A comparative study of the modified Sauvé-Kapandji procedure for rheumatoid wrist with and without stabilization of the proximal ulnar stump.

We compared the clinical and radiological results of the modified Sauvé-Kapandji procedure for 41 of 86 operated rheumatoid wrists with (n=22) and without (n=19) stabilization of the proximal ulnar stump with a slip of half the extensor carpi ulnaris tendon. Gender, age, and follow-up period were similar in the two groups. We found no difference clinically or on radiographs between the two groups other than better early postoperative pain relief in those stabilized. Stabilization of the proximal ulnar stump may not be necessary in the modified Sauvé-Kapandji procedure for rheumatoid wrists.

Clinical outcome of extrasynovial steroid injection for trigger finger.

A prospective clinical study was performed to investigate the clinical results of extrasynovial (subcutaneous) steroid injection for trigger finger. One hundred and twenty-nine trigger fingers were investigated in 100 adult patients; 76 were women and 24 were men. Their mean age was 60 years (range: 17 to 88 years). We classified trigger fingers into three different grades according to clinical severity at a medical examination. All patients were injected with betamethasone mixed with lidocaine. Surgical release of the A1 pulley was performed at the patients' request if steroid injection therapy was not effective. Pain and snapping were relieved in 98% and 74% of cases, respectively. Recurrence occurred in about half our patients, but the same clinical benefit was obtained after re-injection. Surgery was performed for seven fingers. No complications of steroid injections were observed. This study suggests that extrasynovial steroid injection is a valuable conservative treatment for trigger finger and it is not necessary to try and inject into the tendon sheath to get a good result and markedly reduce the risk of causing damage to tendons and other structures.

A case of toe macrodactyly treated by application of a vascularised nail graft.

Macrodactyly is a relatively rare congenital abnormality of the fingers and toes and is difficult to treat. We report a new method for treating toe macrodactyly in which a nail with a vascularised pedicle is raised, the toe is shortened to an appropriate length, and the nail transferred to an aesthetically appropriate proximal site. Although this technique is of a higher level of difficulty than conventional procedures involving pedicled nail flaps, allows aesthetically more favourable nail reconstruction by single-stage operation.

Temporary scapho-trapezoidal joint fixation for Kienböck's disease in a 12-year-old girl: a case report.

Temporary scapho-trapezoidal joint fixation with Kirschner wires was performed for stage IIIB Kienböck's disease in a 12-year-old girl. Preoperative evaluation with radiographs and magnetic resonance imaging confirmed the diagnosis. After 4 months of fixation, wrist range of motion was improved and pain was decreased. Postoperative magnetic resonance imaging revealed revascularization and fracture healing. Temporary scapho-trapezoidal fixation may be useful in the treatment of selected cases of Kienböck's disease in children.

Clinical and neuroradiologic findings of congenital hydrocephalus in infant born to mother with HTLV-I-associated myelopathy.

We describe clinical and neuroradiologic findings in a male infant with congenital hydrocephalus born to a mother who developed human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy. Ultrasonography at age 20 days showed multiple cysts in the subependymal germinal matrix and enlarged lateral ventricles. Elevation of serum HTLV-I antibody suggested that his hydrocephalus was probably due to intrauterine HTLV-I infection. HTLV-I may cause neurotropic infection in utero.