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Congenital Palmar Duplication of the Index Finger: Ventral Polydactyly With Ventral Dimelia
This report describes the case of a 10-month-old boy who presented with a duplicated index finger enveloped by palmar skin on the palmar side of the first web of the left hand. He was healthy without any other abnormalities except the hand anomaly. Surgical resection of the extra finger was performed with triangular flap at 15 months of age. The resected finger was composed of only palmar components: skin without nail or hair; flexor tendons; and digital nerves branching from the median nerve. Histological examination of the specimen demonstrated similar structures on both palmar and dorsal sides, that is, ridged, hairless, and glabrous skin with a high number of epithelial layers and thick corneous stratum and similar shaped tendons inserted into the symmetrical phalanx.A Rare Case of Rosai-Dorfman Disease Affecting the Brachial Plexus: A Case Report
Sinus histiocytosis with massive lymphadenopathy or Rosai-Dorfman disease is a rare but well-established entity, commonly affecting the lymph nodes of the head and neck. Extranodal presentation, affecting the central nervous system, eye orbit, kidneys, testis, bones, upper respiratory tract, lungs, thyroid, small intestine, and peritoneum, has been reported. We present a case of a rare presentation of Rosai-Dorfman disease affecting the brachial plexus.Wrist Reconstruction Using Free Vascularized Fibular Head Graft Following Intralesional Excision for Campanacci Grade 3 Giant Cell Tumors Involving the Articular Surface of the Distal Radius
Reconstruction with a free vascularized fibular head graft after en bloc excision of a Campanacci grade 3 giant cell tumor of bone in the distal radius can effectively control local recurrence. However, it leads to the loss of wrist movement, subsequent radiocarpal subluxation, and an osteoarthritic change. Another treatment option for grade 3 lesions is intralesional excision and cementation, which preserves wrist movement but does not restore the articular surface. We report a case of wrist reconstruction using a free vascularized fibular head graft after the intralesional excision of a Campanacci grade 3 giant cell tumor of bone with invasion of the articular surface of the distal radius.Photobacterium damsela Necrotizing Fasciitis of the Arm
Photobacterium damsela is a gram-negative bacterium that is known to cause infection, most commonly in marine animals and rarely in humans. Photobacterium damsela typically results in skin and soft tissue infections in humans and has been associated with necrotizing fasciitis in several case reports. After an initially benign presentation, P damsela necrotizing fasciitis often progresses rapidly to multiorgan failure and death. Here, we present a fatal case of P damsela necrotizing fasciitis after a minor cut while scaling a fish with a discussion of current literature and treatment strategies.Forequarter Replantation
Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically, forequarter amputation has been treated with hemorrhage control, wound debridement, and soft tissue coverage. To our knowledge, successful forequarter replantation has not been previously reported. We present a rare case of forequarter amputation treated successfully with replantation. At the 4.5-year follow-up after replantation, the patient had antigravity elbow flexion, modest shoulder elevation, modest extrinsic finger function, and crude sensation.Posttraumatic Arthrosis and Triquetral Nonunion Associated With Pisotriquetral Subluxation in Adolescent Female Softball Players
Impaction fracture subluxation of the pisotriquetral joint producing arthrosis and ulnar triquetral osteochondral nonunion is a cause for ulnar wrist pain in batting athletes. Two cases of adolescent female softball players managed successfully with pisiform and triquetral fragment excision are reported.Digital Papillary Adenocarcinoma in the Dorsal Proximal Ring Finger
Digital papillary adenocarcinoma (DPA) is a rare and aggressive tumor arising from the eccrine sweat glands. It is found on the hands and feet and most commonly occurs on the volar and distal finger tips. In this report, we describe a DPA in a 45-year-old woman who presented with a slowly enlarging mass on the dorsal aspect of her proximal ring finger. This report shows that DPA may clinically present as a relatively benign-appearing mass and in an atypical location. Surgical excision, followed by histologic and immunohistochemical evaluations of even benign-appearing digital masses, is important because this is the only way a DPA can be diagnosed.Osteochondrolipoma of the Hand
Lipoma is the most common type of benign soft tissue tumor and is composed of mature adipose tissue. A neoplasm of adipose tissue with admixed mature bone and cartilage, or osteochondrolipoma, is an extremely rare histologic variant. Most documented osteochondrolipomas have occurred in the soft tissues of the head and neck related to the oral cavity, and the tumor is seen involving the extremities. A fatty mass with nonlipomatous elements can present a diagnostic challenge. We present a rare case of osteochondrolipoma involving the wrist.Traumatic Osteonecrosis of the Distal Ulna
A 46-year-old male was referred to our clinic for persistent ulnar-sided wrist pain 9 weeks after sustaining a traumatic injury while playing volleyball. The patient unsuccessfully underwent nonoperative management for a suspected injury to the triangular fibrocartilage complex. After magnetic resonance imaging revealed a lesion of the distal ulna, he was treated with diagnostic wrist arthroscopy and Bowers hemiresection. The diagnosis of osteonecrosis was confirmed through histology. While traumatic osteonecrosis of the carpal bones has been described, no previous literature was found on traumatic osteonecrosis of the distal ulna.Epithelioid Sarcoma Presenting in the Thumb of a Child
Epithelioid sarcoma (ES) is a high-grade, soft tissue tumor of mesenchymal origin that rarely occurs in children and is often misdiagnosed as a benign entity. We present the case of a 12-year-old girl with a delayed diagnosis of ES of the left thumb. Radiological examination showed possible calcinosis from inflammation or traumatic injury. However, histopathological and immunohistochemistry studies showed findings consistent with a diagnosis of ES. She was treated with amputation of the interphalangeal joint of the left thumb.Atypical Pleomorphic Lipomatous Tumor of the Right Hand Mimicing Venous Malformation
We present the case of a 31-year-old woman who was referred with a 12-month history of a tumor on the ulnar side of her dominant right hand. The eventual histopathologic diagnosis was an atypical pleomorphous lipomatous tumor, an entity that has only been recently classified in the World Health Organization Classification of Soft Tissue and Bone Tumors.Pedicled Osteo-Onchyocutaneous Island Flap for Finger Macrodactyly: A Review of Literature
We present a case of middle finger macrodactyly reconstructed in a single stage using multiple techniques. We elevated a pedicled osteo-onychocutaneous island flap, excised the remnant distal phalanx with a segment of 1 digital nerve and skin over the dorsum of the middle phalanx, performed epiphysiodesis and reduction of the middle phalanx as well as soft-tissue debulking, and inset the flap over the dorsum of the middle phalanx. Follow-up at 12 months revealed a satisfactory aesthetic and functional outcome.Septic Arthritis of the Proximal Interphalangeal Joint After Rattlesnake Bite
