A study has been made of fifty-six patients suffering from rheumatoid arthritis in whom sixty-nine wrists were fused. The purpose of the investigation was to evaluate to what extent the position of the fused wrist influenced the position of the fingers in the frontal plane. All sixty-nine wrists were followed up by radiographic examination controls, and thirty-seven of the wrists were also examined clinically. The mean period of observation after operation was seven years and ten months. The findings support the so-called "zigzag" theory based on the concept of carpus-metacarpus acting as Landsmeer's intercalated bone in a bi-articular system. When the wrists were fused in more than 5 degrees of radial deviation seventeen of twenty hands showed ulnar drift of the fingers on radiographic examination. Of the nine patients in this group examined clinically, all showed ulnar drift. A strong tendency to correction of the finger position is seen when the hands are pressed against the cassette. For this reason the clinical examination, during which the finger deviation was examined with the metacarpo-phalangeal joints in 30 degrees of flexion regularly revealed an ulnar deviation of 5 degrees more than that shown by radiographic examination. In eighteen wrists the fusion had been done in more than 5 degrees of ulnar deviation. Fourteen of these hands showed a resulting radial deviation of the fingers on radiographic examination. In a group of thirty-one wrists fused in neutral position (0 degrees±5 degrees) only six hands showed more than 5 degrees of finger deviation to either side. The condition of the metacarpo-phalangeal joints asjudged from radiographs did not seem to influence the deviation of the fingers either in direction or in degree. The direction of the deviation of the fingers was almost regularly the opposite to that of the fused wrist. Five hands showing no visible pathological changes in the metacarpo-phalangeal joints displayed finger drift

1. It was observed clinically that tactile gnosis varies directly with the sudomotor function in the hand. 2. Two methods of fingerprinting were elaborated to register the sudomotor function, and consequently the tactile gnosis objectively. They are sensitive, simple to perform and suitable for clinical work. Their anatomical background, sources of error and relative value are discussed. 3. The correspondence between the sudomotor function, determined with these methods, and the tactile gnosis was established. This was done by, firstly, comparing the regions which did not perspire with the ones which became insensible on total denervation of a region of the hand; secondly, by examining the loss of function after nerve block; and thirdly, by comparing the tactile gnosis and sudomotor function in cases of residual median nerve defect. 4. These two qualities do not accompany each other in skin grafts. Grafts regain sudomotor function but never tactile gnosis. 5. A practical procedure for determining the functional value of the cutaneous sensibility in the hand is described. 6. Cases are related illustrating the usefulness of objective study of the sensibility in the hand

Simultaneous paralysis of the ulnar, median and radial nerves is seen in about 1% of hands with nerve involvement in Hansen's disease. Forty such cases were treated between 1955 and 1976; 35 of these have been followed up. In two hands there was a high radial, median and ulnar palsy and these left no scope for reconstruction. The other 33 cases which underwent two-stage reconstructive surgery are presented here. The first stage consisted of restoring active extension of the wrist, fingers and thumb: for this purpose the ideal muscles for transfer are pronator teres, flexor carpi radialis and palmaris longus respectively, and muscle power exceeding Grade 3 (on the MRC classification) was achieved in 89%, 96%, and 100% of these individual transfers. Arthrodesis of the wrist is not recommended when suitable muscles are available for transfer. The second stage of reconstruction attempts to restore intrinsic function of the fingers and opposition of the thumb; the sublimis is ideal for both purposes and satisfactory restoration of function was achieved in 89% and 85% of cases respectively. Ten of the 18 hands in which all five tendons were transferred had good or excellent results

