Aims. The paediatric trigger thumb is a distinct clinical entity with unique anatomical abnormalities. The aim of this study was to present the long-term outcomes of A1 pulley release in idiopathic paediatric trigger thumbs based on established patient-reported outcome measures. Methods. This study was a cross-sectional, questionnaire-based study conducted at a tertiary care orthopaedic centre. All cases of idiopathic paediatric trigger thumbs which underwent A1 pulley release between 2004 and 2011 and had a minimum follow-up period of ten years were included in the study. The abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH) was administered as an online survey, and ipsi- and contralateral thumb motion was assessed. Results. A total of 67 patients completed the survey, of whom 63 (94%) had full interphalangeal joint extension or hyperextension. Severe metacarpophalangeal joint hyperextension (> 40°) was documented in 15 cases (22%). The median QuickDASH score was 0 (0 to 61), indicating excellent function at a median follow-up of 15 years (10 to 19). Overall satisfaction was high, with 56 patients (84%) reporting the maximal satisfaction score of 5. Among 37 patients who underwent surgery at age ≤ two years, 34 (92%) reported the largest satisfaction, whereas this was the case for 22 of 30 patients (73%) with surgery at aged > two years (p = 0.053). Notta’s nodule resolved in 49 patients (73%) at final follow-up. No residual triggering or revision surgery was observed. Conclusion. Surgical release of A1 pulley in paediatric trigger thumb is an acceptable procedure with excellent functional long-term outcomes. There was a trend towards higher satisfaction with earlier surgery among the patients. Cite this article: Bone Jt Open 2024;5(9):736–741

1 . The extensor assembly of the fingers consists of the central tendon joined by three pairs of components: a) the retinacular ligaments, which link the movements of the interphalangeal joints; b) the "wing" tendons, a lumbrical on the radial side, and usually a palmar interosseous on the ulnar side; c) the phalangeal tendons, usually dorsal interossei. 2. The retinacular ligaments are relaxed in full extension of the proximal interphalangeal joints and are, in this position, unable to extend the distal joints fully. This is because the interphalangeal joint surfaces are eccentric. 3. The pull of the wing tendons alters the shape of the extensor expansion and transfers the pull of the long extensor tendon from the base of the middle phalanx to the base of the distal phalanx, thus enabling full extension of the distal joint to be powerfully achieved. 4. The action of the lumbrical muscle, as an extensor of the interphalangeal joint, is demonstrated by a diagram showing its site and length in the various positions of the finger, calculated from the known excursions of the tendons. This is consistent with the observations on action potentials. 5. The phalangeal tendons of the dorsal interossei have a bifid insertion, a) into the phalangeal tubercle at the base of the proximal phalanx, and b) into the transverse band, and hence to the central tendon. The muscle acts at one or both of these attachments, according to the positions of the metacarpo-phalangeal and interphalangeal joints, in its varying functions of flexion, abduction and hyperextension. Finally an explanation of the deformity of clawing in ulnar palsy is given

We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active range of movement (AROM) of the proximal and distal interphalangeal joints and the grip strength were used for objective assessment. The mean follow-up was 34 months (12 to 49). The mean normalised Michigan hand outcome score was 84. The mean AROM of the proximal interphalangeal joint was 85° and that of the distal interphalangeal joint 48°. The mean grip strength was 92% of the uninvolved hand. Twelve patients have returned to their original occupations. There has been no radiological osteolysis or clinical osteomyelitis. This modified traction system has given acceptable results with a low rate of complications. It is light, cheap, effective and easy to apply

1. The intrinsic paralysis that occurs in leprosy has been treated by the sublimis transfer of Stiles and Bunnell for the past nine years. Since 1951 300 hands have been operated upon, and 150 patients selected geographically have been followed up in this study. 2. The patients have been assessed by a standard method involving: 1) Measurement of range of movement of the interphalangeal joint (unassisted movement, assisted active movement and passive movement); 2) grasp index; and 3) photographs of each hand in six standard positions. 3. Assessment of the open hand—The Stiles-Bunnell procedure is effective in achieving a fully open hand: 73 per cent of the fingers scored good or excellent results. A defect in the operation is that it sometimes hyperextends the interphalangeal joint, producing an "intrinsic plus" hand. 4. Assessment of sequence of joint flexion—The Stiles-Bunnell operation restores satisfactory mechanism of closure of the hand in 93 per cent of cases—that is, the metacarpo-phalangeal joints flex before the interphalangeal joints. 5. The closedfist assessment—About 30 per cent of patients had some defect in the complete closure of the fist after operation. In 5 per cent of cases the fingers did not reach the palm after operation. 6. Complications—The "intrinsic plus" defect is commonest in the best and most mobile hands. This is a late complication which gets worse in succeeding years. It can be corrected by Littler's operation together with a profundus tenodesis in the middle segment of the finger. Lateral deviation of fingers due to radial-side attachment of the transferred tendon can be avoided by ulnar-side attachment of the tendon used for the index finger. Bowstringing of the sublimis stump in the flexor sheath may be avoided by division of the sublimis at it insertion. Weakness of grasp and pinch from loss of sublimis may be avoided by using only one or two sublimis tendons split into several strands. The index finger sublimis should be left in position. 7. It is concluded that the sublimis transfer of Stiles and Bunnell is a very powerful corrective of intrinsic paralysis of the fingers. Its chief defect is that it is too powerful and produces the opposite deformity. For this reason the use of this operation should be restricted to fingers in which there is some limitation of passive extension. For fully mobile fingers an operation should be selected which does not remove the sublimis from its normal position