Snake bites are an uncommon injury requiring intervention by hand surgeons. While counteracting the effects of snake venom is the initial and urgent concern following a bite, infection caused by retention of a foreign body can present in a delayed fashion and may lead to increased morbidity. Standard radiographs of the injury should be carefully examined for foreign bodies, noting that retained snake teeth are somewhat radiolucent due to less mineralization as compared to bone and can be difficult to visualize.Upper-Extremity Phlegmasia Cerulea Dolens With Compartment Syndrome in Coronavirus Disease 2019 Sepsis
A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for chemotherapy administration. On hospital admission day 9, she developed acute right upper-extremity edema and pain. Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein. Her examination result was consistent with acute phlegmasia cerulea dolens and compartment syndrome, but respiratory instability prevented transfer and vascular surgery intervention.A Rare Presentation of Extensor Pollicis Longus Tendon Rupture After Nondisplaced Scaphoid Fracture
Extensor pollicis longus tendon rupture is a reported complication after nondisplaced distal radius fractures. These are thought to occur secondary to mechanical irritation or compromised blood supply. We present a case of extensor pollicis longus rupture after a healed nondisplaced scaphoid fracture, which may have involved a similar attritional process. We are unaware of any prior reports of extensor pollicis longus rupture after this type of injury.Intractable Fractures of the Bilateral Proximal Ulnae After 8 Years of Zoledronate Treatment for Breast Cancer Bone Metastasis
Long-term administration of bisphosphonates strongly suppresses osteoclastic bone resorption and rarely causes atypical fractures. This report presents a case of bilateral atypical ulnar fractures, following an 8-year course of zoledronate to treat breast cancer bone metastasis. Nonsurgical treatment for the left ulnar fracture failed, in spite of minimal displacement with callus formation at initial presentation. After failure of plate fixation with a pedicled vascularized bone graft, removal of osteosclerotic lesions and plate fixation with corticocancellous iliac bone graft resulted in bone healing, although the healing process took 1.5 years.Osteoblastoma of the Distal Radius
Osteoblastomas are rare, benign, bone-forming neoplasms that represent less than 1% of all bone tumors and occur mostly in people aged 10 to 30 years. In long bones, the metadiaphyseal region tends to be most commonly affected. However, to the best of our knowledge, only 11 cases have been reported to occur in the distal radius. We present the clinical, radiological, and histopathological findings of an osteoblastoma of the right distal radius in a 42-year-old woman for whom an open excisional biopsy with nidus removal comprised the treatment and produced a good outcome.Isolated Scaphoid Dislocation With Radial-Axial Instability: A Treatment Strategy Utilizing Spanning Wrist Plates
Isolated dislocation of the scaphoid is a rare injury with only a few case reports in the literature. We report on 2 complex scaphoid dislocations demonstrating concomitant axial instability with disruption of the capitohamate articulation as well as the long–ring metacarpal relationship. Both of these patients underwent reduction and fixation using a wrist spanning plate, which was removed approximately 2 months after injury. Follow-up of these patients demonstrated maintenance of reduction, axial stability, and return of painless range of motion.Atypical Presentation of Juvenile Hyaline Fibromatosis of Hands
Juvenile hyaline fibromatosis is a rare disorder characterized by an extracellular accumulation of hyaline deposit. In the extremities, lesions may remain quiescent or gradually increase in size, eventually resulting in skin ulceration. There is no curative treatment. Surgery may allow some recovery of function, but recurrence is possible. We report a case of juvenile hyaline fibromatosis in both hands of a 25-year-old man who required multiple surgical procedures to address problems with function, pain, and appearance.Surgical Excision of a Thrombosed Persistent Median Artery in a Professional Hockey Player
A persistent median artery is a rare anatomical variant found in approximately 10% of the population. Carpal tunnel syndrome due to a thrombosed persistent median artery is exceptionally rare. A 29-year-old professional hockey player presented with a 2 months history of hand pain and intermittent paresthesias without vascular symptoms. Magnetic resonance imaging and angiography demonstrated a 2-cm thrombosis in a persistent median artery at the level of the carpal tunnel, with otherwise normal vascular anatomy.Solitary Subungual Orf
Orf—ecthyma contagiosum—is an endemic cutaneous disease caused by parapoxvirus that is transmitted via direct contact with contagious animals. The lesions are located frequently on the hands and fingers. Subungual presentation of orf is very rare. We report a case of solitary subungual orf. Suspicious subungual nodular lesions may be cases of orf, especially in endemic areas. Orf disease should be considered in the differential diagnosis of subungual nodular lesions to avoid unnecessary surgical interventions.Open Excision of Olecranon Melorheostosis to Relieve Elbow Extension Block
We report a 34-year-old man who presented with hyperostosis of his right elbow associated with an inability to fully extend his elbow. The radiographic assessment revealed a classical dripping candle wax appearance of his proximal ulna suggestive of melorheostosis. Computed tomography was performed to identify the impingement point and aid in surgical planning. A targeted open excision biopsy via a Boyd incision was performed to excise the exophytic component that was causing the functional block.A Rare Case of Cutaneous Trichophyton verrucosum of the Forearm in a 51-Year-Old Cattle Farmer
Trichophyton verrucosum is a pathogen causing superficial mycoses in cattle worldwide and is one of the few zoophilic dermatophytes. Farmers and veterinarians are at a higher risk for infection owing to frequent direct animal contact. An increase in cases among humans has been observed in the past few years. We report a rare case of T verrucosum of the forearm in a 51-year-old cattle farmer, who after initial treatment with antibiotics and surgery, and in whom diagnosis was delayed, was finally successfully treated with terbinafine and itraconazole.Heterotopic Ossification After Revision Carpal Tunnel Release Causing Mixed Ulnar and Median Compression Neuropathy
We report a case of heterotopic ossification formation 6 years after a revision carpal tunnel release in a 46-year-old woman, causing new-onset mixed ulnar and median nerve compression symptoms. The patient underwent excision of the heterotopic ossification mass along with decompression of the median and ulnar nerves, and postoperative radiation. Four years after treatment, the patient was completely asymptomatic with full range of motion in her hand and wrist.The Medial Metaphyseal Periosteal Artery (MMPA): An Alternate Pedicle for the Medial Femoral Trochlea Flap
We report a case of medial femoral trochlea flap used for scaphoid proximal pole reconstruction, in which the transverse branch of the descending genicular artery was vestigial. The medial metaphyseal periosteal artery was clearly the dominant pedicle supplying the trochlear region. The flap was safely raised on the medial metaphyseal periosteal artery pedicle. The incidence of this uncommon presentation remains unknown and this anatomical variant is newly described.Ulnar-Sided Digital Nerve Tumor of the Thumb in the Professional Baseball Player Who Uses Grip-Adjusting Batting Equipment: A Report of 2 Cases
