Tuberculosis is an infection that can occur in every organ of the body, but it rarely affects the wrist joint. We report a rare case of a male patient with wrist tuberculosis with a subtle presentation. Our patient's left wrist had been swollen for four months and progressively worsened, becoming ulcerated one week prior to presentation to our center. He was asymptomatic, but a previous radiograph showed global destruction of the wrist joint. Clinical investigations, that is, polymerase chain reaction test for tuberculosis and histopathological examination, showed classic findings of tuberculosis, which lead to the initiation of anti-tuberculosis treatment.
A young patient presented to our centre with swollen right hand following a motor vehicle accident. He was diagnosed with closed fractures of trapezoid, ulnar three metacarpal bones, radial styloid and ulnar styloid. The hand injuries were complicated with compartment syndrome. Emergent fasciotomy and application of external fixator of the hand were performed. Definitive fixation of the fractures was delayed due to the wound care post fasciotomy. During the definitive fixation of the hand, the trapezoid was found to be comminuted and completely extruded. Abundant callus was found at the fracture sites of the metacarpal bones. Anatomic fixation was not feasible. Principle-based intra-operative creativity and flexibility were of great significance in the unconventional fixation of the complex hand injuries described in this case report.
Wrist ganglion cysts are the most common benign soft tissue swelling in the hand and wrist. They may arise from flexor and extensor tendon sheaths, interphalangeal joints, wrist joints, and even the neural tissues around the hand and wrist. Some volar wrist ganglion cysts arise from the radiocarpal joint and scaphotrapezial joint. It is uncommonly encountered as an incidental finding during the fixation of a distal radius fracture. In our case, a volar wrist hemorrhagic ganglion cyst was incidentally found during the fixation of the fracture. Prior to the injury, the patient had no complaints of swelling over her right wrist. The cyst was removed using microscopic magnification.
Irreducible closed dorsal dislocation of distal interphalangeal (DIP) joint of the finger is a rare injury. The causes of irreducibility of the DIP joint are volar plate interposition, entrapment of flexor digitorum profundus tendon behind the head of middle phalanx, and buttonholing of the middle phalanx head through the volar plate or flexor tendon. Open reduction with a volar approach is recommended with the advantages of better wound healing, ease of releasing entrapped structures, and possibilities of a volar plate, collateral ligaments, and/or flexor tendon repair. We report a case of irreducible dorsal dislocation of left ring finger DIP joint secondary to volar plate interposition treated successfully with open reduction.
Dorsal dislocations of proximal interphalangeal joint with palmar lip fractures base of middle phalanx of fingers are rare, complex, and often a challenging injury to the treating hand surgeons especially in those chronic cases. Hemi-hamate arthroplasty is the preferred surgical option in treating chronic dorsal fracture-dislocations of the proximal interphalangeal joint. We report two cases with a chronic injury that have been treated with hemi-hamate arthroplasty. Range of motion, pinch and grip strengths, QuickDASH scores, complications, and radiological findings were recorded at follow-up. Good functional outcomes were observed in both patients without major complications. Hemi-hamate arthroplasty can be a reliable surgical treatment for chronic proximal interphalangeal joint fracture-dislocations.
STUDY DESIGN: Randomized Controlled Trial (RCT).
INTRODUCTION: Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations.
PURPOSE: The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries.
METHOD: A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group.
RESULTS: Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group.
CONCLUSION: This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.
KEYWORDS: Exercise therapy; Hand injuries; Occupations; Randomized Controlled Trial
Introduction Treatment of scaphoid fracture is challenging due to its unique blood supply and geometry. Traditionally, a headless compression screw is the standard treatment for unstable scaphoid fracture. Some fractures are complex, for example, comminution with bone loss. A scaphoid plate is an option in these difficult fractures providing adequate rotational stability. Aim To share our experience in using scaphoid plates in complex wrist trauma and comminuted fractures. Method and material Complex wrist trauma involving scaphoid fractures that were comminuted and multi-fragmentary fractures treated with plate osteosynthesis were retrospectively reviewed between July 2019 and September 2021. Patient demographic data, preoperative radiographs, CT scans, pain, wrist range of motion, and fracture union rate to union were reviewed. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH®) score was recorded at 1-year postoperative follow-up. Results Nine patients associated with complex wrist trauma were included in this case series. The mean follow-up was 2.5 years (13-30 months). The union rate was 100%. The mean arc of motion was 105° (95-110°). QuickDASH® score was 19.96 at 1-year postoperative follow-up. Four patients had good outcomes, four satisfactory, and one poor outcome. One hardware complication was observed which was the impingement of the plate proximally over the articular surface of the distal radius. Conclusion A scaphoid plate is a reliable option for treating complex and difficult fractures. It provides adequate stability, especially in comminution, bone loss, or multi-fragmentary fractures which are not amendable using other fixation methods. We recommend the expansion of plate osteosynthesis beyond scaphoid nonunion into complex wrist trauma.