Flexor tenolysis in children.

This study aimed to determine whether there is an age below which flexor tenolysis may not be beneficial and whether there is any detriment to waiting for a more appropriate age. In this study, patients in their first decade had minimal improvement in their active flexion after flexor tenolysis. Six patients were tenolysed more than 1 year after their original operation and none appeared to have been compromised by the prolonged interval between injury repair and tenolysis. Significant improvement in active flexion after tenolysis can be confidently expected only in children over 11 years old.

Dorsal ganglion of the wrist--pathogenesis and biomechanics. Operative v. conservative treatment.

It is shown that the dorsal ganglion arises as a herniation from the dorsal scapholunate ligament. This herniation increases in size (according to La Place's law) owing to the unidirectional pinchcock effect of the mucosal folds of the duct and the pressure of the overlying extensor retinaculum until the distending pressure inside the ganglion equals the overlying tissue pressure. Wrist gangliography, retrograde wrist arthrography, histology and nuclear magnetic resonance were used to prove this conclusively. Bearing the pathogenesis in mind, the best clinical results were obtained by excision of the ganglion with 0.5 cm2 of dorsal scapholunate ligament and closure of the dorsal capsule with a 3/0 Vicryl purse-string suture. Non-surgical sclerotherapy led to severe inflammation and sepsis and a recurrence rate of 45%. Conservative therapy is illogical since the communicating duct remains and synovial fluid from the scapholunate joint will cause a reherniation and recurrence of the ganglion.

Significance of assault injury of the hand. A case report.

A patient who developed septic arthritis of a metacarpophalangeal joint after penetration by a tooth in a fist fight is described. The importance of recognising such a lesion at the time of injury is stressed.