Ligament stability of the metacarpophalangeal joint: a biomechanical study

Capsuloligamentous contributions to metacarpophalangeal joint stability were obtained from load-displacement tests on the joints of 15 human cadavers. The contribution of each ligament to joint stability was obtained by measuring the reduction of load that induced a given joint displacement after sequential ligamentous sectioning. Four modes of joint displacement were examined: distal distraction, dorsopalmar dislocation, abduction-adduction rotations, and supination-pronation rotations. This study demonstrated that both radial and ulnar collateral ligaments play primary roles in stabilizing the metacarpophalangeal joint in all four modes of joint displacement. The accessory collateral ligaments contribute primarily to abduction-adduction rotational stability, but contribute little to stabilizing dorsopalmar dislocation or axial (supination-pronation) rotations. The palmar plate prevents dorsal dislocation only at full extension. The dorsal capsule has a moderate contribution to stability in distraction and supination-pronation rotations.     

Preiser's disease: a case report

Preiser's disease, or avascular necrosis of the scaphoid, is an exceedingly rare although debilitating pathologic process. A case of progressive avascular necrosis of the carpal scaphoid is presented together with a review of the possible etiology of this rare syndrome. Histologic evaluations of resected specimens have demonstrated a localized sequestrum of necrotic bone, leading to the belief that disruption of blood supply is a major predisposing factor. The diagnosis of Preiser's disease or avascular necrosis of the carpal scaphoid should be exclusively reserved to those cases that demonstrate a progressive clinical and radiographic sequence of osteosclerosis and subsequent fragmentation of the scaphoid.     

Locking of the metacarpophalangeal joint: a case report.

A case of an unusual cause of locking of the finger is described. This was brought about by the presence of an exostosis arising from the metacarpal bone, causing rupture of the capsule of the metacarpophalangeal joint with entrapment of the interosseus tendon.     

Glomus tumor associated with pacinian hyperplasia--case report

Features of the glomus tumor and the relatively recently described pacinian hyperplasia are described including signs and symptoms, differential diagnosis and treatment. The role of trauma as an etiology is proposed. A case is reported and discussed in which the patient had a glomus tumor and pacinian hyperplasia in an index finger, and a glomus tumor in the small finger of one hand. Treatment of both entities was surgical excision.     

Immediate reconstruction of the wrist and dorsum of the hand with a free osteocutaneous groin flap

A free osteocutaneous groin flap, based on the deep circumflex iliac artery, was used to primarily fuse the wrist and stabilize the first and second metacarpal bones, as well as provide soft tissue coverage for a severely injured hand. The indications for primary reconstruction with free tissue transfers include a tidy wound with minimal bacterial contamination, ready access to uninjured recipient vessels, and a predictable advantage in the use of free tissue transfer over conventional techniques.     

Osteoblastoma of the metacarpal: A case report.

Osteoblastoma is a rare tumor, but the small bones of the hands and feet are the second most common location. Despite this, the diagnosis of osteoblastoma is rarely considered in the differential diagnosis of bone tumors of the hand. This is a case similar to Jaffe and Mayer's original report.     

Entrapment neuropathy due to bilateral epitrochleoanconeus muscles: a case report.

A case of bilateral entrapment of the ulnar nerves due to accessory epitrochleoanconeus muscles was observed in a young athlete. Hypertrophy of this muscle may be one of the causes of cubital tunnel syndrome.     

A cause of painful clicking wrist: a case report

In a patient with symptomatic unilateral clicking of the wrist, a partial tear of the scapholunate ligament with subsequent scarring of the proximal third of the dorsal portion of the ligament had occurred. At operation the dorsomedial edge of the proximal pole of the scaphoid had snapped over the dorsal edge of the lunate as the palmar-flexed wrist was being returned to a neutral position. Release of the scarred portion of the scapholunate ligament was associated with widening of the scapholunate joint space to normal dimensions and cessation of the clicking phenomenon. Fourteen months after operation there was complete relief of symptoms, a full range of wrist motion and no radiographic evidence of widening of the scapholunate space, ligamentous instability, or rotatory subluxation of the scaphoid.     

Nonunion of the capitate: a case report

A patient with nonunion of the capitate presented for treatment with a painful, snapping wrist. Grafting was successful in obtaining union of the fracture and relief of symptoms.     

Open dorsal dislocations of the proximal interphalangeal joint

Eighteen open dorsal dislocations of the proximal interphalangeal joint were treated in 17 patients over a 12-year period. The severity of this injury may be underestimated. Complications included synovitis, stiffness, septic arthritis, and loss of the digit. Factors associated with a poor prognosis included a concomitant injury to the hand, a fracture from the base of the middle phalanx, and treatment in the emergency room. For optimum results, we recommend antibiotic therapy, thorough debridement in the operating room, reattachment of the palmar plate and repair of the collateral ligaments if necessary, and temporary joint immobilization (3 weeks) followed by an aggressive range of motion program.