Aims: We present a prospective study, with three-year follow-up, of the incidence, course and influence on surgical outcome of the abductor digiti minimi cord in Dupuytren’s contracture of the PIP joint of the little finger.

Methods: All patients presenting for surgery with primary Dupuytren’s contracture of the little finger over a six-month period were included in the study. Patterns of disease cords and joint involvement were noted. All fingers underwent fasciectomy of the central and pre-tendinous cords. If significant contracture remained the abductor cord was excised next, and the PIP joint itself released only if correction could still not be obtained. Contracture and range of movement of affected joints measured with goniometer pre-operatively, at each stage intra-operatively and at 3 months and 3 years post-op.

Results: The abductor cord was present in twleve of the nineteen fingers in the study, including all of those with ulnar-sided disease. The ulnar neurovascular bundle was found to be deep to the cord in nine fingers, encased by diseased tissue in two and displaced superficially in only one finger. Mean initial flexion deformity in these twelve fingers was 59, corrected to only 51 by resection of the central and pre-tendinous cords. Excision of the abductor cord further improved the contracture to 25 while PIP join release improved it to 6. Flexion deformity was 18 at three months and 21 at three years. For the seven fingers in which no abductor cord was found, mean initial flexion deformity was 42, improving to 24 following fasciectomy and 4 with joint release. It was 16 at three months and 18 at three years. No significant difference in outcome could be identified between the groups at three months or three years.

Conclusions: The abductor cord is present in roughly two-thirds of little fingers with contracture pf the PIP joint. The ulnar digital nerve usually lies deep to the abductor cord but in roughly one quarter of cases is either encased in or superficial to it. In affected fingers, resection of the cord accounts for more than half of the total correction obtained and three quarters of that obtained by fasciectomy. Presence of the ADM cord does not prejudice long-term outcome provided it is adequately resected.

Aims: We present a prospective study, with three-year follow-up, of the role and outcome of fasciectomy plus surgical release of structures of the PIP joint in Dupuy-tren’s contracture of the fifth ray. Methods: All patients presenting for surgery with primary Dupuytren’s contracture of the fifth ray over a six-month period were included in the study. All underwent fasciectomy followed sequentially by release of the abductor band, accessory collateral and checkrein ligaments as necessary. Deformity and range of motion in the PIPJ were measured by goniometer preoperatively, intra-operatively (post-fasciectomy and post-PIP release) and at three months and three years postoperatively. Results: Of the nineteen fingers in the study, eight (all mild deformity) achieved a full correction by fasciectomy alone. 78% correction remained at three months and 70% at three years. The remaining eleven fingers (initial mean deformity 70o flexion) obtained only a 38% correction by fasciectomy, increased to 90% with PIPJ release. Of this correction 64% was maintained at three months and 57% at three years. These figures include one recurrence of Dupuytren’s and are comparable with those of other techniques. Conclusion: We conclude that sequential PIPJ release is a useful technique for the correction of severe Dupuytren’s of the fifth ray involving that joint.

The effect of the position of splintage on displacement of fractures of the waist of the scaphoid was studied during operations and in cadavers. We found that these fractures were best splinted in neutral or slight palmar flexion with no ulnar deviation. Providing the wrist was not ulnar deviated, the position of the thumb had no effect on displacement.