OKOJ, Volume 13, No. 2

Factitious Disorders of the Hand

Factitious hand disorders are highly challenging problems for the treating physician both diagnostically and in terms of their management. We have found that the most beneficial strategy for managing these disorders is through a clinically multidisciplinary team that provides both their appropriate diagnosis and treatment. Factitious disorders of the hand are major consumers of medical professional resources, and patients with these disorders often present with complaints that can be difficult to verify, diagnose, and treat. This review is based on the clinical presentations and features of five cases of commonly encountered factitious hand disorders. Each case includes both the physical presentation of the disorder and the psychological issues that underlie it, as well as strategies for its diagnosis and treatment. Each case demonstrates a clear and distinct association between a particular type of factitious hand disorder, the psychopathology underlying it, and its ultimate prognosis.

    • Keywords:
    • factitious disorder

    • mutilating injuries

    • self-inflicted condition

    • factitious lymphedema

    • complex regional pain syndrome

    • feigned symptoms

    • self-tourniqueting

    • Subspecialty:
    • Hand and Wrist

Chordoma and Notochord Tumors

Notochord tumors present as malignant or benign neoplasms that are believed to arise from residual notochord cells. A chordoma is classically described as a malignant bone tumor theorized to originate from notochord cells and with a predilection for the sacrum, mobile spine, and base of the skull. The mainstay of treatment for chordoma is wide en bloc resection, often combined with adjuvant radiation therapy. The prognosis is poor because of the local aggressiveness of the tumor and its relative resistance to radiation and chemotherapy. Benign notochordal cell tumors also arise in the spine from residual notochord cells, but remain intraosseous and are not locally aggressive. Histologically, both malignant and benign notochordal cell tumors contain physaliferous cells, which have foamy, mucin-containing vacuoles, and some evidence suggests a continuum of disease from benign notochordal cell tumors to chordoma. In this article we describe the clinical, radiographic, and histologic evaluation of notochord tumors and their treatment, with a focus on tumors within the sacrum and coccyx.

    • Keywords:
    • chordoma

    • notochord tumor

    • benign notochordal cell tumor

    • incipient chordoma

    • Subspecialty:
    • Musculoskeletal Oncology

Surgical Management of Greater Tuberosity Fractures

Although isolated fractures of the greater tuberosity of the humerus are less common than three- or four-part fractures of the proximal humerus, they can still result in significant disability. Fractures of the greater tuberosity often result from an anterior dislocation of the shoulder. Their nonsurgical treatment is generally reserved for minimally displaced fractures, and generally has good results, albeit with a lengthy recovery period. The surgical treatment of fractures of the greater tuberosity is controversial and ranges from arthroscopic fixation to open reduction and internal fixation. These fractures can be challenging for a variety of reasons, including the pattern of injury, schemes for their classification, methods of fixation, and the measures used to define the outcome of their treatment. Long-term outcome data on the surgical treatment of fractures of the greater tuberosity are lacking, but the literature shows that it can yield favorable outcomes. This article focuses on the surgical indications and arthroscopic and open surgical techniques for treating fractures of the greater tuberosity, on technical pearls for their surgical treatment, and on rehabilitation of the patient following their surgical treatment.

      • Subspecialty:
      • Trauma

      • Shoulder and Elbow