We treated 32 displaced mallet finger fractures by a two extension block Kirschner-wire technique. The clinical and radiological outcomes were evaluated at a mean follow-up of 49 months (25 to 84). The mean joint surface involvement was 38.4% (33% to 50%) and 18 patients (56%) had accompanying joint subluxation. All 32 fractures united with a mean time to union of 6.2 weeks (5.1 to 8.2). Congruent joint surfaces and anatomical reduction were seen in all cases. The mean flexion of the distal interphalangeal joints was 83.1° (75° to 90°) and the mean extension loss was 0.9° (0° to 7°). No digit had a prominent dorsal bump or a recurrent mallet deformity. We believe that this technique, when properly applied, produces satisfactory results both clinically and radiologically

1. The range of variation in the movements at the metatarso-phalangeal and interphalangeal joints of the big toe in fifty males has been investigated by means of lateral radiographs. 2. In the "neutral" position the proximal phalanx is dorsiflexed on the metatarsal and the distal phalanx dorsiflexed on the proximal. Sometimes the distal phalanx is plantar flexed on the proximal but this is not associated with any obvious abnormality of function. 3. There is a wide variation between individuals in the amount of movement found at these joints. 4. At the metatarso-phalangeal joint dorsiflexion is much more free than plantar flexion. The opposite is the case at the interphalangeal joint. 5. There is no significant difference between the right and left sides. Only in plantar flexion at both joints are there significant reductions in the range of movement in older age groups. These reductions are not functionally important. 6. There is an inverse relationship between active and passive dorsiflexion: the greater the range of active dorsiflexion, the less is the range of additional passive dorsiflexion. 7. In lateral radiographs the head of the metatarsal is always rounded

We reviewed the results of reconstruction of 97 upper limbs in a consecutive series of 57 tetraplegic patients, treated from 1982 to 1990. Of these, 49 had functional and eight had cosmetic reconstructions. The principal functional objectives were to provide active elbow extension, hook grip, and key pinch. Elbow extension was provided in 34 limbs, using deltoid-to-triceps transfer. Hook grip was provided in 58 limbs, mostly using extensor carpi radialis longus to flexor pollicis longus transfer, and key pinch in 68, mostly using brachioradialis to flexor pollicis longus transfer. Many other procedures were employed. At an average follow-up of 37 months, 70% had good or excellent subjective results, and objective measurements of function compared favourably with other series. Revisions were required for 11 active transfers and three tenodeses, while complications included rupture of anastomoses and problems with thumb interphalangeal joint stabilisation and wound healing. We report a reliable clinical method for differentiating between the activity of extensor carpi radialis longus and brevis and describe a successful new split flexor pollicis longus tenodesis for stabilising the thumb interphalangeal joint. Bilateral simultaneous surgery gave generally better results than did unilateral surgery

1. The claw position of a finger with intrinsic paralysis is caused by the blocking effect of the transverse lamina on the long extensor. This starts as soon as the metacarpo-phalangeal joint is hyperextended, and increases with further hyperextension. Thus the long extensor loses its pull on the interphalangeal joints and allows them to flex. Therefore, in intrinsic paralysis the claw position can be prevented or cured by keeping the metacarpo-phalangeal joint in flexion, however slight, which can be done by splinting, by tenodesis or by capsulorrhaphy. 2. Replacement of the intrinsics by some active element, although it may improve the action of the fingers, is not necessary for the correction of claw finger. The function of the intrinsics in the prevention of claw finger is not to be found in their extending effect on the interphalangeal joints, but in the flexion effect on the metacarpo-phalangeal joint, or at least in preventing its hyperextension. This is in accordance with the fact that loss of intrinsic function is disastrous only in supple fingers, in which the metacarpo-phalangeal joints tend to assume extreme degrees of hyperextension (Riordan 1953, Brand 1958). In such fingers, the wide range of hyperextension available at the metacarpo-phalangeal joints is, of course, part of a generalised laxity of the soft parts of the fingers. These soft parts generally tend to counteract the tendency to clawing; the less their resistance, the more the human finger as a whole will tend to behave like a musculo-articular model, and such a model without intrinsics will always immediately assume the claw position

