This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1 and 2 of the fingers which had ruptured. Between June 1989 and May 2003, a total of 62 fingers in 61 patients presented with ruptured flexor tendon repairs within 48 hours from rupture. Immediate re-repair and rehabilitation was carried out in 44 fingers (71%) in 43 (70%) patients. Thirty-six patients completed the 8-week therapy programme after re-repair in 37 fingers. Nine (24%) had excellent, 10 (27%) good, 5 (14%) fair and 13 (35%) had poor results when assessed by the original Strickland method. Five fingers in five patients ruptured the re-repair. Poor results and second ruptures were particularly common after re-repair of ruptured tendon repairs in the little finger. In the light of these findings, a policy for dealing with ruptured primary flexor tendon repairs in the fingers is suggested.

Sebaceous carcinoma is a rare tumour. Extraorbital SC is an aggressive and invasive malignancy. Excision margins may need to be wider than previously thought. Exposure to ultraviolet radiation (sunlight) may play a role in the aetiology. Wide excision and selective use of radiotherapy remain the treatment of choice.

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002-May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury.

Background: Traction for phalangeal fractures utilizes the principle of “ligamentotaxis.” In Australia, a number of hand therapists and surgeons have contributed to the design of a skin traction method utilizing rigid sports tape, elastic, and hand-based thermoplastic splint. Aims: The study aims to determine the efficacy and outcomes of skin traction in the treatment of phalangeal fractures in comparison with surgical management. It also aims to define the vectors, force, types of phalangeal fracture, and degree of displacement that skin traction can improve. Method: A retrospective cohort trial is currently underway reviewing outcomes of 103 skin traction cases involving phalangeal and metacarpal fractures performed at the Nepean Hospital in New South Wales over a 3-year period and comparing these to surgical cases. Outcome measures being utilized include total active movement (TAM), grip strength, pain levels, and patient rated wrist and hand evaluation (PRWHE) scores. Radiological analysis is also being undertaken with the intention of developing an algorithm to match the type of fracture with recommended treatment method. We are currently in the process of collecting surgical group data and expect to be able to present this by the time of conference meeting. Results: Preliminary results according to Belsky’s criteria indicate an average of 227.50 total active motion for 54 phalangeal finger fractures treated with the technique. The results were excellent for 37 cases, good for 14 cases, and poor for 3 cases. Grip strength averaged 32.3 kg for the affected limb (99.3% of the non-affected limb). Gingrass criteria for thumb phalangeal outcomes in 6 cases showed average 82.2° TAM for five (5) cases. Excellent outcomes were achieved in 3 cases, and good outcomes were achieved in 2 cases. Pinch strength averaged 4.25 kg and was 79.7% of the non-affected thumb. Conclusion: Skin traction may provide a cost-effective and clinically effective tool for the management of phalangeal fractures.