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Fifty patients underwent a variety of hand operations and were randomized for wound closure either with tissue adhesive (Indermil) or sutures. The two treatment groups had similar demographic characteristics and similar outcomes at the 2 and 6 week postoperative assessments which were performed by a designated tissue viability nurse blinded to the method of closure. Five minor wound dehiscences occurred: three in the adhesive group and two in the suture group. No infection occurred in either group. In conclusion, the study demonstrates tissue adhesive is as effective as suture in this type of hand surgery.

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A 13-year-old boy, right hand dominant, presented acutely to the casualty department having injured both elbows following a fall from height. The patient had been climbing a 7 ft fence and had caught his shoelace at the top, falling onto his outstretched hands. There was obvious deformity bilaterally at the elbow with painful restriction of movement. There was no neurovascular deficit at this time. Aside from a minor head injury, with no sequelae, there were no other associated injuries.Radiographs confirmed bilateral posterior dislocation of the elbows (Figs. 1 and 2). Closed reduction under adequate sedation and analgesia was performed. The right elbow was reduced upon the first attempt (Fig. 3). The left elbow required two attempts to obtain reduction. Check radiographs of this elbow revealed a fracture of the coronoid process (Fig. 4).Bilateral above elbow plaster of paris backslabs were applied and the patient was admitted overnight for analgesia, elevation and observations.The patient was discharged the next day and reviewed at fracture clinic 10 days post injury. At this point the backslabs were discarded and the patient was encouraged to mobilise both elbows. As the left elbow was more painful at this point, a collar and cuff was retained on that side.Two weeks later both elbows were markedly stiff with a range of movement from 45 to 1008 bilaterally. Urgent physiotherapy was instituted at this point consisting of a limited session of passive exercise followed immediately by active training.Four weeks later, the right elbow had improved significantly, with a good range of movement and no instability. Examination of the left elbow revealed a firm mass of scar tissue palpable over the medial collateral ligament. There was no instability but the range of movement was limited slightly, the elbow lacking approximately 108 of full extension.At further review, 5 months later, radiographs were taken (Figs. 5 and 6), and showed Grade II heterotopic ossification 2 around the right elbow, and Grade IV heterotopic ossification 2 around the left elbow. Bone biochemistry was normal. Despite this, right and left elbows achieved a range of movement of 40-1008 and 30-1108, respectively, with well preserved pronation and supination in both forearms. This represents a marked deterioration of elbow function compared to previous review. The patient, however, was satisfied with the range of movement and was not keen on operative intervention. He was therefore treated conservatively.

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