1. The range of variation in full extension at the interphalangeal and metacarpo-phalangeal joints of the thumbs of 133 male and 100 female Europeans, and of 31 male Indians and 30 male Africans, has been investigated. 2. There is considerable variation between individuals in the maximum extension of both joints of the right and left thumbs in all groups studied. 3. The distribution for each joint in both thumbs in all groups is fairly symmetrical. 4. There is a high correlation between the right and left thumbs for both joints in all groups. 5. The mean angle of extension at the right and left metacarpo-phalangeal joints in all groups is similar. Female Europeans, however, show a significantly greater mean angle than male Europeans. 6. The mean interphalangeal angle of extension in male Europeans is significantly greater than that in female Europeans and the mean in the Indian and African groups is significantly greater than in the male European group. 7. There is slight negative correlation between the metacarpo-phalangeal angle and interphalangeal angle in each thumb in the European groups. 8. Many subjects in all groups can increase extension at the metacarpo-phalangeal joint after flexing the carpo-metacarpal joint. Marked hyperextension (over 40°) is more frequent in the left than in the right thumb, in females than in males, and in male Indians than in male Europeans and Africans. 9. Maximum extension at the interphalangeal joints is not related to the presence of a sesamoid bone in the anterior part of the capsule of the joint. 10. The surfaces of the metacarpo-phalangeal joints vary considerably in shape. Those which are flat form about 10 per cent. of the sample and do not show hyperextension. 11. The factors influencing the amount of extension at the interphalangeal joint is the degree of laxity of the anterior capsule. The problem at the metacarpo-phalangeal joint is more complex; both the capsule and the shape of the joint surfaces play important roles

We randomised 79 patients (84 hands, 90 fingers) with Dupuytren’s contracture of the proximal interphalangeal joint to have either a ‘firebreak’ skin graft (39 patients, 41 hands, 44 fingers) or a fasciectomy (40 patients, 43 hands, 46 fingers) if, after full correction, the skin over the proximal phalanx could be easily closed by a Z-plasty. Patients were reviewed after three, six, 12, 24 and 36 months to note any complications, the range of movement and recurrence. Both groups were similar in regard to age, gender and factors considered to influence the outcome such as bilateral disease, family history, the presence of diabetes, smoking and alcohol intake. The degree of contracture of the metacarpophalangeal and interphalangeal joints of the operated fingers was similar in the two groups and both were comparable in terms of grip strength, range of movement and disability at each follow-up. The recurrence rate was 12.2%. We did not identify any improvement in correction or recurrence of contracture after firebreak dermofasciectomy up to three years after surgery

A case is reported of a young girl who presented with macrodactyly of the right middle finger and tumour masses on the palmar side of both interphalangeal joints. The lesions were fibrocartilaginous and appeared to be hyperplastic palmar plates. The macrodactyly and the hyperplasia of the palmar plates were attributed to trauma

1. An investigation of interdigital clavus or corn does not support the opinion that it is found most often in the web of the fourth interspace. 2. Most occur in that interval, but less than a third involve the web. 3. The commonest site is the area of impingement of the distal interphalangeal joint of the fifth toe on the proximal interphalangeal joint of the fourth

1. From India a family is reported in which fifteen of fifty-seven were affected by the nail-patella syndrome. 2. Additional coincidental features not described previously were fiexion deformities of both hips and hyperextension of the interphalangeal joints of the fingers. 3. Patients affected by the condition do not always show the same blood group

There are many operations for hallux valgus and hallux rigidus, but Keller's operation remains one of the most popular, particularly for the older patient. A prospective trial was carried out to compare the results of Keller's operation modified by Kirschner-wire distraction with those of the standard operation. The results suggest that there is no advantage in using temporary Kirschner-wire distraction; indeed, degenerative changes in the interphalangeal joint and a subjectively worse result may result from its use

Immobilisation of the thumb is widely believed to be important in the management of fractures of the carpal scaphoid. To assess the need for this, we randomly allocated 392 fresh fractures for treatment by either a forearm gauntlet (Colles') cast, leaving the thumb free, or by a conventional 'scaphoid' plaster incorporating the thumb as far as its interphalangeal joint. In the 292 fractures which were followed for six months, the incidence of nonunion was independent of the type of cast used

