Examination of the Pronator Quadratus Muscle during Hardware Removal Procedures after Volar Plating for Distal Radius Fractures

BACKGROUND: It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. METHODS: We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. RESULTS: The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. CONCLUSIONS: This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.

Volar Ligament Reconstruction or Trapeziectomy for Thumb Carpometacarpal Joint Osteoarthritis

PURPOSE: The purpose of this study was to evaluate surgical outcomes of thumb carpometacarpal osteoarthritis treated either by volar ligament reconstruction or trapeziectomy with suspensionplasty. MATERIALS AND METHODS: From July 2004 to January 2011, we treated 43 patients with thumb carpometacarpal joint arthritis by volar ligament reconstruction in stages I and II, and by trapeziectomy with suspensionplasty in stages III and IV. Out of the 43, we evaluated 19 patients (9 treated by volar ligament reconstruction, 10 treated by trapeziectomy with suspensionplasty) at an average of 36.8 months (range: 8 to 65 months) after surgery. Outcome measures included pain visual analogue scale (VAS), ranges of motion, and grip and pinch strengths. RESULTS: The mean VAS was 1.2 in the volar ligament reconstruction group and 2.0 in the trapeziectomy with suspensionplasty group at final follow-up. The ligament reconstruction group had significantly better thumb radial abduction and opposition ranges of motion, and key grip strength. No further radiographic arthritic changes were noted in the ligament reconstruction group at a mean follow-up of 39 months. CONCLUSION: The authors obtained satisfactory pain control in patients with thumb carpometacarpal osteoarthritis by volar ligament reconstruction for stages I-II and trapeziectomy with suspensionplasty for stages III-IV.

Patient Characteristics and Treatment of Hallux Polydactyly Associated with Varus Deformity / 대한정형외과학회잡지

PURPOSE: To evaluate patient characteristics such as deformity type, associated disease, and family history, and results of treatment of pre-axial polydactyly with hallux varus deformity. MATERIALS AND METHODS: We carried out a retrospective study of 5 patients who presented with preaxial polydactyly with hallux varus deformity, and were treated between 2003 and 2010 at the authors' hospital. Surgeries including extra digit excision, local flap, osteotomy, and interphalangeal joint fusion were performed taking into consideration the deformity types and patient's age. Family history, associated disease, and types of duplication were assessed, and the outcomes of surgery were evaluated with radiographs and appearances of foot. The mean follow-up period was 34 months. RESULTS: All 5 patients had one or more associated anomalies such as congenital anterolateral tibial bowing and polydactyly in three, translocation of chromosome 2 : 13 associated with cryptorchidism in one, pes planovalgus in one, residual poliomyelitis in one, syndactyly of the foot in two, and leg length discrepancy in one patient. There was no family history of hallux polydactyly in any of the cases. All five patients had duplication of the distal phalanx and one of them had a blocked proximal phalanx. The extra digit was completely removed and the varus deformity was corrected in all cases. CONCLUSION: There was a high incidence of associated diseases in patients with hallux polydactyly and varus deformity. Deformity correction could be obtained by surgeries chosen according to the individual deformity type and patient age.

Acute Shortening and Gradual Lengthening for a Comminuted Tibia Fracture with Massive Bone and Soft Tissue Defect: Case Report

Traditional management of comminuted tibia fractures with massive bone and soft tissue defect includes soft tissue coverage and bone grafting. However, this method requires a large flap and a substantial amount of bone graft. Acute shortening can reduce the amount of required soft tissue and bone graft. We report a case of open tibia and fibula fracture with severe bone and soft tissue defect that was successfully treated by acute shortening of the tibia with immediate fibular strut bone graft and then by gradual lengthening of the tibia at its proximal metaphysis.