Radial Border Research Articles

The distribution and disposition of anomalous notches in the non-epiphyseal ends of human metacarpal shafts.

AbstractThe incidence, duration and location of notches in the non‐epiphyseal ends of the metacarpal shafts were determined from serial sequential radiographs of the left hand of 332 ethnically comparable children. Each series of films extended from shortly after birth to late adolescence or early adulthood. The notches represent vestiges of supernumerary epiphyses or pseudo‐epiphyses and are regarded as indicative of disturbances in skeletal maturation.Metacarpal notching was found in 132 (78.1% ) of 169 boys and in 118 (72.4% ) of 163 girls. The mean number of notches per subject was significantly higher in boys than in girls and in slow maturing as opposed to fast maturing children in each sex. Regardless of sex or speed of skeletal maturation, the most frequent locations of notching were radial border of metacarpal II, ulnar side of metacarpal V and radial margin of metacarpal I. Notches were most common in metacarpal II followed in declining order by metacarpals V, I, III and IV. The notches disappeared approximately two years earlier in girls than in boys. All were obliterated by deposition of osseous tissue long before fusion of the true epiphysis with the metacarpal shaft.

PARTIAL RECONSTRUCTION OF THUMB IN A ONE-STAGE OPERATION

The procedure for lengthening of the first metacarpal in cases of partial loss of the thumb described here utilizes a contiguous skin flap from the hand, reinforced by an iliac-bone graft. It is completed in one operative stage. Its prerequisite is the presence of intact skin along the radial border of the hand. It is not suggested that this procedure will replace the reconstruction of the thumb by transposition of a neighboring finger, but, if feasible, it is preferable to a method of repair in which an abdominal-skin tube is used. The use of the local hand flap imparts nearly normal sensation and a tactile sense to the new thumb.

SYPHILITIC BURSOPATHY

Verneuil, in 1868, first reported four cases of syphilitic bursopathy, which he described as hydropisie des gaines tendineuses des extenseurs des doigts dans syphilis secondaire. Fournier, Moreau, Chouet and Voisin followed in the recognition of syphilitic involvement of the bursae. In 1876, Keyes collected fourteen cases and, in 1884, Finger in an extensive article described this infection of the bursae. Buchler, in 1889, reported four cases, and Velpeau treated it with potassium iodide and mercury, not mentioning it as syphilis. Dr. Halsted at Johns Hopkins reported one case and outlined the bursae involved in the order of frequency; namely, the prepatellar, the subpatellar, the semimembranous, that between the rectus and the crureus, the anserine bursa, that of the extensor digitorum communis, the bursae of the toes and the flexors of the fingers, and that at the radial border of the first phalanx of the forefinger. Halsted's descriptive picture was that

REATTACHMENT OF THE CAPSULE AND EXTERNAL ROTATORS OF SHOULDER FOR OBSTETRIC PARALYSIS

From the point of view of practical therapeutics, the chief cause of the disability of the arm in obstetric or Erb's palsy of the upper arm type is the fixation of the limb in inward rotation and the inability of the patient to rotate his arm outward. In the severe form of this deformity the individual cannot bring the palm of his hand to his face. When he abducts his arm the radial border or the back of the hand faces the head. There is usually poor abduction of the shoulder, which further compromises the function of the limb. Frequently, too, the motion in the elbow and wrist is limited, and what little power there might be in these joints is entirely nullified by the disadvantageous position of inward rotation. Thus there is, in the severe form of obstetric paralysis, actually no useful range of function in the affected member.

APPLICATION OF A SPLINT FOR FRACTURED ULNA

I recently encountered a case of fracture of the ulna in which a new application of an old method seemed indicated. The solution of continuity occurred in the lower third of the shaft of the left ulna. The deformity, caused as usual by direct violence, was that the inferior fragment was driven outward, thereby encroaching on the interosseous space. Reduction by manipulation, was evidently to be maintained by overabduetion of the hand. Just so is overadduction aimed at in Colles' fracture. How could the hand be secured in this position? The simplest method seemed to be to apply a Bond splint in reverse. The patient was furnished with a right-handed splint and instructed to grasp the semicylindrical block with his hand. The shaft of the splint, being free, formed an acute angle with the radial border of the pronated forearm. The hand was secured to the block by adhesive strips applied