1. A review of intra-articular and peri-articular fractures of the phalanges has been carried out, and the late results of such injuries have been examined. 2. These fractures usually unite by bone. 3. The results of conservative treatment by immobilisation are satisfactory in the case of mallet fractures, hyperextension sprain fractures and collateral avulsion fractures of the proximal phalanges. 4. The less satisfactory results after collateral avulsion fractures of the interphalangeal joints and avulsion fractures complicating dislocations are discussed

This annotation reviews current concepts on the three most common surgical approaches used for proximal interphalangeal joint arthroplasty: dorsal, volar, and lateral. Advantages and disadvantages of each are highlighted, and the outcomes are discussed.

Cite this article: Bone Joint J 2022;104-B(12):1329–1333.

We reviewed 31 patients at a mean of five years after mallet deformity of the finger had been treated with a thermoplastic splint. Intra-articular fractures were present in 35% of patients. Osteoarthritic changes had developed in 48%, most in association with fracture, and 29% had a swan-neck deformity. There was a loss of extension greater than 10° in 35%; the average deficit at the interphalangeal joint was 8.3° and the average flexion arc was 48.5°. Despite these findings, patient satisfaction was generally high, with little evidence of functional impairment

The February 2024 Wrist & Hand Roundup³⁶⁰ looks at: Occupational therapy for thumb carpometacarpal osteoarthritis?; Age and patient-reported benefits from operative management of intra-articular distal radius fractures: a meta-regression analysis; Long-term outcomes of nonsurgical treatment of thumb carpometacarpal osteoarthritis: a cohort study; Semi-occlusive dressing versus surgery in fingertip injuries: a randomized controlled trial; Re-fracture in partial union of the scaphoid waist?; The WALANT distal radius fracture: a systematic review; Endoscopic carpal tunnel release with or without hand therapy?; Ten-year trends in the level of evidence in hand surgery.

Aims

Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK.

1. Trigger thumbs present at birth can be safely watched for twelve months because there is an expected spontaneous recovery rate of at least 30 per cent. 2. Trigger thumbs in children first noticed between the age of six to thirty months can be safely watched for six months because there is an expected spontaneous recovery rate of about 12 per cent. 3. Delayed operation left no residual contracture of the interphalangeal joint provided the release was done before the age of four years. 4. Operation is recommended if the child is over the age of three years when first seen

The June 2024 Foot & Ankle Roundup³⁶⁰ looks at: First MTPJ fusion in young versus old patients; Minimally invasive calcaneum Zadek osteotomy and the effect of sequential burr passes; Comparison between Achilles tendon reinsertion and dorsal closing wedge calcaneal osteotomy for the treatment of insertional Achilles tendinopathy; Revision ankle arthroplasty – is it worthwhile?; Tibiotalocalcaneal arthrodesis or below-knee amputation – salvage or sacrifice?; Fusion or replacement for hallux rigidus?.

External fixation is useful for the treatment of selected injuries to the hand. Some authors have suggested that external fixation of a phalanx may tether the extensor hood, thereby hindering active movements and predisposing to permanent adhesions. There is no consensus as to the best site for placement of the pin to minimise these problems. This study was performed on cadaver specimens to investigate the influence of the pin site on the range of simulated active movement of the interphalangeal joint. The dorsal midline position produces least interference with the extensor mechanism; radial and ulnar to this, interdigitating oblique fibres prevent a clean longitudinal split in the direction of gliding thus limiting movement of the extensor hood. At the proximal phalanx, positioning of the pin just off the midline avoids the thickening of the proximal median hood, whereas at the middle phalanx, a true midline position utilises the bare area at its base

We examined prospectively 4719 newborn infants to determine the congenital incidence of trigger thumb. No cases were found. Fifteen other children aged from 15 to 51 months had surgery for this condition. The anomaly had not been seen at birth and all thumbs presented with a flexion contracture without triggering. The condition is usually seen after birth as a flexion contracture of the interphalangeal joint. The term ‘congenital’ is a misnomer because patients acquire the deformity after birth. The term ‘trigger’ is inaccurate as most thumbs show a fixed-flexion contracture without triggering. We suggest that rather than ‘congenital trigger thumb’ a more appropriate description of this disorder is ‘acquired thumb flexion contracture in children’. If the contracture persists after one year of age, treatment by dividing the A-1 pulley is simple and effective

Aims

This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation.

