Forty patients with a 30° to 70° palmar displacement of a little finger metacarpal neck fracture were treated either with closed reduction and intramedullary splinting, or conservatively without reduction. Functional mobilization was started after 1 week in both groups. A radiological and clinical assessment of flexion and extension of the small finger metacarpophalangeal joint was done at 2 and 6 weeks, and at 3, 6 and 12 months. In addition patient satisfaction and grip strength were recorded at 12 months. No statistically significant differences in range of motion and grip strength were found between the two groups. Patient satisfaction and the appearance were superior in the surgically treated group. We conclude that intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic, but not a functional advantage.
Axillary block for brachial plexus anaesthesia is a popular anaesthetic technique for hand surgery with different approaches. We investigated the efficacy of the blind and ultrasound-guided approaches administered by a hand surgeon. A total of 141 patients were prospectively randomized to Group A without and Group B with ultrasound guidance. The principal variables evaluated were number of failures, duration of surgery, time to onset of anaesthesia, volume of anaesthetic injected, and complications. The success rate and the mean time to onset of anaesthesia were significantly better under ultrasound guidance. The duration of surgery and the rate of complications did not differ. Ultrasound-guided plexus anaesthesia is markedly more effective than the blind technique when performed by a hand surgeon.
Classic symmetric quarter light is a practicable lighting technique with limitations in the rendition of detail and 3-dimensionality. Slightly asymmetric lighting offered a perfect compromise, with substantially improved detail rendition and 3-dimensionality. Strongly asymmetric lighting may lead to photographic bias depending on the side of illumination. Frontal documentation of the nose with asymmetric lighting should, therefore, always be performed in duplicate, with asymmetric lighting from the right side and from the left side, to prevent misleading interpretations.
In the case of an early diagnosis, an R0 resection can usually be achieved. A safety resection margin of a minimum of 1.5 cm in the face and 3 cm for localisation on the extremities should be obtained. To reduce the local recurrence rate, adjuvant radiotherapy should be conducted. The benefit from chemotherapy still remains unclear.
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