We studied the diagnostic accuracy of MRI in 35 adult patients with traumatic brachial plexus injury in comparison with intra operative findings. The overall sensitivity to detect root avulsions was 39% and specificity was 75%. MRI was more useful in the diagnosis of lower root avulsions. At trunk and division level injuries, the sensitivity was 87% but specificity was only 26%. It was not able to differentiate the type and extent of postganglionic injuries. The accuracy of pseudomeningocele as avulsion on surgical finding was 96% (27/28). Pseudomeningocele correlates well with root avulsions. Its presence warrants early referral and surgical exploration.

Imaging techniques play an important role in evaluating the complex anatomy of bone and soft tissues of the wrist. The standard wrist radiographs and specialized views still form a very important imaging modality to unravel the wrist pathology in their simplest forms. This article discusses the routine radiography of the wrist followed by ancillary views and dynamic studies for each of the routine view described that helps reveal both static and dynamic pathologies. The literature search was carried out using the search strings or key words, and the databases were searched using the time frame of 1990 to 2011 that included Scopus, MD consult, Web of Knowledge, Pub Med, Ovid Medline and Cochrane Library. The print journals and books available at Manipal University library were hand searched and secondary search was done for the relevant articles included in the references of primary articles. Full articles as well as abstracts were used for the review.

We evaluated the outcome of new technical refinements in abdominal flap coverage of major defects in upper limb for its reliability and safety. 68 patients were assessed for indications, additional procedures, complications and DASH questionnaire evaluation at the end of a year. The mean size of flap was 56 cm 2 (range 6-250 cm 2). Median DASH score was 11.5 (range: 0-63). Hand stiffness was observed in 39% of patients. However, this was absent in whom prophylactic pinning of metacarpophalangeal joints were done in James position. Abdominal flaps give satisfactory results in hand injuries. Competent hand therapy program is essential to get best results.

Therapeutic, Level III.

No abstract

IV.

Radial longitudinal deficiency represents a spectrum of musculoskeletal hypoplasia and dysplasia affecting the upper limb involving mainly the radial aspect of the forearm, wrist, and hand and not infrequently the proximal arm. 2/3rd of the patients with this condition suffer from an associated medical or musculoskeletal disorder and 1/3rd of them show features of a well-known syndrome with systemic manifestations. Hence it is mandatory to do a detailed clinical, radiological and laboratory evaluation which should also include genetic counselling and assessment. Its management has evolved greatly since the beginning of last century. The vast variations developed for the treatment only reflects on the persisting controversy on the ideal treatment which still eludes the medical fraternity. Current treatment options for wrist deformities include radialization or centralization with or without distraction which unfortunately has often shown poor outcomes with high rates of recurrence and poor growth of ulna leading some workers to suggest alternative techniques, which include microsurgical reconstruction using the proximal fibula and the second toe. The management of the associated hypoplastic thumb has been encouraging with recent improvements in classifications and increased options for milder deformities. The article reviews the management options available for this common condition with respect to the recent developments in literature

We report a case of intraneural synovial sarcoma of the median nerve in a 39 year old lady with multiple local recurrences over thirteen years with no distant metastasis. The diagnosis of biphasic type of synovial sarcoma was confirmed by histopathology and immunohistochemistry. At the time of the fourth recurrence below elbow amputation was performed. This case is being reported for its rarity and propensity for local recurrence without distant metastasis.