Background

Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, “How useful are VFCs?”, and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes.

Aims

Osteonecrosis (ON) can cause considerable morbidity in young people who undergo treatment for acute lymphoblastic leukaemia (ALL). The aims of this study were to determine the operations undertaken for ON in this population in the UK, along with the timing of these operations and any sequential procedures that are used in different joints. We also explored the outcomes of those patients treated by core decompression (CD), and compared this with conservative management, in both the pre- or post-collapse stages of ON.

Four cases of carpo-metacarpal dislocation are described. In one case all five metacarpals of one hand were involved

1. Five cases of a sudden block to extension in the metacarpo-phalangeal joint of the middle finger, in middle-aged patients, are described. 2. A possible explanation is that the ulnar collateral ligament gets caught on an osteophyte on the metacarpal head

A successful replantation is reported of a hand completely severed by a circular saw through all five metacarpals. The sequence of primary reconstruction of all important structures beginning three hours after the injury and the functional results eighteen months later are presented

1. A review of seventeen patients who underwent silicone arthroplasty of the trapezio-metacarpal joint by prosthetic replacement of the base of the first metacarpal is reported. 2. Eighteen operations were performed and observed for periods varying from two to five years. 3. The technique of operation and the criteria for the assessment of results are discussed

Link arthroplasty is a system of joint replacement in which the joint is left almost intact with no great removal of bone. It is based on a two-piece self-locking hinge slotted into the metacarpal head and phalangeal shaft. The operation is simple and no special instruments are needed. The preliminary follow-up of fifty-four metacarpo-phalangeal joint replacements showed thirty-five good and sixteen fair results

A minority of cases of osteopetrosis show in addition syndactyly and distal phalangeal anomalies. The seven cases that have been reported with this combination have had an unusual degree of density and thickening of the skull vault, face and mandible, and of the shafts of the metacarpals, metatarsals, proximal phalanges and clavicles. It is submitted that these features constitute a distinct morphological variety of osteopetrosis

The technique described aims to eliminate the drawbacks of the commonly accepted operative procedures for correction of the spastic "thumb-in-palm" deformity without fusion of the thumb. In all seven patients followed up for one and a half to two years after operation the thumb regained a functional position, being held out of the palm together with the metacarpal without hyperextension of the metacarpo-phalangeal joint

Osteomyelitis is a rare manifestation of cat-scratch disease in patients who do not have AIDS. The clinical presentation and non-specific subacute course of the disease make diagnosis difficult. We present a child with osteomyelitis of a metacarpal following a dog scratch. Bartonella henselae was found to be the aetiological agent. The bone healed after treatment with antibiotics. Increased awareness and a comprehensive medical history are needed to identify patients with suspected Bartonella henselae osteomyelitis

We review the case of a 58-year-old man with a benign osteoblastic lesion. This originated in the base of the right second metacarpal and eventually involved several adjacent bones, persisting for at least 27 years despite 11 operations. It was originally reported in the literature as a recurrent osteoid osteoma, but we believe it is more properly diagnosed as an aggressive osteoblastoma, since the histological pattern did not change over the years. The lesion has remained locally aggressive with no evidence of malignant characteristics

We report a case of multicentric massive osteolysis. A 52-year-old woman presented with a three-year history of progressive deformities of the hands. She had osteolytic lesions of the metacarpals and metatarsals, and resorption of the terminal phalanges. During follow-up over four years osteolysis spread to affect the ribs, clavicles, mandible, and long bones. There was no family history of any bone disorder and renal function was normal. Death resulted from resorption of the rib cage and post-mortem studies failed to reveal the cause of the osteolysis

1. Locking of the metacarpo-phalangeal joint from articular derangements is rare. 2. A case due to an intra-articular loose body is described. 3. The literature is reviewed. The commonest cause is catching of the volar capsule or collateral ligaments on osteophytes about the metacarpal head, but intra-articular bands, incongruities of the articular surface and entrapment of the sesamoid have also been described. 4. An analysis of the reported cases suggests the likely cause in the individual patient. 5. Operation is usually required to restore joint motion

Aims

Virtual fracture clinics (VFCs) are advocated by recent British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASTs) to efficiently manage injuries during the COVID-19 pandemic. The primary aim of this national study is to assess the impact of these standards on patient satisfaction and clinical outcome amid the pandemic. The secondary aims are to determine the impact of the pandemic on the demographic details of injuries presenting to the VFC, and to compare outcomes and satisfaction when the BOAST guidelines were first introduced with a subsequent period when local practice would be familiar with these guidelines.

Two patients, a Japanese man and woman both aged eighteen, developed symptoms and signs of osteomalacia over a period of five years. Each of them had a benign osteoblastoma, one in the right fourth metacarpal and the other in the uppermost third of the right humerus. Resection of the tumours without any treatment by vitamin D resulted in rapid cure of the osteomalacia. Attempts to prove a phosphaturic humoral substance or vitamin D antagonist in the osteoblastoma of the humerus were unsuccessful, probably due to prompt excretion from the tumour cells

1. One hundred and twenty-six metacarpo-phalangeal joints affected by rheumatoid arthritis were studied macroscopically at either synovectomy or arthroplasty. 2. The sites and extent of the initial erosion corresponded with the sites and size of the synovial pouches. 3. The areas of cartilage degeneration were related to the degree of flexion, ulnar deviation and subluxation of the proximal phalanx on the metacarpal head. 4. The routine radiographic findings were not a true reflection of all the pathological changes within the joint. 5. It is suggested that by encouraging joint movement and preventing deformity the degree of cartilage degeneration may be diminished

1. A new piece of equipment, the quantitative colour television image analyser, has been introduced as providing a superior method for measuring bone density. 2. This method produces not only a numerical result but also a pattern of density distribution in the form of a seven colour contour map. 3. The changes in twenty rheumatoid hands at an interval of one year have been measured. The metacarpals and proximal phalanges always lose bone, but the metacarpo-phalangeal joint may gain in density if the disease process is far advanced. Some areas can lose 50 per cent of bone in one year