1 . Voluntary activity of any given muscle in the hand is not an absolute indication of the state of the nerve which usually supplies it. 2. Significant variations in the standard pattern of innervation have been found in 20 per cent of 226 cases studied. 3. The pattern of innervation described in standard text-books occurred in only 33 per cent. of cases. 4. A striking variation is the supply of every thenar muscle by the ulnar nerve. In other cases the first dorsal interosseous muscle may be supplied by the median nerve. 5. In order to arrive at an accurate diagnosis when anomalous innervation is suspected, nerve blocks at appropriate levels are required. 6. Great care must be taken during operations to avoid damage to connections between the ulnar and the median nerves, especially in patients with anomalous innervation of the hand muscles

We systematically reviewed all the evidence published in the English language on proximal interphalangeal joint (PIPJ) replacement, to determine its effectiveness on the function of the hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome with a minimum of one year’s follow-up. Quality was assessed using the Cowley systematic review criteria modified for finger-joint replacements. Of 319 articles identified, only five were adequately reported according to our quality criteria; there were no randomised controlled trials. PIPJ replacements had a substantial effect size on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1) and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach was most successful. Post-operative loosening occurred in 10% (95% CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon replacements. Post-operative complications occurred in 27.8% (95% CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not been established. Small observational case studies and short-term follow-up, together with insufficient reporting of patient data, functional outcomes and complications, limit the value of current evidence. We recommend that a defined core set of patients, surgical and outcome data for this intervention be routinely and systematically collected within the framework of a joint registry

The April 2013 Wrist & Hand Roundup. 360 . looks at: whether botox is just for Hollywood; supercharging nerve repairs; YouTube research; options for Keinbock’s disease; volar plates; driving and plasters; symptomatic radial malunion; and MRI and acute scaphoid fractures

Objectives. The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF). Methods. The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach’s α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity. Results. A total of 119 patients (mean age 58 years (. sd. 15)), 74% female, completed PROMs at a mean time of six months (. sd. 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach’s α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires. Conclusion. The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice. Cite this article: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 2018;7:36–45. DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1

1. The success of any method of treating the injured hand is to be measured by the use that is made of the remnant. 2. Careful, prompt surgical treatment of the wound will usually allow prompt healing. 3. Skin-grafts, internal fixation of fractures and the eking out and rearrangement of tissues that have escaped injury have an important place in primary treatment. 4. Many hands so treated are ready for use after one operation and within a few weeks of being injured. 5. Reconstruction in several stages should not be carried out unless it offers a reasonable prospect of improvement that will be useful to the particular patient

1. A report is presented of the method and results of treatment of sixty-nine consecutive cases of infection of the hand. 2. Excision and primary suture, combined with chemotherapy and immobilisation in plaster, was the method of treatment. 3. The results, from the point of view of rapidity and completeness of recovery, justify consideration of the method for further use

1. The occurrence of multiple centres of ossification in the epiphyses of the long bones of the hand and foot is shown to be frequent, and in the first metatarsal and first proximal phalanx of both hand and foot in both sexes the normal pattern of epiphysial ossification must be regarded as taking place in this way. 2. Multiple centres of ossification are shown to occur simultaneously in several epiphyses of the same hand or foot. 3. There seems to be a relationship between the shape of an epiphysial area and the pattern of ossification occurring within it. 4. Care should be taken to avoid confusing these normal patterns of ossification with radiological appearances caused by pathological changes

Little has been published about the Krukenberg operation, which has been regarded as primarily indicated for the blind patient with bilateral hand amputations. Of the 35 Krukenberg cineplasty operations I have performed in the last 36 years, only two have been on blind patients. The operation provides forearm amputees with pincers which allow them to perform tasks without a prosthesis, but does not preclude the use of any type of aid. The author's operative procedure is described and the results illustrate its practical application for most patients

In ten cases definitive loss of sensibility in an important territory of the hand has been treated by a hetero-digital, neurovascular skin island transfer. Operative technique and results obtained are reported. Although not enough patients have been treated to allow us to give precise indications for the procedure, two such indications clearly emerge: 1) the treatment of insensitive digits; 2) the reconstruction of the thumb or fingers. The procedure could probably be used elsewhere than in the hand