No abstract

A review was undertaken of 100 patients with 218 surgically-treated syndactylies operated upon over a ten year period. The pre-operative factors which influenced the result of surgical treatment were the complexity of the syndactyly and the presence of other congenital abnormalities in the hand. The operative factor which most influenced outcome was the type of skin-graft used. 42 patients required at least one secondary operation to obtain an acceptable result, comprising 22% who developed web creep and 26% a significant flexion contracture; five patients developed both a contracture and web creep. In contrast, the type of flap used to reconstruct the web floor had little influence on the result.

77 patients with rheumatoid arthritis, 62 female and 15 male, underwent metacarpophalangeal joint arthroplasty on 375 joints using the Swanson design silicone rubber spacer between 1976 and 1985. Retrospectively, 48 of these patients were evaluated by postal questionnaire and 35 of them also underwent objective assessment at intervals ranging from five to 14 years post-operatively. Objective variables recorded included range of active motion, recurrence of ulnar drift and radiographic appearances. Both in the early and late stages, the vast majority of patients were satisfied with the outcome, with abolition of pain, correction of deformity and improved range of motion. There was some loss of mobility with time. However, functional improvement was maintained in the majority. Complication rates compare favourably with other reported series and no case of silicone synovitis was diagnosed. We agree with previous studies that the procedure is useful for lasting relief of pain and enhancement of a patient's sense of well-being and is associated with few complications.

No abstract

The evaluation and comparison of results of pollicisation for different pre-operative conditions is difficult as no standard method exists. An assessment is proposed, based upon tip pinch, opposition, pulp pinch, grasp, mobility, sensitivity and cosmetic appearance which gives a numerical score.

Between 1977 and 1988, 30 pollicisations were performed on 22 children with hypoplasia or aplasia of the thumb. A review was undertaken to grade the results. 73% were graded good or excellent, 17% fair and ten % poor. 36% required secondary surgery to achieve a satisfactory result. Better results were obtained in Blauth III or IV deformities, with poorer outcomes in Blauth V or patients with associated radial hypoplasia. Good functional and cosmetic results were found in patients operated upon at an early age. The presence of previously unreported bony spikes was a significant cause of poor mobility and was amenable to secondary surgery.

Eight hands amputated at wrist or distal forearm level were replanted between 1983 and 1990. Steinman pins were used to obtain skeletal fixation at the wrist level in three patients. Secondary surgery was performed in seven patients. Six of the patients were available for review between 1.5 and 7.5 years (mean 3.6) after the injury. The functional results were assessed using the Tamai scoring system. Recovery of useful hand function has been achieved in most patients, although long-term recovery of sensibility was found to be disappointing. Despite this finding, five out of the six patients were highly satisfied with the result and four have returned to work.

No abstract