Neuropathy of the ulnar digital nerve of the thumb is a relatively rare clinical entity. We report 2 cases of ulnar-sided digital nerve tumors of the thumb in 2 professional baseball players who routinely used grip-adjusting batting equipment. Symptomatic relief was achieved with nonsurgical treatment that allowed both players to continue playing during critical times during their season. We postulate that there may be an association with the grip-adjusting batting equipment and the development of digital neuropathy.Extensive Tumoral Calcinosis of the Hand
Tumoral calcinosis is a rare and benign subtype of calcinosis cutis, a group of disorders involving soft tissue calcium deposition. Only 250 cases have been described since 1898; hand involvement is exceedingly rare. We report a case of extensive calcinosis within the flexor sheath of the little finger. Presentation included a painful mass over the volar aspect of the little finger, restricted digit motion, and skin compromise at the site of the mass. Surgical debulking was performed resulting in restoration of finger function.Parosteal Lipoma of the Proximal Phalanx of Hand
Parosteal lipomas are rare benign tumors accounting for less than 0.1% of all primary bone tumors. Only 3 cases of parosteal lipoma have been previously described affecting the distal and middle phalanges. We describe a case of parosteal lipoma in a 45-year-old man involving the proximal phalanx of the right middle finger. The tumor was marginally excised with the osseous attachment. There was no clinical or radiological recurrence at a follow-up of 2 years, with full range of movement at the proximal interphalangeal joint.Spontaneous Bone Regeneration of Distal Half Ulnar Segment After Open Fracture of Forearm in a Pediatric Case
Loss of the radius with open fractures of the forearm is rarely reported in pediatric cases and to the authors’ knowledge, cases of segmental loss of the distal half of the ulna have not been previously reported. A 6-year-old girl was admitted with a Gustilo-Anderson type IIIB open forearm fracture and loss of the distal half of the ulna after a motor vehicle accident. Serial debridement was performed and a Kirschner wire was inserted into the distal half of the ulna. Unexpectedly, the ulna regenerated and the defect healed 4 weeks later.Locally Advanced Pleomorphic Dermal Sarcoma of the Forearm
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor that shares pathological features with atypical fibroxanthoma, but also exhibits tumor necrosis, invasion beyond the superficial subcutis, and vascular or perineural infiltration. In addition, PDS also has relatively high rates of local recurrence and metastasis and is usually encountered in elderly men, especially in the head and neck area. In this article, we report a rare case of PDS that infiltrated the fascial tissues in the forearm of a female patient.Persistent Trigger Finger Due to Tendon Subluxation
We report the case of an adult patient with persistence of triggering after A1 pulley division in the ring finger, which was caused by flexor digitorum superficialis tendon subluxation. This resolved after longitudinal flexor digitorum superficialis tendon separation.Revascularization of a Circumferential Hand and Forearm Degloving Injury Using an Arteriovenous Shunt
Major upper-extremity degloving injuries with distal dysvascularity are rare and challenging surgical problems. When these degloving injuries occur over nonexpendable regions, such as the glabrous skin of the palm and digits, revascularization or replantation may be the treatment of choice. Because the degloved skin flap is often separated in the suprafascial plane, direct arterial repair may be impossible. We present a rare case of circumferential degloving of the hand and forearm with distal dysvascularity, treated successfully with revascularization with arterial anastomosis, venous anastomosis, and arteriovenous shunt creation.Volar Tilt of the Lunate After Open Reduction Internal Fixation of a Distal Radius Fracture
The pathophysiology of carpal adaptations after fracture of the distal radius is incompletely understood. We report 5 patients who had normal carpal alignment on injury radiographs that developed marked volar angulation of the lunate during recovery from volar plate fixation of a fracture of the distal radius. There were no signs of alteration of the carpal ligaments. Two patients had similar volar tilt on the contralateral side. The cause and optimal treatment of carpal malalignment after restoration distal radial alignment are unclear.Hedgehog-Transmitted Trichophyton erinaceid Causing Painful Bullous Tinea Manuum
Trichophyton is a species of fungus that commonly infects hedgehogs. As the popularity of keeping hedgehogs as pets increases, there have been reports of Trichophyton species infection in humans. Diagnosis and appropriate treatment of Trichophyton infection can be delayed owing to physicians’ low index of suspicion and unfamiliarity with the physical manifestations. We describe a case of a 27-year-old healthy man who developed tinea manuum after handling a pet hedgehog. Presenting symptoms included a worsening bullous eruption and severe pain.A Variant of Madelung Deformity: Management of the Distal Ulna Within the Carpal Canal
Madelung deformity is a rare disease that affects the normal growth of the distal radius and occurs in 1.7% of all pediatric congenital hand deformities. It is characterized by progressive deformity and shortening of the radius at the distal radial physis owing to anomalous tethering of the ulnar-volar growth plate. The distal ulna overgrows the radius and usually displaces dorsally. As growth continues, the carpals assume a wedge shape. Deformity, pain, and functional limitations are the usual presenting problems.Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Intractable Pain Originating From a Lipofibromatous Hamartoma of the Median Nerve
This case report presents an application of peripheral nerve stimulation to the median nerve to treat a patient with intractable pain due to a lipofibromatous hamartoma of the left upper extremity. Ultra high-frequency ultrasound was used to determine the boundaries of the hamartoma. The patient then underwent an ultrasound-guided implantation of 2 stimulator electrodes distal to the elbow along the median nerve with stimulation coverage achieved at 1.2 and 1.4 mA, respectively. After an uneventful procedure, the pain score immediately decreased from 9 out of 10 to less than 6 on a numeric rating scale.Giant Cell Tumor of the Ring Finger Distal Phalanx
Giant cell tumor (GCT) is a benign but locally aggressive neoplasm generally located in the epiphysis and metaphysis of the long bones. Its occurrence in the bones of the hand is rare. Giant cell tumors occurring in the hand account for only 2% of all the GCTs reported. The epimetaphyseal region of short long bones is a common site of GCTs in the hand; however, a phalangeal GCT originating in the distal phalanx is extremely rare. We present the clinical, radiological and histopathological findings of a case of GCT of the distal phalanx of the left ring finger presenting with a fungating mass and treated with en bloc resection by disarticulation of the distal interphalangeal joint.Gorham Disease Limited to the Left Upper Extremity Without Hand Involvement
In this case report, we present a young female patient with a history of Gorham disease, who sustained pathologic fractures of the left radius and ulna after a low-impact fall. Massive osteolysis of the left forearm and wrist was noted on plain radiographs. The patient had had 8 previous left upper-extremity fractures without evidence of disease in any other area of the body.Pediatric Olecranon Osteochondral Flap Fractures With Subtle Radiographic Abnormality
