Periosteal sleeve fractures, or avulsions of cartilage and/or periosteum with or without an osseous fragment in skeletally immature individuals, are notoriously easy to miss and a high index of suspicion is necessary for accurate diagnosis and treatment. While periosteal sleeve avulsion fractures are classically reported in the patella, they have also been reported in the shoulder, clavicle, and elsewhere in the knee. However, no published reports exist for a periosteal sleeve avulsion fracture in the hand. This case details the first reported instance of such an injury involving a thumb metacarpal in a 3-year-old boy, treated with open reduction and percutaneous pinning of the thumb metacarpal.

Finger amputations in children present unique challenges and require special considerations compared to their adult counterparts. Maximizing length and preserving fingertip bulk and sensation is essential for maintaining a functional digit. Synthetic dermal substitutes have been recently used for soft tissue coverage for pediatric syndactyly as well as burn injuries; however, the literature discussing pediatric amputation cases with soft tissue damage proximal to the bony level is limited.In this case, we report a two-year-old patient who developed dry gangrene of her right index finger after multiple rabbit bites and underwent an amputation through the distal interphalangeal joint. Circumferential soft-tissue debridement proximal to the tip of the middle phalanx was required, leaving substantial exposed bone with no soft tissue envelope. We report our experience of single-stage stacking Integra dermal substitute directly onto the exposed bone to provide both finger bulk and soft tissue coverage.The patient displayed no functional limitations three years post-surgery.For instances when local or distant flap coverage may not be feasible, we present a novel technique to reconstruct, provide bulk, and preserve length in pediatric finger amputations. This case highlights that the utility of dermal substitutes is expanding and are providing more technical options.

The most common cause for catching or snapping in the finger is stenosing tenosynovitis, that is, trigger finger. Although less common, snapping can also occur as a result of extensor mechanism injury. Among these injuries, sagittal band rupture is most common and leads to snapping at the metacarpophalangeal joint. Snapping at the proximal interphalangeal (PIP) joint is rare with only 4 reported cases; reported mechanisms of PIP joint snapping include retinacular ligament injury or tendon impingement. We present a unique case of painful finger snapping at the PIP joint as a result of longitudinal tear of the central slip, leading to sudden subluxation of one-half of the central slip and conjoint lateral band with flexion of the PIP joint.

Infantile digital fibromatosis (IDF), also called inclusion body fibromatosis is an uncommon benign tumour occurring in the digits of young children. In about a third of cases, it is congenital and the diagnosis is based on the presence of peculiar intracytoplasmic inclusions on histology. Recurrence rate post-surgery is high. However, spontaneous regression has been reported. We present a case of a 5-month-old infant who had excision of a right second toe mass, which has been present from birth. Histological examination revealed this to be infantile digital fibromatosis. To the best of our knowledge, no report of this has been made in Nigeria. It is important that this diagnosis be entertained in young children with masses on the digits as this will influence the management instituted.

Avascular necrosis of the metacarpal head, known as Dieterich disease, is rare. The underlying pathogenesis of the disease is not clearly understood, and there are few cases reported in the literature. Nonoperative treatment with rest and nonsteroidal anti-inflammatory drugs is often successful, but surgical management is sometimes indicated. The case outlined here describes a novel application of the known technique of metacarpophalangeal joint denervation to relieve pain while maintaining joint mechanics and grip strength.

UNASSIGNED: Pachydermodactyly is an uncommon or under diagnosed variant of digital fibromatosis. It is a benign disease, described by symmetric proximal interphalangeal (PIP) involvement, progressive swelling, absence of inflammation or pain, and without limitation of function. It has been linked in some cases with psychiatric disorders such as obsessive-compulsive disorder or repetitive mechanical stimulation.
UNASSIGNED: We aim to report a case of pachydermodactyly that was diagnosed in a young 17-year-old male patient with painless swelling of the digits mainly at PIP joints with hyperkeratosis that was treated conservatively.
UNASSIGNED: Pachydermodactyly is an under diagnosed and underestimated entity; the recognition of a case in clinical practice can prove to be challenging. A high index of suspicion must be kept at all times when no reason for the swelling is found.

Background: Distal digital nerve repairs can present unique challenges for hand surgeons due to their sensitive location and ongoing difficulty obtaining soft tissue coverage in this region. Although autografts and nerve conduits have been shown to be of benefit with nerve gaps, they can have morbidities associated with their use. Nerve allografts have become a viable option over the past decade as their use has increased and data are now showing similar outcomes, particularly in short gap segments. Flaps and skin grafts are traditional coverage options for full thickness wounds but can pose challenges with multiple digit involvement, depth of wound, and critical structures exposed. Methods: We present a case where nerve allograft was used for distal digital nerve repair. Due to the distal nature of the nerve repair in the index digit distal to the trifurcation, the distal end of the nerve graft was connected to multiple small nerve ends. Dermal substitute was placed to achieve distal coverage of the affected digits. Results: At 6-month follow-up, the patient demonstrated improved strength, normal sensation, and full return of digital function. Conclusion: Nerve allograft can be used in combination with dermal skin substitute to achieve normal sensation and return of digital function following distal digital nerve injuries.

BACKGROUND: Confluent squamous cell carcinoma in situ, or Bowen\'s disease, involving the hand, digit, and nail bed is rare and represents a significant therapeutic challenge. Surgical excision is recommended as first-line treatment but in cases of extensive disease can lead to unacceptable functional morbidity or cosmetic outcomes. Radiation therapy has been shown to be equally efficacious to surgery in the treatment of carcinoma in situ but its use has historically been limited due to concerns regarding toxicity. In this case report we present a novel therapeutic technique that may enable radiotherapy to be employed as a definitive treatment option in these challenging cases.
METHODS: A 75-year-old white man with a previous history of carcinoma in situ of his right hand previously treated with 5-fluorouracil presented with recurrent biopsy-proven confluent squamous cell carcinoma in situ of multiple surfaces of his right hand and digits with involvement of nail beds. To avoid extensive resection and possible amputation he was offered definitive external beam radiation therapy utilizing a water bath as a tissue-equivalent bolus material. This protocol enabled improved dose homogeneity to the target volume while minimizing acute toxicity. He experienced complete clinical resolution of the disease with only minimal acute edema and hyperpigmentation. Twenty months following treatment completion he remains disease-free with normal function and excellent cosmesis.
CONCLUSIONS: Therapeutic radiation utilizing water as a tissue-equivalent bolus in this complicated case enabled definitive treatment of disease without compromising functional or cosmetic outcomes. Radiotherapy may therefore be an alternative and under-utilized approach to surgical excision in difficult-to-treat cases of carcinoma in situ.

Pacinian neuromas are rare benign tumours of pacinian corpuscles of the digits. They generally occur on the volar aspect of the fingertips. Pacinian corpuscles are specialised nerve endings with a lamellated structure and are regarded as pressure and vibration receptors. Here, we report a case of pacinian neuroma presenting as congenital macrodactyly of the right little finger with pain for which the lesion was surgically excised.