We present a system for treatment by controlled motion after repair of flexor tendons in the hand. This Washington regimen incorporates both controlled active extension against passive flexion by rubber band and the use of controlled passive extension and flexion. We utilise the Brooke Army Hospital modification of the rubber band passive flexion splint; this provides for maximal excursion of the tendon with full passive flexion of the finger. The 66 patients (78 fingers) who form the basis of this study all sustained complete laceration of the flexor profundus and superficialis tendons in "no man's land". Results were evaluated by the Strickland formula of total active motion (TAM) of the proximal and distal interphalangeal joints. Sixty-two fingers (80%) were rated "excellent", 14 fingers (18%) were "good", two fingers (2%) were "fair", none was rated "poor". Our regimen of controlled motion rehabilitation has also been applied with equal success to cases of flexor tendon grafting

1. The method of treatment of a mallet finger deformity by immobilisation in a plaster in the position of hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint is, on the whole, unsatisfactory because the splint is difficult to apply, it may need to be changed frequently, and it is sometimes complicated by pressure sores. 2. In many cases the deformity is still present after six weeks of adequate immobilisation, but gradual improvement from the contraction of fibrous tissue occurs for up to six months. Therefore an assessment of the results of any method of treatment should be made only after an interval of at least six months. 3. The subjective end results at the end of six months are satisfactory whether or not there has been efficient immobilisation in hyperextension. Few patients have any disability and only rarely is this sufficient to cause interference with normal activities. A high proportion of patients show slight persistent deformity and limitation of movement, and this is seemingly uninfluenced appreciably by the type or duration of treatment. 4. The only treatment necessary for most cases of mallet finger is the application of elastic adhesive strapping or a straight spatula splint in order to relieve the initial discomfort from the injury

We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient satisfaction was 86%. The deformity of the hallux was corrected in 80 feet. Catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications. Hallux limitus was more likely when elevation of the first ray occurred (p = 0.012). Additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p < 0.0001). The deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered. The muscle balance and stability of the entire first ray should be taken into consideration in the management of clawed hallux

1. Léri's pleonosteosis is characterised by broadening and deformity of the thumbs and great toes, flexion contracture of the interphalangeal joints, limited movement of other joints, and often a Mongoloid facies. Four such cases are described. 2. A review of the twenty reports in the literature, and the cases now described, shows that the deformities are due to capsular contracture rather than deformity of bone. 3. In one patient there was striking evidence of fibro-cartilaginous thickening of the anterior carpal ligaments. It is suggested that the primary pathological change in pleonosteosis may be in the joint capsules rather than in the epiphyses. 4. The patient with thickening of the anterior carpal ligaments had bilateral median palsy from carpal tunnel compression. 5. The causes of carpal tunnel compression of the median nerve are reviewed. Acute compression may be due not only to dislocation of the semilunar bone but to haemorrhage in the palm. Late compression by bone may occur twenty to fifty years after injury. Late compression without bone abnormality has been attributed to occupational stress, but it is suggested that pathological thickening of the anterior carpal ligament may be the cause. 6. The patient with pleonosteosis and bilateral median palsy had also bilateral Morton's metatarsalgia with large digital neuromata. 7. Plantar digital neuritis has already been shown to be an ischaemic nerve lesion preceded by degenerative changes in the digital artery. The significance of the fibrous tunnel through which the artery passes to reach the digital cleft is considered

The August 2023 Wrist & Hand Roundup360 looks at: Complications and patient-reported outcomes after trapeziectomy with a Weilby sling: a cohort study; Swelling, stiffness, and dysfunction following proximal interphalangeal joint sprains; Utility of preoperative MRI for assessing proximal fragment vascularity in scaphoid nonunion; Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review; The position of the median nerve in relation to the palmaris longus tendon at the wrist: a study of 784 MR images; Basal fractures of the ulnar styloid? A randomized controlled trial; Proximal row carpectomy versus four-corner arthrodesis in SLAC and SNAC wrist; Managing cold intolerance after hand injury: a systematic review.

Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees.

Cite this article: Bone Joint J 2021;103-B(3):430–439.

Aims

The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome.

Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the proximal interphalangeal (PIP) joint. Operations were carried out to obtain stability, followed by application of a dynamic external fixator in 20 patients with a mean age of 29 years. This provided stability and distraction, and allowed controlled passive movement. Most (70%) of the patients had a chronic lesion and the mean time from injury to surgery was 215 days (3 to 1953). The final mean range of movement was 12 to 86°. Complications included redislocation and septic arthritis, which affected the outcome. Four pin-track infections and two breakages of the hinge did not influence the result. The PIP Compass hinge is a useful adjunct to surgical reconstruction of the injured PIP joint

Aims

In the UK, fasciectomy for Dupuytren’s contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients.

Abstract

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.