Pediatric olecranon osteochondral flap fractures are shear injuries of the humeroulnar joint with elevation of an articular cartilaginous flap from the subchondral bone of the olecranon articular surface. All previously reported cases included an osteochondral flap containing the coronoid, with varying imaging and fixation methods used. We treated 2 pediatric patients with this injury. One of our patients had a large, displaced osteochondral fracture of the medial semilunar notch including the coronoid, in addition to avulsions of the medial flexor mass and distal ulnar collateral ligament.Unusual Manifestation of Chronic Lymphocytic Leukemia in the Hand
Chronic lymphocytic leukemia (CLL) involving the hand, especially with bone involvement, is extremely rare. We report a case of a 62-year-old man, with a 4-year history of a subclinical CLL, presenting with chronic swelling and pain over the dorsal surface of the right hand, mimicking an infectious process. There was no clinical response to broad-spectrum antibiotics and topical corticosteroid therapy. Imaging was inconclusive. A tissue biopsy revealed a manifestation of the underlying leukemia.Hand Deformities in Hajdu-Cheney Syndrome: A Case Series of 3 Patients Across 3 Consecutive Generations
Hajdu-Cheney syndrome is a rare condition characterized by acro-osteolysis, osteoporosis, and multiple craniofacial anomalies. The goal of treatment is to reduce the associated symptoms and to prevent osteoporotic fractures. This is a report of 3 patients across consecutive generations demonstrating variable phenotypic severity. The hand surgeon was the first medical care provider visited by the patients because of the shortening of the fingers.Mycobacterium bolletii Osteomyelitis of the Metaphyseal Distal Radius Treated With Amikacin Antibiotic Beads
Mycobacterium bollettii, a subset of the group M. abscessus, is a slow-growing, nontuberculous mycobacterium that was first characterized in the early 2000s. We report a case of M. bollettii infection in an otherwise healthy 49-year-old man who sustained an open fracture of the right distal radius. After his initial surgery, the patient presented 1 month later with wound drainage requiring hardware removal and was treated with intravenous antibiotics. However, there was a persistent infection. We treated his osteomyelitis with debridement and placement of amikacin antibiotic beads.Rapidly Progressive Soft Tissue Infection of the Upper Extremity With Aeromonas veronii Biovar sobria
Aeromonas veronii, a bacterium found in freshwater, is an unusual pathogen in healthy patients. We present a case report of a rare, aggressive subtype in a young, immunocompetent individual. History of injury in an aquatic environment and culture data are key for identification of the causal agent and should dictate acute clinical management and antibiotic therapy. Coverage should include cephalosporins, quinolones, or sulfas if Aeromonas is suspected, and adjusted depending on culture and sensitivity.Topical Treatment for Cutaneous Mucormycosis of the Upper Extremity
Mucormycosis is a relatively rare but extremely aggressive fungal infection that commonly affects patients who are compromised hosts. These infections typically come in various patterns: pulmonary, sinus, rhinocerebral, cerebral, cutaneous, or disseminated forms. Treatment usually consists of a combination of antifungal agents and surgical debridement, although morbidity and mortality are high. In this case report, we describe the course of a patient with a disseminated Mucor infection, primarily involving the upper extremities, who was successfully treated with topical and systemic antifungal agents without the need for surgical intervention.Ulnar Artery Aneurysm as a Late Sequela of Marfan Syndrome
Marfan syndrome (MFS) is a connective tissue disorder caused by mutations of the FBN1 gene encoding fibrillin-1, which leads to overexpression of transforming growth factor-β, increased hyaluronan deposition, and matrix metalloproteinase activity in the media of the aorta and other muscular arteries. Marfan syndrome patients present with connective tissue laxity and aneurysmal changes to muscular arteries. Successful medical and surgical intervention has prolonged the life expectancy of MFS patients, which can allow atypical presentations of the syndrome to manifest.Pathological Findings of Hourglass-Like Constriction in Spontaneous Posterior Interosseous Nerve Palsy
We report the pathological findings of hourglass-like fascicular constriction (HLFC) under optical and electron microscopy. A 24-year-old man with spontaneous posterior interosseous nerve palsy was treated by interfascicular neurolysis at 29 weeks after onset. One fascicle in the radial nerve presented severe HLFC with torsion at 5 cm proximal to the elbow. Functional recovery was achieved by resection of the enlarged fascicle including HLFC and sural nerve grafting. Proximal to the HLFC, the endoneurium was filled with clusters of regenerating nerve fibers.Iatrogenic Femur Fracture Following Medial Femoral Condyle Flap Harvest
A case of iatrogenic femoral fracture after harvest of a medial femoral condyle flap is presented. The procedure was performed for a recalcitrant nonunion of the clavicle that required a flap of 6 × 1 × 1 cm. The patient suffered a supracondylar fracture at the proximal extent of the flap harvest site 3 weeks after surgery, requiring surgical fixation of the femur.Targeted Muscle Reinnervation in the Hand: Treatment and Prevention of Pain After Ray Amputation
Targeted muscle reinnervation (TMR), originally developed as an experimental technique for prosthetic control, has been shown to be safe and effective for the treatment and prevention of postamputation pain. Targeted muscle reinnervation involves coaptation of residual nerve ends to nearby motor nerve branches of healthy but expendable muscles proximal to an amputation. It has been shown to prevent and reduce residual limb pain and phantom limb pain after major upper and lower extremity amputation.Bilateral Plexiform Neurofibromas of the Posterior Interosseous Nerve Mimicking Dorsal Wrist Ganglions
A 33-year-old woman presented with bilateral dorsal wrist masses associated with pain and limited range of motion. On initial presentation, the masses were believed to be ganglion cysts and the patient opted for observation. Three years later, she was found to have a chest wall mass diagnosed by biopsy to be a neurofibroma. When she later returned to seek treatment for her wrist masses, magnetic resonance imaging demonstrated posterior interosseous nerve (PIN) neurofibromas. Dorsal wrist masses situated over the scapholunate interval are commonly attributed to ganglion cysts.Linear Morphea With Inflammatory Myositis
Morphea is an autoimmune disorder characterized by sclerosis and inflammation of the skin and soft tissues. Early diagnosis and treatment are essential to minimize morbidity such as joint contracture. In this report, we present the case of a 19-year-old man with linear morphea with inflammatory myositis who presented to our clinic 1 year after symptom onset with severe elbow flexion contracture. Through reviewing this rare disorder, it is hoped that early diagnosis will lead to better outcomes in the future.Radial Artery Occlusion in a Patient With Lupus, Antiphospholipid Syndrome, and Raynaud Phenomenon: A Multimodal Approach
Radial artery occlusion (RAO) is a known complication of transradial catheterization for cardiac procedures. The transradial approach has decreased bleeding complications compared with the transfemoral approach, but risks provoking hand ischemia. We present a case of a 29-year-old peripartum woman with a history of lupus, antiphospholipid syndrome, and Raynaud phenomenon who developed RAO with hand-threatening ischemia despite therapeutic anticoagulation. Given the patient’s medical history, a multimodal approach was applied including thrombectomy, arterial bypass, venous arterialization, and onobotulinum toxin A sympathectomy.Cutibacterium (Propionibacterium) acnes Infection of the Native Wrist Joint
