Surgical rehabilitation of the upper limb in quadriplegia.

Fifteen quadriplegic (tetraplegic) patients from the Spinal Injuries Unit of the Austin Hospital have had surgery to improve function in 17 of their upper limbs. Changes in strength, function, subjective ratings and the influence on 198 activities of daily living are reviewed. The posterior third of the deltoid muscle was transferred into 8 triceps tendons to provide active elbow extension in seven patients. Six patients had transfers of forearm muscles to provide grasp and lateral pinch or active extension of wrist and fingers. Other operations included transfer of the latissimus dorsi to the forearm producing elbow flexion, medial advancement of the anterior deltoid origin improving shoulder control (an operation which has not been described previously), and tenodesis for stabilizing the wrist. The objective results were satisfactory in 12 patients. Eleven patients had either good or excellent subjective results. The maximum force of active elbow extension achieved was 6.8 kg and the peak grip strength reached was 10.5 kg. Six patients achieved subjective results higher than would have been expected from objective assessment. All patients benefited in some way, 13 patients felt that surgery was worthwhile and no patient lost appreciable function. The results of this series indicate that upper limb surgery has a definite place in rehabilitation of the quadriplegic patient. Improved surgical technique may reduce the time required for postoperative rehabilitation and thus make these procedures feasible for a larger number of patients.

A giant cell tumor of the thumb: a case report.

Giant cell tumors of the flexor sheath are the second most common tumors of the hand. We present a case that is unusual in the extent of the tumor and the pronounced bony invasion, which is rare. Preoperative diagnosis was complicated by a history of gout in our patient.

The headbangers tumour.

Two cases are reported of West Indian black children who presented with chronic soft tissue swellings in the centre of the forehead. These lesions, not previously described, are the result of habitual head banging and their benign nature was confirmed histologically. Self-inflicted trauma should be seriously considered in the diagnosis of similar lesions and, in children particularly, the possibility of non-accidental injury should not be overlooked.

Volvulus of the transverse colon: a postoperative complication of truncal vagotomy and gastrojejunostomy.

An instance of volvulus of the transverse colon in the postoperative period following truncal vagotomy and anterior gastrojejunostomy is reported. The clinical features of volvulus of the transverse colon are sudden onset of abdominal colic, distension and vomiting. A plain X-ray film of the abdomen is diagnostic. Laparotomy is recommended, followed by untwisting alone, or untwisting and colostomy when the bowel is viable, or resection with a transverse colostomy and mucous fistula as a first stage when the bowel is gangrenous.