FDP Avulsion Injury Due to Enchondroma: A Unique Surgical Approach.

Flexor Digitorum Profundus avulsion injury associated with an enchondroma at the level of the distal phalanx is extremely rare. There have been few cases reported to date and most have been surgically managed using a screw and/or Bunnell pull-out wire technique with or without bone grafting. We describe the first case using a simple interosseus fixation technique for the reattachment of FDP tendon without bone grafting. The patient made an excellent post-operative recovery. This technique is a simple, effective, patient-friendly and internalised solution which, in addition, may prevent the need for bone grafting.

Prospective Clinical Trial Comparing Trapezial Denervation With Trapeziectomy for the Surgical Treatment of Arthritis at the Base of the Thumb.

BACKGROUND: Trapeziectomy is considered to be the "gold standard" procedure for first carpometacarpal joint (first CMCJ) osteoarthritis. First CMCJ denervation offers the potential benefit of a shorter procedure with bone and joint preservation and swift postoperative rehabilitation. This trial aimed to compare functional outcomes, patient satisfaction, quality of life, and cost effectiveness following these treatments. METHODS: This study was a prospective clinical trial commencing December 2005 to November 2013. A range of functional outcomes assessments were used preoperatively at 6 and 12 mo and 5 y after surgery. These included measurements of strength/motion, visual analogue score, Michigan Hand Outcomes and the European Quality of Life-5 Dimensions questionnaires. Data were analyzed using a two-sample t-test and Mann-Whitney test. RESULTS: A total of 45 patients were studied of 55 recruited. Age ranged from 41 to 72 (mean = 59). Thirty-five patients underwent denervation and 10 initially had trapeziectomy. Nine patients were converted to trapeziectomy within an average of 6 to 12 mo. There was no significant difference in the functional outcomes at different points of follow-ups. Similarly, there was no significant difference in the time of return to work or cost effectiveness. Denervation achieved a success rate of just above 70%, whereas no revisions were required for the trapeziectomy group. CONCLUSIONS: There was no difference between the two treatments. First CMCJ denervation does not appear to be superior to trapeziectomy. However, the advantage of rapid rehabilitation makes it more favored by patients but at the expense of 30% reoperation rate. LEVEL OF EVIDENCE: Level II.

Pedicled distal phalanx fillet flap for finger length preservation in trauma.

Lawnmower injuries to the digits are becoming increasingly common and are often complex in nature with multiple levels of injury. The management of these injuries as with that of other hand injuries is often tailored to the individual patient considering factors such as occupation and hobbies with the ultimate goal of restoration of function and a sensate fingertip. The concept of using amputated, mangled or non-salvageable parts in a form of fillet flap has become more common in the recent years. We report a complex case of a multi-level injury to the dominant index finger of a professional typist from a lawnmower where finger length was maximised using a pedicled distal phalanx fillet flap which ultimately allowed the patient to return to work.