The presence of an extensor digitorum brevis manus represents a variation of the normal anatomy of the fourth extensor compartment of the wrist. It usually presents as a swelling on the dorsum of the wrist and is often inaccurately diagnosed. An awareness of its existence and of its characteristic appearance on diagnostic imaging studies is the basis for diagnosis. Symptomatic cases require division of the extensor retinaculum or excision of the muscle, depending on subtype, while asymptomatic cases require no intervention.Key Words: Anomalous extensors; Extensor digitorum brevis manus; EDBM; Fourth-compartment syndrome Un muscle extenseur commun court des doigts : Un syndrome de la quatrième loge La présence d'un muscle extenseur commun court des doigts représente une variation de l'anatomie normale de la loge du quatrième extenseur du poignet. D'ordinaire, cette manifestation prend la forme d'un oedème du dos du poignet. Elle est souvent mal diagnostiquée. La prise de conscience de son existence et de son apparence caractéristique à la visualisation diagnostique constitue le fondement du diagnostic. En présence de cas symptomatiques, il faut diviser le ligament annulaire ou exciser le muscle, selon le sous-type, tandis que les cas asymptomatiques n'exigent aucune intervention.T he vast majority of variations of the extensor tendons of the hand are asymptomatic throughout life, but their importance in hand surgery has been documented (1-4). The variations are often found incidentally at the time of surgery and at the time of diagnostic imaging (5). On occasion they may be associated with dorsal wrist pain, but a direct correlation is often difficult in the presence of other pathology, such as a ganglion or synovitis (6-9).First described by Albinus in 1734, as "muscles extensor brevis digiti indicis vel medii" (1), the existence of this anomalous muscle was questioned owing to its infrequent clinical presentation. Various anatomical descriptions persisted, but in 1866 Macalister (10) coined the term 'extensor digitorum brevis manus' (EDBM). The first clinical correlate was reported in 1926 (11). Since then, over 100 articles have been published on the topic leading to the development of two separate classifications. With incidences reported to be between 1% and 9% (11-16), the occurrence of this muscle should not surprise the anatomist or hand surgeon. In light of the high incidence and the lack of symptomatic case reports, the majority of EDBM cases must remain asymptomatic.A case of EDBM in association with an intraosseous ganglion of the lunate as a cause of fourth-compartment syndrome is reported. A review of the literature and current imaging techniques are presented to underline the clinical implications of this anomalous extensor muscle. CASE PRESENTATIONA 36-year-old, right-hand dominant woman was referred with left wrist pain after falling on her outstretched hand. The initial swelling and pain was managed with physiotherapy. However, the pain persisted over the central dorsal aspect of the wrist and s...

RC Mahabir, CM DeCroff, L Thurgood, AR Harrop. Closed reduction internal fixation rates and procedure times for metacarpal fractures treated in a minor surgery area before and after the introduction of a mini C-arm unit. Can J Plast Surg 2008;16(3):162-164.BACKGROUND: Mini C-arm units are compact, mobile, fluoroscopic imaging systems designed for real-time imaging of the extremities. They deliver the lowest possible radiation exposure to the patient and physician while minimizing operator effort and inconvenience. METHODS: A retrospective chart review was undertaken for consecutive metacarpal fractures requiring internal fixation treated in the minor surgery centre before (n=100) and after (n=100) the introduction of the mini C-arm. Open versus closed approach, procedure time and total operating room time were recorded. RESULTS: Before the introduction of the mini C-arm, the percutaneous rate was 48% and the average procedure and total operating room times were 55 min and 102 min, respectively. After mini C-arm implementation, the percutaneous rate increased to 59% and the average procedure and total times were 36 min and 78 min, respectively. CONCLUSIONS: The use of a mini C-arm increased the rate of successful closed reduction internal fixation and reduced the procedure time for metacarpal fractures treated in the minor surgery area.

The presence of an extensor digitorum brevis manus represents a variation of the normal anatomy of the fourth extensor compartment of the wrist. It usually presents as a swelling on the dorsum of the wrist and is often inaccurately diagnosed. An awareness of its existence and of its characteristic appearance on diagnostic imaging studies is the basis for diagnosis. Symptomatic cases require division of the extensor retinaculum or excision of the muscle, depending on subtype, while asymptomatic cases require no intervention.Key Words: Anomalous extensors; Extensor digitorum brevis manus; EDBM; Fourth-compartment syndrome Un muscle extenseur commun court des doigts : Un syndrome de la quatrième loge La présence d'un muscle extenseur commun court des doigts représente une variation de l'anatomie normale de la loge du quatrième extenseur du poignet. D'ordinaire, cette manifestation prend la forme d'un oedème du dos du poignet. Elle est souvent mal diagnostiquée. La prise de conscience de son existence et de son apparence caractéristique à la visualisation diagnostique constitue le fondement du diagnostic. En présence de cas symptomatiques, il faut diviser le ligament annulaire ou exciser le muscle, selon le sous-type, tandis que les cas asymptomatiques n'exigent aucune intervention.T he vast majority of variations of the extensor tendons of the hand are asymptomatic throughout life, but their importance in hand surgery has been documented (1-4). The variations are often found incidentally at the time of surgery and at the time of diagnostic imaging (5). On occasion they may be associated with dorsal wrist pain, but a direct correlation is often difficult in the presence of other pathology, such as a ganglion or synovitis (6-9).First described by Albinus in 1734, as "muscles extensor brevis digiti indicis vel medii" (1), the existence of this anomalous muscle was questioned owing to its infrequent clinical presentation. Various anatomical descriptions persisted, but in 1866 Macalister (10) coined the term 'extensor digitorum brevis manus' (EDBM). The first clinical correlate was reported in 1926 (11). Since then, over 100 articles have been published on the topic leading to the development of two separate classifications. With incidences reported to be between 1% and 9% (11-16), the occurrence of this muscle should not surprise the anatomist or hand surgeon. In light of the high incidence and the lack of symptomatic case reports, the majority of EDBM cases must remain asymptomatic.A case of EDBM in association with an intraosseous ganglion of the lunate as a cause of fourth-compartment syndrome is reported. A review of the literature and current imaging techniques are presented to underline the clinical implications of this anomalous extensor muscle. CASE PRESENTATIONA 36-year-old, right-hand dominant woman was referred with left wrist pain after falling on her outstretched hand. The initial swelling and pain was managed with physiotherapy. However, the pain persisted over the central dorsal aspect of the wrist and s...