On the basis of experience, the authors recommend meticulous attention during the surgical technique. To prevent skin irritation and stitch abscess formation leading to osteomyelitis, the FiberWire loop is best cut with a knife at least 1 cm beyond the knot, allowing the sharp end of the FiberWire to lay flat adjacent to the fibula. Painful aseptic osteolytic reaction to the TightRope necessitates removal. To prevent rediastasis, a small medial incision is recommended for endobutton positioning directly abutting the tibial cortex without soft tissue interposition. Inserting the TightRope through a fibula plate prevents lateral button pull-through and rediastasis.

Surgical wrist denervation involves division of the anterior and posterior interosseous nerves and articular branches of the superficial radial nerve. In this outcome study, 37 patients were individually assessed and deemed suitable for denervation surgery due to appreciable symptom resolution following a local anesthetic wrist block. At a mean of 18 months following denervation surgery, median activity pain scores had decreased by 60% (p < 0.001) from initial assessment levels, and more than three quarters (30/37) of patients reported continued improvement in their activity pain (p < 0.001). More than two thirds of patients had a satisfaction VAS of greater than 50, with less postoperative resting pain and a greater reduction in postoperative activity pain as the important predictors of patient satisfaction. Thirty-one out of the 37 patients had not represented to our department for revision wrist surgery by a mean of 10.3 years follow-up. We have found this procedure useful in ameliorating symptoms for some patients who would conventionally have required partial or total wrist fusions with greater residual functional limitation.

of their presentation to the emergency department. None were prescribed oral antibiotics on discharge.Those patients who were admitted (n ¼ 12) were admitted to the plastic surgery or orthopaedic surgery units, with a majority being received in plastic surgery (50 from 51 patients). This is mainly attributable to the proportion of days on call for hand trauma (6:1). Of those patients who were admitted, two were transferred to the children's hospital due to their age. Surgical exploration was performed exclusively in the emergency theatres, under general anaesthesia and tourniquet. Specialist registrars performed 100% of cases. Structural damage was revealed in 83% of cases. The injuries were flexor tendon laceration (n ¼ 6), digital nerve damage (n ¼ 4) or both tendon and nerve damage (n ¼ 2). The majority of admissions were for injuries to zones II and III (5 and 6 admissions respectively). One patient presented with a laceration to the skin overlying the mandible.Oral antibiotics were prescribed on discharge to 10 patients; all were admitted patients who underwent surgery during their admission, with amoxicillin clavulanic acid (Augmentin Duo Õ ) the antimicrobial of choice (n ¼ 9). Fourteen patients were reviewed at least once postoperatively. Mean follow up was 8.4 weeks (range 1 to 36 weeks). Five of these patients dropped out of follow up and the remaining nine were discharged by the reviewing doctor. Six individuals, all with flexor tendon injury, were referred for physiotherapy. Longterm subjective complaints were seen in two individuals. One patient complained of stiffness and one patient complained of numbness associated with severed superficial digital nerve branch. Two flexor tendon repairs were lost to follow up. Longer follow up will be required for any meaningful conclusion to be drawn.To our knowledge, this is the first large study to clinically document the epidemiology and pathology of hand injuries caused by corrugated iron fences. The results indicate that the majority of the injuries are of a superficial nature, not particularly different from those caused by knives, glass and saws. Such injuries require similar treatment, consisting in repair of damaged structures. The majority of cases can be managed on an outpatient basis.

We retrospectively reviewed a consecutive single surgeon series of 57 Ascension pyrocarbon proximal interphalangeal joint arthroplasties, with a mean follow-up of 7.1 years (range 2 years to 11 years 6 months). We assessed the ranges of motion, deformity, stability and pain of the operated joints, grip strength of the hand and patient satisfaction. Of the cases, 44 were for osteoarthritis, five for rheumatoid arthritis and eight for post-traumatic arthritis. The median post-operative active arc of motion was from 0° to 60°. The median post-operative visual analogue pain score was 0.3 out of ten. Thirty six of the joints had no complications; 14 had minor complications (squeak, slight swan neck); three required early reoperation (joint release, flexor tenodesis); and five required implant removal. A total of 69% of our patients would have the same operation if they had to make the decision again. The Kaplan-Meier survival method estimates the mean implant survival to be 10.7 years (95% confidence intervals 9.96-11.37 years). All five failures occurred during the first 2 years.Level of evidence 4 (Case-series).