Cutibacterium (Propionibacterium) acnes (C. acnes, previously known as P. acnes) is an anaerobic organism that commonly colonizes the human skin. After Staphylococcus spp. and Streptococcus spp., it is a common organism associated with deep prosthetic shoulder joint infections. We describe the case of rapidly progressive arthropathy of the native wrist secondary to infection with C. acnes. Diagnosis was made on prolonged enrichment cultures. The patient went on to complete a long-term course of oral sulfamethoxazole-trimethoprim with clinical improvement.Lower Trapezius Muscle Transfer for Elbow Extension Reconstruction After Failed Nerve Transfer for Tetraplegia
Reconstruction of elbow extension is a first priority in the surgical management of patients with tetraplegia. Traditionally, posterior deltoid and biceps to triceps muscle transfers were used, but in recent years, nerve transfers have become the preferred choice of a few surgeons. However, nerve transfer reconstruction failures exist, often related to poor donor nerves, prolonged intervals between the injury and surgery, and advanced patient age. As a valid surgical alternative in such cases, we propose transferring the lower trapezius muscle to reconstruct elbow extension, because this procedure is already being performed successfully in patients with brachial plexus injury.Pedicled Serratus Anterior Flap as an Alternative Muscle Target for Targeted Muscle Reinnervation in Transhumeral Amputees
Upper limb amputation is a universally devastating injury that results in substantial loss of function. Myoelectric prostheses represent a new generation of battery-powered programmable prostheses controlled by EMG signals. The aim of upper limb targeted muscle reinnervation (TMR) is to enhance the control of a myoelectric prosthesis by improving the number and quality of EMG signals that can be used to control prosthetic elbow, wrist, and hand movements. Current TMR techniques rely on preservation of parts of biceps and triceps to be used as reinnervated muscle targets.Parosteal Osteosarcoma of the Proximal Phalanx of a Finger
Osteogenic sarcoma of the hand is very rare and fewer than 50 cases have been reported. There are only 2 previously reported cases of parosteal osteosarcoma involving the phalanges. We report a primary parosteal osteosarcoma involving the proximal phalanx of the right middle finger in a 20-year-old woman, which was managed by ray amputation. There was no evidence of local recurrence or systemic metastasis in the postoperative follow-up period of 2 years.Successful Digital Revascularization in a Patient With Factor V Leiden Mutation
Replantation/revascularization involves microsurgical anastomosis of the digital arteries and veins, which are often 2 mm or less in diameter. Thrombosis is a known risk of revascularization that ultimately can lead to ischemic digital loss. Factor V Leiden mutation is present in 3% to 8% of the population and results in generalized hypercoagulability. We present the case of a single-digit revascularization that was successful following vein grafting in a patient with factor V Leiden mutation.An Extraosseous Ewing Sarcoma of the Index Finger Masquerading as a Benign Tumor
Ewing sarcoma is a malignant, small, round, blue cell tumor that often affects the long bones and pelvis. It is rarely seen in the bones of the hand. A minority of Ewing sarcoma cases arise in soft tissue. This case report details the clinical and radiological presentation of an extraosseous Ewing sarcoma of the index finger in a 22-year-old woman. Treatment consisted of an index ray amputation followed by adjuvant chemotherapy. After 1 year, the left hand had excellent function with an acceptable cosmetic appearance and no evidence of metastasis or local recurrence.Multicentric Reticulohistiocytosis: Elective Excision of Symptomatic Hand Nodules With 1-Year Follow-Up
Multicentric reticulohistiocytosis is a rare non–Langerhans cell histiocytic rheumatologic disorder characterized by multiple skin lesions, painful hand nodules, and destructive polyarthritis that results in arthritis mutilans in 20% to 30% of patients. In the current literature, there have been approximately 300 cases reported and the pathogenesis remains unclear. Currently, there is no diagnostic serologic test and no consensus on management. In this case report, we present a patient with multicentric reticulohistiocytosis who was treated with selective excision of 3 painful nodules on the hand.Synovial Hemangioma of the Wrist With Cystic Invasion of Trapezoid and Capitate Bones
Synovial hemangiomas (SHs) are rare lesions of the joints or tendon sheaths that are difficult to diagnose. We present the case of an 18-year-old man with an SH in the wrist joint. Physical examination revealed a slightly tender, ill-defined, nonpulsatile soft mass, 3 cm × 3 cm in size on the dorsal aspect of the left wrist. Computed tomography showed an irregular, ill-defined, soft tissue mass in the expanded joint space, which was formed by the scaphoid, trapezoid, and capitate bones. Magnetic resonance imaging showed the typical features of SH and also revealed cavitary erosion of the scaphoid, trapezoid, and capitate bones.Cutaneous Histoplasmosis in a Renal Transplant Patient Presenting With Hand and Forearm Necrotizing Myofasciitis
Histoplasmosis rarely manifests as a primary infection of the extremities, but when it does, the damage inflicted can be severe. We present a case report of cutaneous histoplasmosis of the upper extremity due to direct inoculation in a renal transplant patient, presenting as myofasciitis. The patient initially had a salvaged upper extremity that was functional, but a persistent infection recurred with aggressive myofasciitis requiring a subsequent amputation.The Modified Vilkki Procedure: Vascularized Metatarsophalangeal Joint Transfer to Reconstruct a Full-Length Radius in Type III Radial Hypoplasia
Radial longitudinal deficiency is a spectrum of deformity ranging from thumb hypoplasia to a shortened or absent radius. Traditional treatments are hindered by recurrent deformity and disruption of future forearm growth. These deficiencies can be addressed by a Vilkki procedure in which a free second toe metatarsophalangeal joint is used to restore a radial column and provide viable physes for continued forearm growth. A classic Vilkki procedure positions the proximal toe metacarpal on the native ulna to create a Y-shaped one-bone forearm.Congenital Hypoplasia of the Extensor Tendons of the Fingers: A Case Report and Review of the Literature
We present a rare case and unusual presentation of digital extensor tendon congenital hypoplasia. A 34-year-old woman presented to our clinic with the inability to extend her index, middle, and ring fingers since birth. Her tendons were reconstructed using transfer of flexor digitorum superficialis tendons from the middle and ring fingers to the extensor aponeurosis of the index, middle, and ring fingers. An acellular dermal substitute was applied in a novel way to reconstruct the extensor retinaculum and promote a successful functional outcome.Contralateral Heterotopic Thumb-to-Thumb Replantation With Free Ulnar Forearm Fasciocutaneous Flap and Targeted Muscle Reinnervation
