Abstract
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The lumbrical muscles are among the most variable muscles in the human body in terms of anatomy. The first lumbrical is the most constant in terms of anatomy. It is never bipennate; the more ulnar lumbricals are more often bipennate (91% of third lumbricals, 63% of fourth lumbricals).
Schmidt HM, Lanz U. Surgical Anatomy of the Hand. Stuttgart, Thieme, 2004: 144
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Boutonnière injuries affect zone 3. They may follow a direct blow, and it is characteristic that the deformity only arises after several days. This means that one must be vigilant in the accident and emergency department, and offer advice that the patient should return promptly if deformity develops. Whilst early splintage may be successful in a flexible boutonnière, late surgery is difficult. The deformity will not develop after simple division of the central slip – this is the principle of the Fowler central slip tenotomy for chronic mallet deformity.
Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. Green’s Operative Hand Surgery. 7th ed, Philadelphia, Elsevier 2017: 169.
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This neuropathy was first described in 1932 by Robert Wartenberg (1887 – 1956), clinical professor of neurology at the University of California. The nerve runs under cover of brachiodradialis (BR), and may be entrapped between BR and ECRL or under the edge of BR as it emerges on the dorsum of the wrist. This is 9 cm above the radial styloid; the nerve bifurcates 5.1 cm above the styloid.
Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. Green’s Operative Hand Surgery. 7th ed. Philadelphia, Elsevier 2017: 947.
Abrams RA, Brown RA, Botte MJ The superficial branch of the radial nerve: an anatomic study with surgical implications J Hand Surg Am. 1992, 17:1037-41.
Aird RB. Robert Wartenberg 1887-1956. AMA Arch Neur Psych.1957, 77:490-1.
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The kerf of the saw blade is the gap between the teeth. For small resections this may have a significant impact, especially if using a large blade. The packaging will normally give this measurement. An oblique osteotomy is preferable as it increases the surface area and allows for compression. If the proximal cut is made first the distal (now free) end is very difficult to control when making the second cut. A number of commercial jigs take some of the eyeballing out of the operation.