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A modified technique of palmar plate advancement (PPA) was used to treat certain patients, most with failed previous treatment, with fracture subluxation of the proximal interphalangeal joint. The modification of the original technique consisted of using two sutures to attach the palmar plate and tying them deep to the skin on the dorsum. This allowed consistent maintenance of reduction, and there were no infections. The results of 11 of 23 patients who were treated with this technique and followed from 2 to 9 years postoperatively are reported. The indications for PPA in this injury are discussed.

Patients with a tear of the horizontal part of the triangular fibrocartilage complex and ulna plus variance were treated by excision of the distal part of the ulnar head. Three of the seven consecutive patients also had lunotriquetral ligament injuries and had fusions of that joint. Six of the seven patients had either complete relief or marked improvement of symptoms at the distal radioulnar joint. When ulnar shortening is indicated, ulnar head shortening should be considered.

Comminuted low velocity gunshot fractures of the proximal phalanx were stabilized with an external fixator in 15 patients. This device was found to be useful. It allowed healing of the fracture in good alignment in 13 patients. And motion of the metacarpophalangeal joint was preserved.

An infection of the biceps fascia, later myositis, and spreading to the pectoralis is described in six patients. The majority were synergistic infections with an anaerobic Peptococcus, Eikenella, or Bacteroides and an aerobic Streptococcus. Five of the patients were drug abusers. Excision of the biceps and portions of the pectoralis major was necessary in four patients.