Social deprivation and hand injury.

This study investigated the relationship between socioeconomic deprivation and the incidence, patterns of injury, process of care and outcome of hand trauma using data collected prospectively on 1234 injuries presented during six months. The Index of Multiple Deprivation 2004 was derived from census data and postcodes. Socioeconomic deprivation is significantly associated with hand trauma. The odds ratio for suffering hand injuries in the most deprived quintile is 1.6 (SE 0.09 95% CI 1.45, 1.83) compared to the least deprived quintile. This is most marked among older children and adults. Fractures, sprains and ligament injuries showed the strongest association with the degree of deprivation. Injuries related to sport were not associated with deprivation. Surgical time utilised is greater in more deprived patients and their self reported physical outcome is worse. Hand surgery units working in areas of high socioeconomic deprivation will have higher trauma workloads and unit costs. Social deprivation may also influence physical outcomes.

The effect of flexor digitorum profundus quadriga on grip strength.

This study evaluated the flexor digitorum profundus quadriga effect by mimicking stiffness of one finger and observing its effect on the strengths of the other three fingers of the same hand. Thermoplastic wedges were used to simulate mild, moderate and severe stiffness of each finger and the individual strengths of each finger during power grip were measured using a digit-grip(TM) dynamometer in ten healthy adult volunteers. Middle, ring, and little fingers strength diminished significantly (P<0.05) when each of the other fingers, including the index, was stiffened. Index finger strength was largely unaffected by simulated stiffness of the other fingers. The degree of simulated stiffness influenced the strength of the other fingers, but there was considerable intersubject variability, suggesting that the significance of the quadriga effect varies between individuals. An anatomical basis for our findings is suggested.

Marjolin's ulcer--a near forgotten entity.

We report a case of a 55-year-old man who presented with a 6-month history of a fungating ulcer on the right hand at the site of a previously healed ulcer that had been present for 40 years. Histopathological examination of four-quadrant biopsy specimens showed a moderately differentiated squamous cell carcinoma (SCC). A transradiocarpal amputation with stump closure using radial flap was performed as it was not possible to achieve a functionally and cosmetically acceptable hand after a wide excision with 2 cm tumour-free margin. It is our intention to highlight this rare condition as reminder to consider this entity as a differential diagnosis of chronic non-healing skin ulcer.

A prospective randomized controlled study of fixation of long oblique and spiral shaft fractures of the proximal phalanx: closed reduction and percutaneous Kirschner wiring versus open reduction and lag screw fixation.

Patients with an isolated spiral or long oblique fracture of the proximal phalanx were randomized into two groups. One was treated by closed reduction and Kirschner wire fixation and the second treated by open reduction and lag screw fixation. An independent observer assessed function, pain, movement, grip strength and intrinsic muscle function. X-rays were assessed for malunion. Thirty-two patients were entered the study and 15 in the Kirschner wire and 13 in the lag screw group were reviewed at a mean follow-up of 40 months. There was no significant difference in the functional recovery rates or in the pain scores for the two groups. X-rays showed similar rates of malunion and there were no statistically significant differences in range of movement or grip strength.

Is routine splintage following primary total knee replacement necessary? A prospective randomised trial.

It was hypothesised that routine splintage following primary total knee replacement has no affect on flexion deformity and offers no benefit over simple wool and crepe. Fifty-five patients undergoing primary total knee replacement were entered into a prospective study. The patients were randomly assigned to two groups: The first group was rehabilitated without a splint and the second received an adjustable semi-rigid extension splint (Richards splint) for the first 48 h after surgery. Range of motion measurements were recorded pre-operatively and at 2 days, 1 week and 3 months post-operation by a research nurse blinded to the allocation. No statistically significant difference in flexion deformity was found at any stage (P>0.5). No difference was found in general or wound complications, or requirement for blood transfusion, and the post-operative stay was equal in the two groups. We conclude that routine use of a semi-rigid splint following primary total knee replacement has no advantage over simple wound dressings.

Isolated paralysis of the extensor pollicis longus muscle: a further variation of posterior interosseous nerve palsy.

A case of isolated extensor pollicis longus paralysis is reported representing a fourth, very localized, variation of posterior interosseous nerve palsy. Extensor indicis proprius transfer resulted in a return to function. As the posterior interosseous nerve supplies this and other muscles available for transfer, and the preoperative assessment of extensor indicis proprius function is difficult, the management of this localized nerve palsy presents a dilemma to the surgeon.