Mangling hand injuries can be difficult to manage owing to the severity and heterogeneity of the injuries. Outcomes after reconstruction of unique injuries are less well-known but provide valuable insight. We present an unusual spare parts reconstruction of a bilateral upper-extremity mangling injury treated with a heterotopic thumb-to-thumb replantation, an acute forearm fasciocutaneous free flap, and targeted muscle reinnervation. This report highlights the utility of microsurgical reconstruction with available autogenous tissue in the acute setting.Dislocation of the Medial Head of the Triceps With Ulnar Nerve Location Anterior to the Medial Epicondyle
Snapping elbow is a rare syndrome caused by dislocation of the medial head of the triceps. Simultaneous dislocation of the ulnar nerve occurs even less frequently. We report a case of ulnar nerve dislocation accompanied by dislocation of the triceps over the medial humeral epicondyle. The ulnar nerve was located in front of the medial epicondyle and did not change position with the elbow flexed or extended. At the point of insertion, the proximal end of the triceps muscle was displaced anteriorly.Acute Bilateral Compartment Syndrome of the Forearms
A 43-year-old woman presented to our emergency department with severe bilateral forearm pain. On examination, both forearms were tense and swollen and the patient had excruciating pain, made much worse on passive extension of the fingers. The pain did not resolve with analgesia. The symptoms and clinical examination were highly suspicious for compartment syndrome. However, there was no history of trauma, strenuous physical activity, or any other obvious factor that might have precipitated the onset of a compartment syndrome.Opioid-Sparing Pain Management in Upper Extremity Surgery: Part 1: Role of the Surgeon and Anesthesiologist
A multimodal pain management strategy combines complementary medications and techniques, targeting unique pathways, to improve overall analgesic effect and reduce opioid requirements. In this 2-part review, we examine the literature identifying nonopioid analgesic modalities and their targets in the pain pathway as well as anesthetic techniques found to be opioid-sparing in the practice of upper extremity surgery. First, we focus on operative anesthesia and analgesia and areas for future research specific to upper extremity surgery.Inclusion Body Myositis Mimicking Bilateral Anterior Interosseous Neuropathies
Anterior interosseous neuropathy is a rare cause of weakness of flexion of the thumb interphalangeal and index and middle finger distal interphalangeal joints, most commonly caused by trauma, compression, or inflammation. Bilateral anterior interosseous nerve palsies are rare, and other neuromuscular disorders may present with a similar pattern of weakness. We describe 2 patients who initially presented for orthopedic evaluation for suspected anterior interosseous neuropathy and were subsequently diagnosed with inclusion body myositis, an uncommon inflammatory myopathy affecting adults, with a predilection for finger and thumb flexor muscles.The Use of Denosumab in Osteoblastoma of the Metacarpal
Osteoblastoma is a benign aggressive primary bone tumor that occasionally presents in the hand. Because surgical treatment remains the mainstay of treatment, there are no established nonsurgical pharmacological options for patients in whom resection is not feasible. Novel therapies, such as denosumab, are currently being investigated in primary bone tumors. We report a case of osteoblastoma of the first metacarpal that was successfully treated with denosumab. The patient showed a rapid and dramatic response to treatment that led to the transformation of a locally destructive tumor into an ossified painless mass, restoring function while avoiding surgery.Osteoid Osteoma in the Thumb of an Adolescent Patient
Osteoid osteoma is a relatively common benign tumor of bone, typically presenting in the diaphysis of long bones during the second or third decades of life. This tumor is rarely reported in the hand and wrist, making up only approximately 10% of cases. When reported in the hand, osteoid osteoma tends to occur more frequently in the proximal phalanx of the index and middle fingers. We present the case of an osteoid osteoma in an adolescent male in the distal phalanx of the thumb. The presentation of this osteoid osteoma was atypical owing to its location and lack of characteristic clinical features, making the initial work-up and final diagnosis challenging and pointing to the importance of considering this diagnosis on a differential for painful bony tumors in the hand.Mycotic Aneurysm of the Ulnar Artery Secondary to Bacillus Calmette-Guérin Therapy for Bladder Cancer: A Rare Presentation of Hypothenar Hammer Syndrome
Mycotic aneurysms, especially those of the upper extremity, are rarely reported in literature. These aneurysms are caused by bacterial endocarditis and, therefore, are more commonly seen in patients who are in an immunocompromised state, including those requiring bacillus Calmette-Guérin (BCG) therapy for bladder cancer. Owing to the inevitable rupture of mycotic aneurysms, the standard treatment is surgical repair with appropriate secondary antibiotics. We present a unique case of a mycotic ulnar artery aneurysm following BCG therapy and repetitive hand trauma in a patient with bladder cancer that was successfully repaired with microsurgical techniques and secondary antibiotics.Idiopathic Avascular Necrosis of Trapezoid in Adolescence: 3-Year Follow-Up
Avascular necrosis (AVN) is relatively uncommon in the carpal bones, although it most frequently involves the lunate and scaphoid. The trapezoid has abundant vascular channels from a rich network of dorsal and palmar vessels, and only a few cases of AVN have been reported in adults who sustained a traumatic insult. We present a rare case of idiopathic AVN of the trapezoid in an adolescent presenting with refractory pain at the second metacarpal base. Over a period of 36 months, follow-up symptom evaluations and serial magnetic resonance images showed prominent gradual improvement, consistent with spontaneous resolution.Intraosseous Epidermoid Cyst of the Radius
We report the rare case of an intraosseous epidermoid cyst of the distal radius associated with an acute infection in a 79-year-old woman.Phalangeal Osteoid Osteoma of Thumb
Osteoid osteomas are typically benign osteoblastic bone tumors. Patients often present in their twenties with progressively increasing pain that is worse at night and relieved with nonsteroidal anti-inflammatory drugs. These lesions rarely occur in the hand or wrist; however, when those are involved, the proximal phalanx is the most common location and the index finger is the most commonly affected digit. Lesions affecting the distal phalanges are least likely to occur and the thumb is least likely to be affected.Avascular Necrosis of the Lunate Following Reconstruction of the Scapholunate Ligament Using the Scapholunate Axis Method (SLAM)
Various surgical treatment options have been described to address chronic scapholunate dissociation. The Scapholunate Axis Method (SLAM) is a new technique used to reconstruct the scapholunate interosseous ligament. It is biomechanically advantageous compared with other ligament reconstruction techniques but clinical studies are lacking. We describe a previously unreported complication of avascular necrosis of the lunate after the SLAM procedure.Spontaneous Rupture of the Extensor Pollicis Longus Tendon With Repair and Contralateral Prophylactic Decompression: A Case Report and Review of the Literature
