Splint immobilization of gamekeeper's thumb.

Thirty-nine patients diagnosed with 40 acute complete ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint were treated primarily with thumb spica splint immobilization. Duration of splinting ranged from 8 to 12 weeks. Thirty-four of these injuries (85%) followed for 1 to 5 years (average 2.4 years) healed without significant instability, arthrosis, pain, or stiffness (range of motion within 80% of the contralateral hand). Six ruptures (15%) demonstrated persistent instability and pain at 12 weeks and were treated with surgical reconstruction. Currently accepted guidelines for surgical intervention as primary treatment for ligamentous disruption at the thumb metacarpophalangeal joint may need revision. This study suggests that splint immobilization is an effective primary treatment modality. The minority of patients who demonstrate persistent laxity can be successfully treated surgically with excellent results.

Pediatric update #15. Florid reactive periostitis of the digits.

Benign fibrous lesions of the digits can present a considerable diagnostic challenge. Some lesions may resemble sarcomas, resulting in needless amputation. One such benign entity resembles myositis ossificans histologically but presents as an aggressive hand lesions. Unfortunately, this lesion has been given multiple names. It is most appropriately termed florid reactive periostitis. This paper reports a case of florid reactive periostitis in a 12-year-old girl.

Effect of nicotine on the rate and strength of long bone fracture healing.

Empirical clinical observation suggests that cigarette smoking had an inhibitory effect on long bone fracture healing, but this has not been proven scientifically. Forty female New Zealand White rabbits had midshaft tibial osteotomies performed and plated. These were divided randomly into two groups receiving either systemic nicotine or saline (placebo). Lateral radiographs were taken at 4, 6, and 8 weeks that showed a 17.2% average difference in callus formation between the two groups and a significant lag in formation of cortical continuity in the nicotine group. The rabbits were sacrificed 8 weeks after fracture, and healing was compared biomechanically. Three (13%) fractures showed no clinical evidence of union in the nicotine group, whereas all fractures in the control group healed. Biomechanical testing showed the nicotine exposed bones to be 26% weaker in three-point bending than were those exposed to placebo.