Operative resection is a viable treatment of macrodactyly of the foot caused by lipofibromatous hamartoma: a case study with 5 year follow-up.

UNLABELLED: Lipofibromatous hamartoma (LFH) is a benign tumour of nervous tissue that most commonly involves the median nerve. Only a few cases of LFH in the foot have been described. In these cases growth of bone and other tissue causing macrodactyly, a condition known as macrodystrophia lipomatosa, is often observed. Conservative treatment of LFH is usually preferred because of the potential loss of neurological function after surgery. Here we present a rare case of a 44-year old patient with LFH causing macrodactyly of the second ray of the left foot whose symptoms did not improve after conservative treatment. We describe the diagnostic process and the operative resection that was performed and show the follow-up results 5 years after surgery. All the symptoms experienced by our patient had disappeared. This case demonstrates that operative treatment of LFH in the foot is a viable option in patients with persistent symptoms following conservative treatment. LEVEL OF EVIDENCE: Level V.

Impairment and disability after severe hand injuries with multiple phalangeal fractures.

PURPOSE: Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. METHODS: The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores. RESULTS: Seventy-eight patients with 228 phalangeal fractures were available for testing, with a mean follow-up period of 7.5 years. No statistically significant correlation existed between the AMA impairment ratings for the hand and the DASH module scores. There were weak correlations between the AMA impairment ratings for the arm and total body and the DASH module function scores. CONCLUSIONS: The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.

Functional outcome after surgical treatment of phalangeal fractures in severely injured hands.

We assessed functional results after treatment of phalangeal fractures in severely injured hands. Our aim was to quantify digital functional loss with (combinations of) risk factors of unsatisfactory function. Patients who had multiple phalangeal fractures necessitating operation in a 10-year time period were tested, using measurements of total active movement. Seventy-eight patients with 228 phalangeal fractures were available for follow-up. In 88 fingers, the fractures ended in amputation and were excluded from the study. In the resulting 140 fractures, 74 (53%) had a good result (movement >180degrees for fingers 2-5, and >98degrees for the thumb), and 66 (47%) in an unsatisfactory result. Associated soft tissue injury, level of injury, and arthrodesis were risk factors for diminished function. Intra-articular fractures and multiple fractures within the same finger predisposed to arthrodesis. Despite the extensive and severe injuries more than half had good results, which is comparable with reports describing hand injuries with less extensive trauma.