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The functional dexterity test (FDT) is a timed pegboard test based on the manipulation of each peg and suitable for young children as it is both simple and quick to perform. We assessed the postoperative FDT values for children with Blauth type 2 hypoplastic thumbs after opponensplasty. We evaluated hand function using FDT for 12 hands of 11 patients with Blauth type 2 hypoplastic thumbs. Opponensplasty was performed in all hands following by Huber's procedure. All patients were evaluated from 6 to 12 months after surgery for hand function using three types of FDT scores: time in seconds to complete the test (FDT time), combined total time with penalty seconds added to the initial time (FDT total), and the number of pegs per second to complete the task as a percentage against normative values (FDT speed). We compared the postoperative FDT scores with those for Blauth type 1 or 2 hypoplastic thumb patients without surgical treatment. FDT time and FDT total for the patients postoperatively were both significantly shorter than those in the type 2 patients without surgical treatment. FDT speed was significantly higher than that for the patients without surgical treatment. There were no significant differences in the three FDT scores between the postoperative patients and the type 1 patients. There were several limitations including small sample size, large ranges of the data, and high number of variables. FDT reflected postopponensplasty improvement in hand dexterity in young children with Blauth type 2 hypoplastic thumb.

Hand aesthetics in general and aesthetic refinements of soft-tissue coverage of the hand in particular have been increasingly considered over the past few years. Advancements of microsurgery together with the traditional methods of tissue transfer have expanded the number of techniques available to the reconstructive surgeon, thus shifting the reconstructive paradigm from simply "filling the defect" to reconstructive refinement to provide the best functional and aesthetic results. However, drawing the boundary between what does and what does not constitute "aesthetic" reconstruction of the hand is not straightforward. The selection among the vast amount of currently available reconstructive methods and the difficulties in objectively measuring or quantifying aesthetics have made this task complex and rather arbitrary. In this article, the authors divide the hand into several units and subunits to simplify the understanding of the basic functional and aesthetic requirements of these regions that may ultimately bring order to complexity.

Advances in anatomical research have created the base for a vast variety of flaps that can be raised in the hand. They are either based on the palmar arterial system or on the dorsal vascular system, which is fed by either perforating vessels from the palmar side or the dorsal arterial system nourished by dorsal carpal arterial network. The majority of small to moderate size defects in the hand can be reconstructed with these types of flaps., (2011 Elsevier Inc. All rights reserved.)

In summary, there is a complex interplay between the extrinsic and intrinsic components of the digital extensor mechanism. Numerous examples of dynamic anatomy and pathology of the extensor mechanism in common clinical settings have been described. Treatment principles have been outlined. This review should provide the orthopaedic surgeon with a framework for management of common hand problems.

Thirty-seven children with congenital (n = 32) or post-traumatic (n = 5) hand anomalies underwent unilateral or bilateral toe transfers. All had undergone preoperative counselling. After rehabilitation and more than 1 year after surgery, the children and their parents were reviewed by a clinical psychologist to assess the psychosocial outcome of the surgery. A high level of satisfaction was reported with regard to the surgery, in terms of function, cosmesis, donor site, psychosocial wellbeing and the reactions of others. This was true regardless of the gender of the child. However, there was a tendency for the children to be more positive in their responses than their parents.

The authors present their experience of early passive mobilisation in hand surgery, by a continuous-cycle motorized device. This method of treatment has been applied to various pathological conditions (post-operative management following such operative procedures as stable osteosynthesis of fractures of the long bones, tenolysis and teno-myolysis, arthrolysis and treatment of complex trauma of the hand), demonstrating very good efficacy. This device allows continuous passive mobilisation of the fingers and represents useful complement in the rehabilitation program of the hand.