Ruptures of the extensor pollicis longus (EPL) tendon are known to occur primarily from local mechanical causes at Lister’s tubercle. Other reasons for ruptures have been proposed including local steroid or even distant steroid injections that might have weakened the tendon, leading to rupture. There have been rare cases in the literature that describe ruptures without any known causes. Here, we describe a case with no known risk factors and with a spontaneous EPL rupture on one side and subclinical tendinopathy on the other.Bone Grafting in Total Wrist Arthrodesis With Large Bone Defects Using the Reamer-Irrigator-Aspirator: A Case Study of 2 Patients
Total wrist arthrodesis, fusion of the carpus to the radius, is a well-established and commonly performed procedure for the management of pancarpal degenerative arthritis, trauma, and other severe diseases of the wrist. A well-known complication of this is radiocarpal nonunion, with a rate of 4.4%. Commonly, bone grafting is done at the time of the surgery using local bone, iliac crest bone graft, or cancellous allograft bone. The Synthes Reamer-Irrigator-Aspirator (RIA) is a flexible reamer originally designed as a single-pass intramedullary reamer that can be used in reaming of long bone fractures prior to insertion of an intramedullary nail.Infection Due to Saksenaea vasiformis Following a Spider Bite
Cutaneous mucormycosis due to Saksenaea vasiformis species is exceptional. There have been about 40 reported cases worldwide, with most being fatal. We report an exceptional nonlethal case of mucormycosis due to S. vasiformis following a spider bite. The patient was in an immunosuppressed state owing to previous chemotherapy and diabetes mellitus. The origin of the inoculation was the bite of a Loxosceles laeta spider, which caused loxoscelism. The initial skin injury was quickly progressive, requiring amputation of the right upper limb.Ewing Sarcoma in an Infant Metacarpal
We describe a case of Ewing sarcoma in the metacarpal of a 5-month-old male. After pain, erythema, and swelling of the hand failed to resolve with antibiotics, radiographs and magnetic resonance imaging raised suspicion for a neoplastic condition. Open biopsy confirmed the diagnosis of Ewing sarcoma and treatment with chemotherapy and surgical resection was initiated. Ewing sarcoma of the hand in a patient this young is an exceedingly rare diagnosis, which highlights the importance of a broad differential diagnosis when the treatments for more common conditions fail.Failure of Adjustably Aligned Modular Radial Head Arthroplasty With Head-Neck Dissociation and Metallosis
Radial head arthroplasty was introduced in 1941 and the literature supports satisfactory overall midterm patient outcomes and acceptable complication profiles with several models. There are several previously described mechanisms by which radial head complications typically occur. We present the case of a rarely described mechanism of radial head implant failure: elbow synovitis and pain from partial dissociation and metallosis in an adjustably aligned, modular, monopolar, mixed metal, press-fit radial head arthroplasty.Absence of the Pronator Quadratus Muscle Precluding Distal Nerve Transfer
The branch of the anterior interosseous nerve to the pronator quadratus (PQ) is increasingly used as a donor nerve for end-to-end and reverse end-to-side nerve transfers. The anatomy of the PQ (and its nerve branch) is generally considered reliable in the absence of prior trauma. In this report, we describe a patient with an absent PQ despite intact clinical examination of other muscles supplied by the anterior interosseous nerve. The absence of the PQ precluded the use of its nerve as a donor nerve for transfer.Primary Surgical Treatment of Erythema Elevatum Diutinum
Erythema elevatum diutinum (EED) is a rare skin disease caused an Arthrus-type immunological reaction to antigen with immune complex deposition in the cutaneous microvasculature, which leads to tissue damage secondary to the effects of complement and leukocytes. It presents as brown or red cutaneous nodules, papules, or plaques, often on the extensor surfaces of the hands, knees, or elbows. Onset usually occurs in the fourth to sixth decades but possibly younger in patients with human immunodeficiency virus.Initial Misidentification of Thumb Poroma by Shave Biopsy
Poromas are benign adnexal neoplasms originating from the intraepidermal portion of sweat gland ducts. With the possibility of malignant transformation, accurate clinical diagnosis and treatment are crucial. Numerous reports of hand poroma lesions have been reported. We present an unusual case of a distal thumb poroma originally identified as a squamous cell lesion in a shave biopsy and eventually accurately identified after excisional biopsy. This report highlights the limitations of shave biopsy associated with soft tissue hand lesions and the need to consider poroma when evaluating a soft tissue lesion of the hand.Metacarpal Aneurysmal Bone Cyst En Bloc Resection Reconstructed With Osteoarticular Allograft
Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore, wide resection is commonly necessary, leading to challenging reconstruction of the defect, especially when the articular surface is involved. We present a case of an aneurysmal bone cyst of the fourth metacarpal, treated with an en bloc resection and reconstruction with a metacarpal osteoarticular allograft. At 8 years after surgery, the patient has shown no signs of recurrence, but radiographic articular reabsorption was noted.Mucormycosis Osteomyelitis of the Hand
Mucormycosis is a relatively uncommon but highly aggressive fungal infection caused by the Mucormycotina subgroup of fungi. Mucormycosis usually affects the skin, sinuses, or lungs of an immunocompromised host. Other risk factors for development of mucormycosis include hematologic malignancy, intravenous drug abuse, chronic steroid use, and contaminated traumatic wounds. Cutaneous mucormycosis of the hand involving the skin and soft tissues is rare but has been reported previously. In this case report, we review the clinical course of a patient with mucormycosis of the hand who was found to have extensive soft tissue and bony destruction and ultimately required amputation.A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure
Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis.Delayed, Atraumatic Index Metacarpal Fracture After Trapeziectomy and Suture-Button Suspensionplasty for Thumb Carpometacarpal Osteoarthritis: A Report of Three Cases
Trapeziectomy with suture-button suspensionplasty is a surgical treatment option for thumb carpometacarpal osteoarthritis refractory to nonsurgical management. We describe the cases of 3 patients who presented with index metacarpal fracture, in the absence of traumatic injury, over 4 months after trapeziectomy with suture-button suspensionplasty. All 3 fractures demonstrated the same pattern: short oblique/spiral, oriented proximal radial to distal ulnar with the distal end in the vicinity of the index metacarpal button, presumably after the orientation of the metacarpal drill hole.An Acute Nocardia Infection in a Pediatric Hand
Nocardia species are aerobic gram-positive filamentous organisms that may cause cutaneous or pulmonary disease in humans. Primary cutaneous nocardiosis may manifest as an acute superficial pyogenic infection that can mimic more common organisms such as Staphylococcus or Streptococcus. Acute pyogenic Nocardia infection of the pediatric hand is a rare manifestation of this condition. We present a 17-month-old boy who presented with an acute abscess formation on his left fourth and fifth digits that was found to be secondary to Nocardia brasiliensis.Delayed Idiopathic Hardware-Associated Osteomyelitis of the Scaphoid
