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The HandDoc Blog

 

High Median Nerve Palsy (Postgraduate Series)

The median nerve serves a crucial role in extrinsic and intrinsic motor and sensory function to the the hand. Median nerve palsy is often caused by deep, penetrating injuries to the arm, forearm, or wrist. It may also occur from blunt force trauma or neuropathy. 

Even with appropriate recognition and contemporary nerve reconstruction, motor and sensory recovery may be inadequate. With isolated persistent high median nerve palsies, a variety of available tendon transfers can improve key motor functions and salvage acceptable use of the hand.

View the video below on Prof Michael Solomon’s High Median Nerve Palsy.
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Decision Making in Chronic Perilunate Dislocation

Perilunate dislocations are potentially devastating closed wrist injuries.

These injuries involve dislocation of the carpus relative to the lunate which remains in normal alignment with the distal radius. They should not be confused with lunate dislocations where the lunate is dislocated in a volar direction and no longer has normal radiolunate articulation.

View the video below on Prof Michael Solomon’s decision making of this Perilunate dislocation.

Boxers Fracture

A boxer’s fracture is when you break a bone at the base of your finger, near the knuckle or neck of the bone. That bone is known as a metacarpal.

A boxer’s fracture may also be called fifth metacarpal fracture. It usually happens to the small (pinky) finger or the ring finger and is most common in men.

View the video below on Prof Michael Solomon’s diagnosis of Boxers Fracture.

South African Society for Surgery of the Hand

Dr Solomons was invited to talk at the South African Society for Surgery of the Hand. He gave three lectures during the conference:

1A novel test to confirm Green 1 and 2 trigger finger. – This lecture describes a brand new test to uncover suspected trigger finger so the diagnosis is not in doubt

2: The Management of Chronic Dorsal Proximal Interphalangeal dislocations – when a patient presents late with this problem it can be difficult to decide what to do

3:  Are you sure it’s Kienbock’s (before you submit your patient to an outrageously over – invasive surgical procedure)  – This talk is designed to implore colleagues to be sure they are making the correct diagnosis as the consequences are dire ( Kienbocks = avascular necrosis of the Lunate bone)

International Faculty to lecture on Hand Surgery

Dr Solomons was invited to speak at an International Faculty to lecture on Hand Surgery in Fiji. His focus and lectures included:

  • Total Wrist Arthroplasty vs Total Wrist Fusion – How to decide on the pros and cons of these two options when the wrist is destroyed with arthritis
  • Mistakes I’ve made &n operations I no longer do
  • Developing an algorithm for ulnar sided wrist pain(USWP) – Probably the most confusing diagnostic dilemma for most wrist surgeons is USWP. This lecture tries to simplify the issue
  • Three weird but clinically relevant conditions of the hand

FP Fouche

Dr Solomons was invited to give the prestigious Eponymous FP Fouche lecture at the South African Orthopaedic Association in September 2018. The title of the lecture was “However far a stream flows it never forgets its source”. The lecture honoured one’s mentor and becoming a mentor to others.

 

British Society for Surgery of the Hand

In May 2018, Dr Solomons was invited to give 5 lectures at The British Society for Surgery of the Hand. The lectures were titled:

  1. Mistakes I’ve made and operations I no longer perform
  2. HIV related infection and TB
  3. Reconstruction of the non-reconstructable median nerve defect
  4. Practising Hand and Wrist Surgery without an Arthroscope: An evolution?
  5. Thats weird … Three very strange Hand Pathologies.

 

‘I screamed and then saw my hands lying there’

Michelle Pietersen, Cape Times, Monday  16 August 2016

One moment Bongani Mpange was cutting paper with the industrial guillotine he had been using for nine years, the next he was starting down in horror as his bloody hands detached from the rest of his body. 

“I pulled the paper. The blade fell down, cut both my hands and then went up. I screamed and then saw my hands lying there. There was nothing more I could do,” Mpange, 31 said. 

The accident occurred just before noon on Thursday at the Da Gama paper factory in Parow industria. 

Mpange believed it happened because the machine was “broken”. 

He said he guillotine was fitted with a sensor and was designed not to drop if it sensed there was an object there other than paper below it. 

“I didn’t think the blade would come down, but it did,” Mpange said. 

Moments after his hands had been severed, fellow staff members ran to Mpange’s assistance. 

“There was a lot of blood and I was feeling the pain,” Mpange said. 

“People working with me fetched my hands and put (them) on ice. 

“They tied (my wrists because they were) bleeding too much.”

Mpange’s supervisor called an ambulance, and it arrived about 30 minutes later.

Mpange was taken to the Vincent Pallotti Hospital in Pinelands where two teams of doctors worked for seven hours to re-attach his hands. By about 9:30pm he was wheeled out of the theatre, his hands re-attached, and into the intensive care unit. 

But that was not the end of the ordeal for Mphange. 

According to Andrew Bruce-Chwatt, a plastic surgeon who was a member of the surgical team, Mpange returned to the theatre on Saturday because of clots in the veins.

“We were not satisfied with the view outflow. The blood was flowing in but not out of his hands,” Bruce-Chwatt said. 

With the limited time available to them, the team of four doctors then “reworked” all the severed veins and repaired the nerves and tendons on the backs of the palms of his hands. 

During the six-hour operation, the team repaired two arteries in each hand, two veins in one hand and four in the other, using a thread finer than a strand of hair. 

Specialise hand surgeon Mike Solomons said it was rare to deal with a case in which both hands were severed. 

“It was definitely a first for everyone involved and one of the first (double re-attachment procedures) in South Africa.” 

Mpange was under the knife for about 13 hours. Solomons said the operations were difficult and posed challenged for the team, but what had counted in Mpange’s favour was that the cutes were clean. 

“We repeated the operation to join his veins. Because of the extent of the trauma there was excessive clotting. His hands swelled up and began bleeding,” said Solomons. 

He said the team – including himself, plastic surgeon Alexander Zuhlke, orthopaedic surgeon Ian Koller and microvascular specialist Conrad Pienaar – was hopeful that Mpange’s hands would regain reasonable function. 

“It’s still early days.”

Mpange said he was grateful he would be able to use his hands again. “At least I look better now. I’m still young and I have to work because I am the breadwinner.”

Just 24 hours after his second operation, Mpange said he was starting to feel sensation in his hands. 

 

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