The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture after hand injuries in different pediatric age groups attending a hand unit. Three hundred sixty children (237 boys, 123 girls) under 16 years of age who presented with hand injuries between April 1, 2000, and Sept. 30, 2000, were included in the study. Bony injuries accounted for 65.5% (236 injuries); 33.3% (120 injuries) were soft tissue injuries. The projected annual incidence rate for skeletal injuries was 418/100,000 children. The incidence was low in toddlers (34/100,000), more than doubled in preschool children (73/100,000), and steeply increased to around 20-fold after the 10th year (663/100,000). Girls had a higher incidence of hand injuries among toddlers and preschool children. Crushing was the most common cause of hand injury (64%), and most injuries were sustained at home (45%). Toddlers sustained soft tissue injuries predominantly (86%) and older children sustained more bony injuries (77%). Sport was the cause of injures commonly in the older children. There was a higher incidence of fracture in the little finger (52%) followed by the thumb (23%). The proximal phalanx was the most frequently fractured bone (67%) among the phalanges. Diaphyseal fractures (46%) were more common in the metacarpals, and basal fractures (51%) were common in the phalanges. At discharge more than 80% of the patients felt that they were cured or significantly better. This paper highlights the changing pattern and the different varieties of hand injuries in different pediatric age groups.

Age related differences in demographics, morphology, treatment and outcome were investigated in 701 fractures of the metacarpals or phalanges, including fracture-dislocations, in 655 patients. Fractures mainly due to sport occurred in 184 children, usually after 10 years of age. The base of the proximal phalanx was especially vulnerable. Thirty-seven percent of 256 young adults fractured their fifth metacarpal. The thumb was rarely involved. Half of these two groups fractured the fifth ray. Older adults had more fractures of the distal phalanx and displaced extraarticular fractures requiring stabilisation. Women predominated in the patients over 65. Forty percent of this group sustained their fracture on the road and more fractures involved the thumb, were oblique, intraarticular or multiple than in other groups. Detailed analysis of 423 X-rays demonstrated that only 10% of 70 intraarticular fractures and 19% of 363 extraarticular fractures were completely undisplaced. Patient response to postal questionnaire based outcome assessment using SF-12, MHQ was very poor.

Although scaphoid fractures are relatively common encounters in orthopaedic and trauma surgery, the demographics of these injuries are not well studied. The classical teaching in the subject limits scaphoid fractures in the age between ten and 60 years (or 70 years in other sources). The incidence or the prevalence of scaphoid fractures in the elderly population is not focused on and not studied or explored. We reviewed the literature for any available epidemiological studies of scaphoid fractures. We also sought the available data of scaphoid fractures in the elderly population in case series and case reports which have relevant data on the subject. Four epidemiological studies, two case series, and one case report are included. We discuss the available data in these articles and conclude that scaphoid fractures in the elderly, although rare, have been reported. However, there are not enough epidemiological studies to draw figures. Ignorance of this proportion of population could result in missed fractures in the elderly. Therefore, we encourage researchers to carry out epidemiological studies of scaphoid fractures with more focus on this population group.

We enrolled 34 normal volunteers to test the hypothesis that there were two types of movement of the wrist. On lateral radiographs two distinct patterns of movement emerged. Some volunteers showed extensive rotation of the lunate with a mean range of dorsiflexion of 65°, while others had a mean range of 50°. The extensive rotators were associated with a greater excursion of the centre of articulation of the wrist. It is suggested that dynamic external fixation of a fracture of the distal radius carries with it the risk of stretching the ligaments or causing volar displacement at the site of the fracture. Movement of the wrist during flexion and extension takes place at the radiolunate and lunate-capitate joints. Because of the complexity of its kinematics, many studies describe multiple readings on a few specimens or volunteers, 1,2 although a few have reported more extensive series of subjects. 3,4 There is debate as to whether the wrist functions as a row of carpal bones or as a column. Recently, Craigen and Stanley 3 suggested that there may be two types of wrist, one functioning as a row and one as a column. Their comparative study was based on measurements of lengthening and shortening of the scaphoid as seen on the posteroanterior view of the wrist. Our study is based on the senior author's (BDF) observation that, when the wrist is viewed from the lateral side during dorsal and palmar flexion, the lunate seems to rotate more in some wrists than others. If this observation is true there are implications for dynamic external fixation of the wrist. Our study was designed to investigate whether there are two types of wrist movement as seen on the lateral view, and to relate this observation to the study by Craigen and Stanley 3 of posteroanterior carpal kinematics. Subjects and MethodsRadiographs were taken of the non-dominant wrists of 34 subjects in five standard projections with the shoulder abducted to 90° and the elbow flexed to 90°. Two posteroanterior views were taken with the wrist in full active radial and ulnar deviation and three lateral views with the wrist in full active dorsiflexion, neutral and in full active palmar flexion.On the posteroanterior radiographs, measurement of the length of the scaphoid and the degree of scaphoid translation were made in both radial and ulnar deviation and the CR index and translation ratio calculated as described by Craigen and Stanley.3 The CR index is the length of the scaphoid in radial deviation divided by its length in ulnar deviation. We measured the scapholunate gap in ulnar deviation on the radiographs to exclude occult scapholunate instability and the angle of volar inclination of the articular surface of the distal radius on the lateral films. The angles of dorsal and palmar flexion of the lunate and capitate in relation to the radius were also determined. The range of flexion and extension of the capitate within the lunate fossa was calculated from these figures. The centre of the capitate was located and the distance which it moved during dorsal and pa...

Glomus tumours of the elbow remain a challenge to diagnose correctly and efficiently. We present a case of a glomus tumour as a complication of elbow surgery. This has not been described previously. This case highlights the possibility of injury as a causative factor in these tumours and the difficulty in differentiating them from postoperative neuromas by clinical presentation and ultrasound imaging alone.