We report triggering of the thumb in a 2-year-old female child caused by intratendinous granulation tissue after trauma to the thumb.

No abstract

Circumferential defects of digit are uncommon but present a challenging problem to the clinician. The use of simple skin grafts tends to cause tendon adhesions and can limit digital range of motion. The use of local skin flaps, such as a cross-finger flap, is limited by the considerable skin loss in a defect that is circumferential in nature. Other options have included the use of reversed forearm flap or some free tissue transfer. We report a case in which the circumferential defect of an index finger, measuring 6 cm around the digit and 3 cm long, is resurfaced by the use of a free arterialized venous flap raised from the volar forearm skin.

A rare case of an epitheloid haemangioendothelioma presenting as an aggressive soft tissue mass in the wrist of an infant is presented. The management of the lesion presents particular difficulties because of its diffuse involvement of surrounding muscles, tendons and neurovascular bundle and the importance of preserving hand function. The epitheloid haemangioendothelioma rarely occurs extravascularly with less than 15 such cases reported in the literature.

Fixation of small bones in the adult and the child's hands remains a challenge. The authors present a technique of bone fixation using customized staples made intraoperatively from K-wires (0.9-1.6 mm in diameter). Their specific purpose was to provide axial alignment and rotational stability for carpal bone fixation and for epiphysiodesis in phalanges. This technique was used in 14 cases (11 adult and three paediatric). No bone shattering, implant breakage, implant loosening or infection occurred. As K-wires are quite malleable, custom sized and shaped staples which follow the bone contours could be made to give a more exact fixation. All cases had satisfactory outcomes, achieving the preoperative objectives of bony fixation. This method is safe, precise and technically easy. It is also relatively cheap and only requires simple, standard instruments.