Background: Clinodactyly or inclination of the digits, particularly the fifth digit, is a congenital anomaly of the hand that occurs in 1% to 19.5% of the population. This deformity requires reconstruction of both the functional and the aesthetic appearance of the finger, if it is severe, to avoid future growth deformity. Objective: The study aims to review the outcomes and the complications associated with closing and reverse wedge osteotomy techniques for treating clinodactyly. Patients and Methods: Ten patients’ ten fingers with clinodactyly were submitted for reconstruction from March 2014 to May 2016 in the Al Wasity teaching hospital in Baghdad. They were treated using the closing and reverse wedge osteotomy techniques. In the closing wedge procedure, a wedge was removed from the most convex part of the middle phalanx. Subsequently, the finger is aligned in the midaxial plane and repaired with 2 K-wires. In the reverse wedge osteotomy, the wedge was rotated 180 degrees and reinserted into the bone gap with the wide end first. This buttressed the osteotomy open. Subsequently, the K-wires were inserted in retrograde fashion, maintaining the graft’s position. Then, dressing was applied with the small splint from the PIP to the tip of the finger. Results: After a 15-month follow-up, all the patients showed satisfactory results aesthetically and the functionally—with full range of motion. There was no recurrence in any case. Only one case had residual angulation and no major complications were encountered. Conclusion: The closing and reverse wedge osteotomy was proven effective in treating clinodactyly. The closing wedge is simpler than the reverse wedge. The technical difficulty of reverse wedge osteotomy may make it a less appealing option to surgeons but the outcomes we had were rewarding, both techniques provided good overall correction of angulation in one stage, and straightforward procedure, with few complications, good aesthetic outcome and patient satisfaction with improved function. Keywords: clinodactyly, closing wedge, reverse wedge

Background. Flexor tendon injuries are frequent, due to variable hand activities, and the repair is challenging to hand surgeons, especially in zone II, because of the coexistence of two tendons within a tight fibro-osseous tunnel. Flexor tendon repair under tumescent infiltration provides anesthesia and a bloodless field, so that no tourniquet or sedation is needed. Aim of study. The goal of this study was to identify a surgical adjustment and intraoperative total active movement examination of the repaired tendon so that no gapping is formed, and smooth gliding is obtained, avoiding tendon rupture and producing an optimal range of motion. Patients and method. From January 2016 to April 2017, 9 patients (17 tendons), with a mean age of 31.8 years, presented within 3 to 14 days of injury to zone I or zone II of their flexor tendons. Tendon repair was done under tumescent infiltration (lidocaine 1% with adrenaline 1:200,000) only, with no tourniquet or sedation, and with an intraoperative total active movement examination. Result. After 6 months of follow up, all the patients had excellent range of motion according to the Boyes outcome scale, and none showed signs of postoperative tendon rupture. Conclusion. Tumescent infiltration for flexor tendon repair allows intraoperative surgical adjustment and total active movement examination, which will minimize postoperative rupture and adhesion. This procedure will also facilitate the surgeon’s work by eliminating the need for general anesthesia or sedation; however, this procedure is not applicable for children, major trauma, or those who are mentally challenged.

Background. The hand is the most frequently injured body part. Injuries to the fingertips are among the most common hand injuries. In this article an anterograde pedicle flap based on the dorsal branches of proper digital artery from the dorsum of the middle phalanx was used to reconstruct the fingertip defect as described by Peng Wei MD in a single stage to provide a durable, sensate coverage with the least possible complications. Aim of study. To introduce and assess the result and long term follow up of using an anterograde pedicle flap based on the dorsal branches of proper digital artery from the dorsum of middle phalanx. Patients and method. A total of twelve male patients were presented to us between November 2016 and January 2018. All of them had history of fingertip injuries and had undergone reconstruction using anterograde pedicle flap based on the dorsal branches of proper digital artery from the dorsum of the middle phalanx” the period of follow up ranged from one month to six months with an average of three months. Result. In this study 12 patients presented with fingertip defect were surgically treated by using an anterograde pedicle flap based on the dorsal perforator. All the patient had satisfactory result with good pliable contour coverage of their injured fingertip with no restriction of finger movements. Conclusion. The use of anterograde island flap based on the dorsal branches of proper digital artery from the dorsum of middle phalanx is suitable for reconstruction of fingertip defects of various amputation planes, it provided good contour texture with preservation of digital artery and nerve, it also provides patient with acceptable fingertip appearance.One of the major drawbacks of this procedure is that it requires tedious and meticulous dissection and that donor site requires full-thickness skin graft, which leads to donor site morbidity and scarring. Keywords.