A Case of Pseudarthrosis of the Capitate

Pseudarthrosis of the capitate bone is extremely rare. In this case, the injury and pseudarthrosis was so old, the bone with a nutrient vessel was grafted, and bone union and excellent results are obtained.

MORPHOLOGICAL STUDY OF THE ENTRAPMENT POINT OF UPPER EXTREMITY

The morphological study of cubital tunnel, carpal tunnel and the ulnar (Guyon) canal of adult cadavers was done using stereoscopy after injection of the resin into the brachial artery. MRI (Magnetic Resonance Imaging) of the carpal tunnel was also performed for normal volunteers. In the area of sulcus nervi ulnaris at the elbow, the amount of fibrofatty tissue was extremely small in the nerve trunk, and the nerve was superficially located and found to run close to the hard bony tissue. At the distal margin of the bony sulcus of the ulnar nerve, the nerve ran on the base of hard collateral ligament, where it was covered with a hard ligamentous aponeurosis. The nutrient vessel to the epineurium of the nerve did not exist in the tunnel under the cover of aponeurosis and the nerve was fed by vessels at the entrance of the tunnel and by the recurrent vessels ascending from the musculature at the distal end of the tunnel. The thickness of the flexor retinaculum from the inlet to the midst of carpal tunnel increases and the thickness became maximum at the outlet. The images of MRI of the carpal tunnel were similar to the corresponding levels, and demonstrated the accuracy of imaging with the anatomical relationships. The ulnar canal itself had few bone elements, and there were neither tight connective tissue nor tendons on the palmar side except for the inlet portion.

Vascular Supply of Nerves in the Tarsal Tunnel

The normal vascular supply of nerves in the tarsal tunnel was studied by intra-arterial injection of latex. In general, the blood supply to the tibial nerve and its branches came directly from corresponding arteries. Each nutrient artery to the tibial nerve bifurcated on the surface of the lateral plantar nerve fasciculus to create longitudinal vessels that made anastomoses with bifurcating nutrient vessels proximally and distally. This primary longitudinal system supplied intersubfascicular vessels to the medial plantar fasciculus. The last nutrient artery from the posterior tibial artery usually supplied the terminal branching point of the tibial nerve midway through the tarsal tunnel. The lateral and medial plantar nerves received most of the nutrient vessels from their corresponding arteries in shorter intervals. In 65% of cases, the lateral plantar nerve received a nutrient vessel from the medial plantar artery. Potential anatomical areas of vascular compromise in the etiology or surgical release of tarsal tunnel syndrome are discussed.

Two Flaps to Resurface the Basal Flexion-Crease of the Finger Area

Two flaps are described which have been designed to resurface the skin around the basal flexion crease of the fingers. Their most common use is on the ulnar side of the hand but any finger can be resurfaced. Both flaps are 1 cm in width so the donor sites can be repaired directly without the use of skin grafts. Mobilisation of the fingers is therefore permissible within 24 hours and thus postoperative stiffness avoided. The one-stage cross-finger flap is of particular value in resurfacing and preventing the recurrence of Dupuytrens in the M.P. joint area. The palmar transposition flap based on the inter-digital cleft is useful for the release of volar contractures and resurfacing localised full thickness burns. They are quick to raise and very reliable, providing their nutrient vessel is retained. The donor site distortion is minimal. We have had no flap loss and no limitation of flexion