Small flake, big problem: an unreported cause of extensor pollicis longus tendon rupture.

Fracture of the base of the third metacarpal with associated avulsion of the extensor carpi radialis brevis tendon is a rare injury. We report such a fracture and the unusual resulting complication of division of the extensor pollicis longus tendon by the avulsed bony fragment. Careful monitoring using lateral radiographs is needed to make the diagnosis and displacement of the avulsed fragment warrants open reduction and internal fixation.

The use of ADCON-T/N after repair of zone II flexor tendons.

This double-blinded randomised clinical trial investigated whether application of ADCON-T/N to zone II tendon repairs improved their outcome. Fifty-nine patients were randomised into control or ADCON-T/N treated groups and all followed an early mobilisation regime following tendon repair. Tendon rupture rates were comparable between the control and ADCON-T/N treated patients. At six months follow-up, the ADCON-T/N treated group had better proximal interphalangeal motion.

The use of ADCON-T/N glycosaminoglycan gel in the revision of tethered scars.

Recurrent subdermal scar tethering is a difficult management problem in areas of high tissue mobility. We describe a novel solution to this clinical problem, which involves instilling the anti-fibrotic gel ADCON-T/N in the plane between the skin and the underlying structures. We present our results in three difficult clinical situations where excellent results have been achieved using this method.

Mammography and breast implants.

Mammography in the presence of breast implants is complicated by the opacity of the implants, the displacement of breast tissue by the implant, and the presence of secondary changes such as calcification within a fibrous capsule. A special technique of mammography, known as the displacement technique, has been developed by Eklund in the USA, where it is widely used. The displacement technique of X-ray mammography has been shown to provide superior results to the standard compression method. We conducted a telephone survey of 23 mammography units in order to assess mammographic practice in the United Kingdom for the patient with breast implants. We found a wide variation in practice. There was a general lack of awareness of the displacement technique and of its advantages. Only 4 mammography units in our sample (17.4%) used the displacement technique.

The generation of anchoring fibrils by epidermal keratinocytes: a quantitative long-term study.

Anchoring fibrils (AFs) are derived from basal keratinocytes, but the kinetics of their formation is unknown. In this study, de novo generation of AFs by cultured human keratinocyte autografts was assessed from 1 week to 6 years postgrafting. Within 2 weeks, AF population densities were equal to those of normal controls and remained normal thereafter. However, AF diameters were narrow compared to controls (P < 0.05) until 3 years postgrafting. The depth of extension of AF-anchoring plaque lattices into the subjacent stroma was normal by 3 weeks but, after 1 month, was typically 1.5-to 2-fold greater than normal. The findings indicate that: (1) basal keratinocytes immediately re-establish a full complement of AFs; (2) once reformed, AF populations remain normal in density over time; (3) nascent AFs are thin and require several years to reach full maturity; and (4) abnormally thick AF lattices may form over time in healed wounds.