial ray of the right duplicated thumb to the base of the left thumb. When he was 6 years old, the patient underwent an abductor digiti minimi muscle transfer to create opposition for the left thumb and deepening of the first web. At the final follow-up, he could grasp items in the first web space and pick up small items between the thumb and other digits of the left hand. The treatment represents a method of using otherwise discarded tissues for effective reconstruction.     

An unusual case of transverse mesocolic internal hernia with abnormality of both hands and high arched feet

IntroductionAn internal abdominal herniation is the protrusion of a viscus through a normal or abnormal mesenteric or peritoneal aperture. It is a rare cause of small bowel obstruction with a reported incidence of 0.2–0.9%. It can either be acquired through a trauma or surgical procedure or can be related to congenital peritoneal defects. Herniation through transverse mesocolon is very rare.Presentation of caseA case of acute intestinal obstruction due to internal herniation through a congenital rent in transverse mesocolon with rotation of gut approximately 180° around axis of the band. Patient also had bilateral hypoplastic thenar muscles with rudimentary 1st metacarpals and high arched feet. Reduction along with derotation of gut, with closure of the rent in transverse mesocolon and fixation of the caecum to lateral peritoneum was performed.DiscussionThe preoperative diagnosis of mesenteric defect is difficult because of wide range of acute abdominal symptoms, and there are no specific radiographic findings. CT is the most important diagnostic tool is, with 77% accuracy in such cases. Due to the risk of strangulation of the hernial contents, even small internal hernias are dangerous and may be lethal.ConclusionInternal hernia should be suspected in patients with signs and symptoms of intestinal obstruction, particularly in the absence of inflammatory intestinal diseases, external hernia or previous laparotomy. Surgical decision-making is on the basis of clinical findings of intestinal strangulation or ischemia, and emergency laparotomy should be performed without preoperative diagnosis of such a rare disease.     

Recurrent calcifying aponeurotic fibroma of the thumb: case report

We present an unusual case report of an aggressive, recurrent calcifying aponeurotic fibroma of the thumb in an adult man with invasion into the distal and proximal phalanges, the skin, the radial and ulnar neurovascular bundles, and the tendons, treated with amputation and an immediate toe-to-thumb transfer.     

Chondroma in a sesamoid bone of the thumb: case report

Sesamoid tumors of the hand are uncommon. We report a 50-year-old man presenting with a right thumb sesamoid chondroma. Surgical excision was successfully performed. At 12-month follow-up, the thumb function is normal, and there is no evidence of other lesions or recurrence.     

Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report

We report a successful thumb replantation by resecting the remnants of the crushed proximal phalanx and uniting the distal phalanx with the thumb metacarpal. The procedure resulted in extreme shortening, which we managed by distraction lengthening and deepening of the first webspace.     

Modified method for reconstruction of thumb abduction function in children undergoing surgical treatment of thumb duplication

PurposeThis study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication.MethodsThis retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed.ResultsThe deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A.ConclusionReconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique.Level of evidenceIII     

Incidence and development of trigger thumb in children

PURPOSE: Whether trigger thumb is congenital or acquired remains controversial. The purpose of this study was to identify whether trigger thumb is present at birth and to clarify whether trigger thumb represents a developmental condition. METHODS: We examined 1,116 babies born at Yamagata Prefectural Nihonkai Hospital within 14 days after birth. All patients were examined by the author (N.K.), a hand surgeon. Patients were followed up to determine whether trigger thumb would present later even though it was not present at birth. We informed parents about the development of trigger thumb by providing informational sheets for neonatal screenings after hospital discharge. They were asked to check their child for a year or more to see if any flexion deformity of the interphalangeal joint of the thumb occurred. After discharge from the hospital, the family was responsible for noticing trigger thumb in their infant and seeking medical treatment. RESULTS: Trigger thumb was not identified in any patient at birth. Responses were obtained from 601 families. Trigger thumb manifested in 2 thumbs of 2 children in the screening group at 8 and 11 months after birth; however, 3 additional children developed trigger thumb at 15, 21, and 30 months of age. CONCLUSIONS: The incidence of acquired trigger thumb in children 1 year of age was 3.3 per 1,000 live births. It is unlikely that this study identified all cases of trigger thumb in patients older than 1 year in the primary screening group. The results of this follow-up study, however, suggest that trigger thumb is not present at birth but develops with postnatal growth.