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Acute carpal tunnel syndrome caused by pseudogout occurred in a Chinese patient. The radiological findings mimicked those of synovial chondromatosis. Such radiological findings were very unusual. Diagnosis of such conditions may be difficult, since the clinical features may be confused with those of gout and infection. Surgical release is the treatment of choice.

A prospective study of fifty-two fresh traumatic unstable fractures of the proximal or middle phalanges of the hand in forty-seven patients was reviewed. All the fractures were fixed with A.O. miniature screws and plates. The overall results were not satisfactory and complications were frequent. Only 26.9% of the fractures had good results. Fractures associated with significant soft tissue injuries had very poor results. When the present series was compared with a comparable group of fractures fixed with Kirschner wires, there was no significant improvement in the results. The unsatisfactory outcome of this group of unstable fractures may be largely due to the frequent association with poor prognostic factors.

A splint for controlled active motion after flexor tendon repair is described. It incorporates a single core-coated elastic band passing around a palmar pulley and attached proximally to a spring wire. Its mechanical properties were tested against six other systems. The tension in various systems all rose near full extension. However, the palmar pulley, the spring wire, and the elastic band each could lower the tension significantly. When the bending moments at the interphalangeal joints were measured, all systems produced a peak during the latter part of extension. With the palmar pulley, spring wire, and elastic band, the rise was minimal and in fact, the bending moments diminished near full extension. Initial results in 28 flexor tendon repairs using this splint showed less flexion contracture when compared with 78 flexor tendon repairs using a standard rubber band anchored at the wrist.

The development of an internationally accepted system of assessment of results after flexor tendon repair is important. In a prospective study of ninety-five digits, gross discrepancies were demonstrated between five popular methods of assessment: Buck-Gramcko, linear measurement, Grossman, American Society for Surgery of the Hand, and Strickland. The relative merits of each systems were studied and modifications for the Buck-Gramcko system are suggested.

There were 578 patients with more than 728 congenital anomalies of the upper limb seen in our center over a 10-year period. All anomalies were classified with the system recommended by the International Federation of Societies for Surgery of the Hand (IFSSH). Our results differ from other reported series with group III duplication anomalies being most common (35.9%) followed by group II (31.3%); group I (12.2%); group VII (9.3%), group VI (6.5%), group V (4.3%), and group IV (0.5%). Variations among different ethnic groups are significant although some apparent differences can also result from different patient referral patterns and method of classification. The classification adopted by the IFSSH was found to be practical in the majority of cases. However, difficulties were encountered in the classification of multiple anomalies; group VII cases and the complex spectrum of atypical cleft hand, brachysyndactyly, and transverse arrests. In addition, many common anomalies had not been included in the classification.

We report a prospective study on 284 digital fractures of the hand in 235 patients. Management followed clear guidelines set out in a protocol. Important factors in the selection of the treatment method were, acceptable alignment, functional stability, and associated "significant" soft tissue injuries. "Functionally" stable fractures treated by free mobilization had satisfactory results. Unstable fractures treated by splints or Kirschner wire fixation produced unsatisfactory results. "Open fracture," "comminuted fracture," and "associated significant soft tissue injuries" were identified as unfavorable prognostic factors. The anatomic site of the fractures was not important in determining the final outcome. About 15% of the displaced fractures became functionally stable after closed reduction and their results were comparable with the undisplaced fractures. About 30% of the patients had various degrees of difficulty after they returned to work. About 14% of the patients eventually changed their jobs because of their residual disability.

A case of constriction band at the fingers arising from keratosis palmoplantaris is reported. Excision of the band and closure of wound by Z-plasties resulted in complete relief of clinical symptoms and vascular insufficiencies. Histologic examination revealed the variability of this skin lesion even in the same patient. The sparsity of keratohyaline matrix in the horn cells in the skin may contribute to the constriction ring formation.

Five patients with Mycobacterium marinum infection of the hand involving deep structures were seen recently. Four of them were fishermen. Hydrocortisone injection or simple incision and drainage led to worsening of the infection. The clinical presentation, operative finding, and histopathologic and microbiologic features were quite similar in all five patients. Extensive debridement and therapy with ethambutol and rifampin led to satisfactory results in four patients while biopsy and therapy in the fifth patient seemed to offer another form of acceptable treatment.