A prospective series of 32 cases with tuberculosis of the hand and wrist is presented. The mean age of the patients was 23.9 years (3 to 65), 12 had bony disease and 20 primarily soft-tissue involvement. The metacarpal of the little finger was the most commonly involved bone. Pain and swelling were the usual presenting features and discharging sinuses were seen in three cases. All patients were given anti-tubercular chemotherapy with four drugs. Operative treatment in the form of open or arthroscopic debridement, or incision and drainage of abscesses, was performed in those cases where no response was seen after eight weeks of ATT. Hand function was evaluated by the modified score of Green and O’Brien. The mean was 58.3 (25 to 80) before treatment and 90.5 (80 to 95) at the end. The mean follow-up was for 22.4 months (6 to 43). Conservative treatment was successful in 24 patients (75%). Eight who did not respond to chemotherapy within eight weeks required surgery. Although tuberculosis of hand has a varied presentation, the majority of lesions respond to conservative treatment.
In radial polydactyly, the Wassel’s classification is most commonly employed. This classification depends upon the bifurcation site of the thumb. In this paper the author discusses his experience in the treatment of duplicated thumb at various levels. In duplicated thumbs, the supernumery digit (thumb) is excised in patients in whom one of the two thumbs is extremely hypoplastic. When both of the digits have an equal amount of tissue, some reconstructive surgical procedure is employed to centralize the thumb to improve the cosmesis and/or function. If thumb excision is done in such a case, the thumb may develop instability, axial deviation and may require secondary procedures for stabilization. The thumb may develop vascular compromise, though rarely, due to anomalous vascular supply. The author has employed the Bilhautcloquet procedure or its modification in the treatment of 12 cases of duplicated thumb. This paper discusses the entity, the surgical technique and the results in 12 cases of duplicated thumb. The mean follow up is 3 years.
Giant-cell tumour of the tendon sheath, also called pigmented villonodular synovitis, is a benign tumour with a high incidence of recurrence. We have tried to identify risk factors for recurrence. Of the 48 patients included in the study, 14 received radiotherapy after surgery. Only two (4%) had a recurrence. This compares favourably with previously reported incidences of between 25% and 45%.
We report the results of the treatment of 23 patients with macrodactyly. Eighteen had a two-stage bulk-reducing (defatting) procedure; phalangectomy was used to shorten the digits. At a mean follow-up of nine years (2 to 12), two patients had been lost to follow-up, and three await a second-stage procedure. Good cosmetic correction was achieved in 12 patients, with satisfactory results in seven; two patients had poor results and required amputation.
We have reviewed 26 patients treated by trapezius transfer for deltoid paralysis due to brachial plexus injury or old poliomyelitis. We assessed the power of shoulder abduction and the tendency for subluxation. There were good results in 16 patients (60%); five were fair and five poor. Trapezius transfer appears to give reasonable results in the salvage of abductor paralysis of the shoulder.
