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A patient is described who presented with a painful swelling on the dorsum of the hand which arose from the hamate and proved histologically to be a secondary from a previously resected gastric adenocarcinoma. [ABSTRACT FROM PUBLISHER]

Goal of Surgery: Relieve of pain and increased stability at the base of 1st metacarpal., Indications: Painful degenerative and inflammatory arthritis in trapeziometacarpal joint (TMCJ)., Contraindications: Patients not willing to undergo lengthy intensive postoperative rehabilitation. Rheumatoid arthritis (relative)., Positioning and Anaesthesia: Supine. Hand table. General or regional anaesthesia., Surgical Technique: Modification of the Burton-Pelligrini operation by using half of the flexor carpi radialis for interposition between base of 1st metacarpal and scaphoid. Stabilization with a Kirschner wire. In the presence of scaphotrapezoid arthritis an arthrodesis of this joint is performed for better pain control., Postoperative Management: Immobilization in a below elbow cast for 6 weeks. Then active physiotherapy, night splint for another 6 weeks., Possible Complications: Fracture while drilling the base of the 1st metacarpus, migration of Kirschner wires, injury to the radial artery and cutaneous nerves., Results: Out of 15 patients 12 (14 thumbs) were followed for at least 6 months. In 11 patients the shape of the hand was normal and 10 patients were satisfied with the result of the operation. Complications included: twice postoperative migration of Kirschner wires, and once intraoperative tearing of the tendon which had to be sutured.

We report the first known example of an entirely fibrous loose body lying in the flexor tendon sheath of a finger. This was seen initially as a painless swelling in a fit young woman and was surgically excised with full restoration of function. The cause of the loose body is unknown, but it may have originated as a fibroma of the flexor tendon sheath or as a localized nodular tenosynovitis.

In psoriatic arthritis, trauma to joints may be important in determining the site of joint involvement. We describe a child with a psoriatic arthritis in whom penetrating injury with a rose thorn led to a localized chronic synovitis which could not be distinguished clinically from psoriatic arthritis but which was effectively treated by synovectomy and removal of the remaining thorn.

Clearer indications regarding when to replant an amputated digit can be obtained by comparing the functional capabilities of two similar groups of patients, one of which has had amputations and one of which has had replantations. This paper reports such a comparative study. Function was assessed by asking the patient to perform 10 tests designed to cover a broad spectrum of everyday activities, and grip strength was compared to that in a normal hand. Grip strength was appreciably greater in patients with replanted thumbs and multiple digits, and less so in those with replanted single digits. Based on our findings on the small, but intensively studied, number of patients assessed in this review, it would appear that thumbs should always be replanted if possible. In contrast, the functional analysis shows little necessity for replantation of a single finger. Multiple digital replantation assumes lesser functional value if one or more fingers remain that can oppose the thumb to provide prehension.

The occurrence of a fracture in a limb is accompanied by large changes in the electrical characteristics of the region. Resistivity of bone is more than a hundred times that of bone. The relative permittivities of the two are also different. The fracture site is also known to be electronegative. Electrical Impedance Imaging is capable of reconstructing a two dimensional (2D) representation of the average distribution of amplitude and phase in a three dimensional (3D) region. The spatial resolution in impedance imaging is low, yet the technique is sensitive to properties that are rapidly changing in growing tissues. Though the reconstructed image is an average of a thick slice, this may be of some advantage in impedance osteography precluding the need for imaging multiple planes to cover the extent of the fracture. We used the Aberdeen Impedance Imaging System which uses the 4 electrode technique in a split array, and a current of 1 milliampere on a carrier of 10 kHz to collect a number of data sets. The averaged data sets were used to reconstruct images by the Equipotential backprojection method. In this pilot study we concentrated on the real part of the complex impedance to produce images of log resistivity. The a-priori assumption of bilateral symmetry of human limbs allowed us to reconstruct equivalent regions of the normal and fractured limbs by inverting the electrode array. We obtained static images of the distribution of log resistivity when we used a homogeneous distribution as a reference, and a differential image comparing the fractured to the normal limb. The three patients in our study were at different clinical stages of fracture healing as confirmed by radiography. Our results show the feasibility of using the technique to study and monitor fractures during the healing process.