Secondary deposit from carcinoma is rare in the hand. We describe three cases, and discuss some of the diagnostic difficulties.

A metastasis in a terminal phalanx which presented with the clinical features of a pulp space infection is described. The primary was a carcinoma of the esophagus.

A plea is made for greater recognition of the differences between triphalangeal thumb and five-fingered hand. Both conditions can benefit from surgical management but the methods required are entirely different.

In a severe compound and contaminated injury of the hand with loss of soft and bony tissues, restoration of function was obtained by a free composite vascularised tissue transfer.

It has been suggested that where a double lesion to a peripheral nerve exists, the results of regeneration of the nerve is actually improved. This has been studied by comparing the results of nerve section and repair with and without an accompanying second lesion in the form of freezing of the nerve proximal to the anastomosis. While the effects of freezing does not adversely affect the results of nerve repair it has not been shown to produce any significant improvement.

The importance of the arterial blood supply of the median nerve in the carpal tunnel depending on the type of hand vascularization was examined in view of surgical intervention in this region. Special attention was given to the anastomoses of the arterial branches which take part in the median nerve blood supply.

Carpal tunnel syndrome is a result of median nerve compression within the carpal canal. Factors associated with the appearance of carpal tunnel syndrome can be related to the bony architecture of the carpal canal, to its contents and to systemic disease. The purpose of this work is to see if changes in the elasticity of the transverse carpal ligament may cause carpal tunnel syndrome.

Compression of the ulnar nerve in the canal of Guyon is a well recognised condition but we have not been able to find another reported case resulting from extrinsic pressure from calcium deposits at the wrist level. The causes of pathological calcification are briefly reviewed.

The case of a thirty-year-old woman with a cystic lesion in the right lunate is reported. The cyst was an intraosseous ganglion which is a relatively rare entity in that location.

We describe a case of pisotriquetral arthritis associated with ulnar nerve paraesthesiae. We briefly review the literature and discuss the aetiology of this particular case.

Two cases of osteoid osteoma of the capitate bone are described. This lesion is rare in the capitate: only ten cases have been reported. Noctural pain was the most significant clinical feature, with characteristic relief by aspirin. The findings on routine x-rays, although not very typical, were sufficient to establish the diagnosis and to make the use of tomograms, bone scans and angiograms unnecessary. Resection "en bloc" through a dorsal approach led to complete cure.

Carpometacarpal dislocation of the base of one or more of the four ulnar metacarpals is extremely rare. This case report describes a carpometacarpal dislocation of all four ulnar metacarpals treated with open reduction under anaesthesia and internal skeletal fixation for six weeks. The result twelve weeks after the accident was functionally and anatomically excellent.

A case of volar transscaphoid perilunar dislocation of the wrist with a follow-up of six months is described. Conservative treatment resulted in union of the scaphoid without avascular necrosis. The patient had a good functional result. In volar transscaphoid dislocations a conservative approach is proposed due to the preservation of vascular supply to the scaphoid in an injury caused by hyperflexion of the wrist.