Osteomyelitis of the carpal bones is rare and usually occurs in the setting of penetrating wounds or immune compromise. A case of hardware-associated scaphoid osteomyelitis is reported in a 33-year-old man who underwent screw fixation of a scaphoid fracture more than 20 years prior to presentation. The patient was treated with operative debridement including a total scaphoidectomy as well as intravenous antibiotics. Methicillin-sensitive Staphylococcus aureus was isolated from intraoperative cultures.Implant Failure After Motec Wrist Joint Prosthesis Due to Failure of Ball and Socket-Type Articulation—Two Patients With Adverse Reaction to Metal Debris and Polyether Ether Ketone
We describe 2 cases of articulation-related failures resulting in revision surgery after a Motec total wrist arthroplasty: one with an adverse reaction to metal debris and the other with an adverse reaction to polyether ether ketone. In the first patient, blood cobalt and chrome levels were elevated and magnetic resonance imaging showed clear signs of a pseudotumor. The other patient had an extensive release of polyether ether ketone particles into the surrounding synovia due to adverse wear conditions in the cup, leading to the formation of a fluid-filled cyst sac with a black lining and diffuse lymphocyte-dominated inflammation in the synovia.Myopericytoma of the Base of the Finger: Radiological and Pathological Description of a Rare Benign Entity
A previously healthy 46-year-old woman presented with a mass lesion between the bases of the fourth and fifth fingers of the right hand. The mass had grown progressively over 2 years and started to cause practical difficulties in everyday life. Imaging depicted a hypervascular and well-circumscribed soft tissue tumor with imaging characteristics of a sarcoma. The lesion was treated surgically. The final diagnosis of the specimen upon pathology was a myopericytoma, a benign smooth-muscle cell neoplasm.Osseous Rosai–Dorfman Disease Presenting as a Solitary Lesion of the Distal Radius
Rosai–Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a rare entity in which bone involvement occurs in less than 5% to 10% of patients and skeletal cases are usually multifocal. Extranodal solitary lesions of bone without nodal involvement or additional clinical manifestations are exceedingly rare. We present the clinical course and management of a 34-year-old African American woman who presented with the disease as a solitary lesion of the distal radius.Trapezius Muscle Transfer for Restoration of Elbow Extension in a Traumatic Brachial Plexus Injury
Voluntary elbow extension is essential for optimal upper limb positioning required for daily living activities, particularly above-shoulder maneuvers. The authors present a case of traumatic brachial plexus injury in which paralysis of the musculature selectively supplied by the posterior cord was based on magnetic resonance imaging and nerve conduction studies. An attempt at a radial nerve graft at another center was not effective. Ipsilateral hand function improved after multiple local tendon transfers were performed.The Use of a Magnetic Port Finder in the Retrieval of Air Rifle BBs to the Upper Extremity
Air-powered rifles shoot ball bearings with enough kinetic energy to penetrate skin and fracture underlying bones. In addition, there are reports of these ball bearings embolizing within the vascular network, causing serious injuries such as ischemic stroke with resultant blindness. The severity of these complications warrants occasional removal of these foreign bodies; however, they can be difficult to localize. In this case report, we describe the use of a magnetic port finder, a sterilizable tool used in breast reconstruction, to localize the foreign body in situ.Intramuscular Epithelioid Sarcoma Presenting as Extrinsic Flexor Tightness in the Forearm
Epithelioid sarcoma is an uncommon soft tissue sarcoma involving predominantly the distal extremities of adolescents and young adults. Its rarity makes it difficult to diagnose accurately and treat properly in the early stages. We discuss the delayed diagnosis of a 37-year-old man who presented with extrinsic flexor tightness of the wrist and fingers. We initially thought that the lesion resulted from inflamed soft tissue of the flexor muscles causing contracture. However, histological examination of a biopsy specimen revealed nodular proliferation of epithelioid and spindle cells, which were immunoreactive to epithelial and nonepithelial markers, respectively, leading to the final diagnosis of epithelioid sarcoma.Physeal Bar Resection Under Guidance With a Navigation System and Endoscopy for Correction of Distal Radial Deformities After Partial Growth Plate Arrest
Partial growth plate arrest caused by trauma may lead to severe deformity and dysfunction. The Langenskiöld method is a surgical technique that involves resection of the physeal bar causing partial growth plate arrest. However, it is a technically demanding procedure. We used the Langenskiöld method under guidance with a navigation system and endoscopy and obtained good results in 2 cases. We consider that use of these tools can be a helpful adjunct to the carrying out this procedure.Accidental Injection of Freund Complete Adjuvant With Mycobacterium Tuberculosis
Accidental needlestick injuries are common in laboratory and health care workers. Injection of atypical pathogens, such as those encountered in the animal laboratory setting, may pose considerable problems at the site of inoculation. We present the case of an otherwise healthy laboratory worker who accidentally self-injected Freund complete adjuvant with heat-killed Mycobacterium tuberculosis into her hand, requiring multiple debridement operations over a prolonged treatment course.Lunate Grafting Into the Radius for Lunate Fossa Reconstruction in Madelung Deformity
A 40-year-old woman presented with Madelung deformity and severe arthritic changes at both the radiocarpal and the distal radioulnar joints. She was treated by using her lunate as an osteochondral graft into the radius allowing reconstruction of the lunate fossa. The scaphoid and triquetrum were removed concomitantly and a Sauve-Kapandji procedure was performed. Complete bone healing was achieved. Ten years later, an excellent functional result was maintained, with a pain-free wrist, an acceptable wrist joint range of motion, as well as a favorable aesthetic appearance.Treatment of Cervical Spondylotic Amyotrophy With Nerve Transfers
Cervical spondylotic amyotrophy is characterized by severe, proximal upper extremity weakness including an inability to abduct the shoulder and flex the elbow. Treatment using both medical and surgical decompression approaches has produced variable results. This paper reports the use of nerve transfers (spinal accessory to suprascapular, flexor carpi ulnaris fascicle of ulnar to biceps motor branch, radial nerve branch to triceps to axillary) to restore shoulder and elbow function in a case of unilateral cervical spondylotic amyotrophy involving C5 and C6 myotomes.A Rare Manifestation of Primary Bone Lymphoma: Solitary Diffuse Large B-Cell Lymphoma of the Little Finger
Solitary primary non-Hodgkin bone lymphoma of the hand is a rare entity with only 3 cases reported in the literature. We report the case of a 77-year-old patient with isolated large B-cell bone lymphoma of the proximal phalanx of the little finger without rheumatoid arthritis or methotrexate treatment. The patient was treated with digital amputation and at 6 months’ follow-up showed no relapse or dissemination of the disease.A Rare Cause of Pyogenic Flexor Tenosynovitis: Nocardia nova
Infection complicates approximately 5% of open trigger digit releases. Both superficial and deep infections may occur. We present a unique case of a cactus farmer who underwent an uneventful thumb trigger finger release and subsequently developed pyogenic flexor tenosynovitis and acute carpal tunnel syndrome resulting from Nocardia nova infection.
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