Stress Radiographs under Anesthesia for Painful Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: Anterior drawer and varus stress radiographs are commonly to diagnose chronic lateral ankle instability. We compared the preoperative stress radiographs with the intraoperative radiographs under anesthesia to determine the accuracy and efficacy of stress radiographs in an outpatient clinical environment. MATERIALS AND METHODS: Data was collected from patients who underwent a modified Broström operation for painful chronic unilateral lateral ankle instability between January 2014 and June 2016. Subjects were divided into three groups—complete tear, partial tear, and instability without rupture—according to the status of preoperative MRI findings of the anterior talofibular ligament. The anterior drawer and varus stress radiographs were taken preoperatively and intraoperatively under anesthesia. RESULTS: Ninety-six patients, with a mean age of 29.63 years, were enrolled. There were 39, 46, and 11 patients in the complete tear, partial tear, and instability without rupture groups, respectively. On the anterior drawer and varus stress radiographs of the affected limb, talar anterior translation and varus tilting were significantly increased by 2.56 mm and 2.0°. The gaps between the unaffected limbs were also increased by 2.47 mm and 1.32° after anesthesia. Although the stress radiographs were taken under anesthesia, the results were often smaller than the diagnostic value. CONCLUSION: Stress radiographs for painful chronic lateral ankle instability taken at the outpatient clinic might be inaccurate for diagnosis.

The Fate of Anterior Interosseous Nerve Syndrome

PURPOSE: We report the causes and prognosis of anterior interosseous nerve syndrome (AIN) according to the treatment. METHODS: From March 2009 to December 2015, the 20 patients with the clinical symptom of AIN syndrome were enrolled in the study and electromyography (EMG) of AIN was performed. We retrospectively reviewed hand function test, active range of motion, the disabilities of the arm, shoulder and hand (DASH) score and EMG during the recovery from disease. We further surveyed the time of recovery and residual symptoms. RESULTS: The patients with unknown cause of the disease (12 cases), heavy work or trauma (6 cases) and infection (2 cases) were investigated in the study. Thirteen out of 15 cases with conservative treatment and 2 out of 5 cases with a surgical treatment at an average of 8 months from disease were recovered. In addition, 8 cases with fine motor disturbance and 3 cases with tingling residual symptom were observed. CONCLUSION: Due to the low possibility of entrapment neuropathy, conservative treatment for 7 months is the first choice rather than surgical treatment. If there is no improvement from the conservative treatment, surgical exploration of AIN is the indication of treatment. After recovery, patients may have the symptoms of fine motor disturbance and tingling.

Suspended Replantation in Complete Amputations of the Hand and Finger

PURPOSE: We report the results of replantations which was intentionally delayed for a certain period of time in patients with an amputation of multiple digits, both hands or the single digit presented at night. MATERIALS AND METHODS: Two staged intentianlly delayed replantations were performed in twenty patients. Three patients had amputations of four or more fingers, two had bilateral hand amputations and fifteen had a single digit amputation. RESULTS: The mean warm ischemic time was 3 hours and 58 minutes. The mean cold ischemic time was 2 hours and 36 minutes for the first operation, and 15 hours and 13 minutes for the second operation. Twenty digits out of 28 digits (85%) survived completely. At the mean follow-up of months, functional results according to Chen's criteria were rated as excellent in six patients, good in eight, and fair in five. CONCLUSION: When the patients had multiple finger amputations, bilateral hand amputations or presented late at night, intentional delay of the replantation also provide satisfactory outcomes.

Dupuytren's Contracture Release with Straight Line Incision and Multiple Z-plasty

PURPOSE: To report the results of patients with a Dupuytren's contracture treated with fasciectomy combined with straight line incision and multiple Z-plasty. MATERIALS AND METHODS: We performed retrospective study on 33 hands in 28 patients who had a Dupuytren's contracture between March 2006 to July 2009. Patients were males and the average age was 62-year-old ranging from 50 to 75. There were 15 single and 18 multiple digits involvement. Operation involved fasciectomy using straight skin incision combined with multiple Z-plasty. Postoperative assessment was based on the Honner's classification and range of motion of the involved fingers. RESULTS: According to Honner's classification, the clinical results were excellent in 19 cases, good in 11 and fair in 3. No complication was found except three patients who complained of pain for 6 months after the surgery. The mean range of motion of the involved fingers was 120degrees preoperatively and it increased to 205degrees postoperatively. Cold intolerance lasted for about 6 months in 5 patients but improved spontaneously. CONCLUSION: In patients with a Dupuytren's contracture, fasciectomy with a straight midline incision and multiple Z-plasty provides satisfactory recovery of finger motions.

Reconstruction of Soft Tissue Defects in the Finger using Arterialized Venous Free Flaps

PURPOSE: To report the clinical results of the use of arterialized venous free flaps in reconstruction in soft tissue defects of the finger and to extend indications for the use of such flaps based on the clinical experiences of the authors. Materials and METHODS: Eighteen patients who underwent arterialized venous free flaps for finger reconstruction, between May 2007 and July 2009 were reviewed retrospectively. The mean flap size was 4.7x3.2 cm. The donor site was the ipsilateral volar aspect of the distal forearm in all cases. There were 8 cases of venous skin flaps, 5 cases of neurocutaneous flaps, 4 cases of tendocutaneous flaps, 1 case of innervated tendocutaneous flap. The vascuality of recipient beds was good except in 4 cases (partial devascuality in 2, more than 50% avascuality (bone cement) in 2). RESULTS: All flaps were survived. The mean number of included veins was 2.27 per flap. Mean static two-point discrimination was 10.5 mm in neurocutaneous flaps. In 3 of 5 cases where tendocutaneous flaps were used, active ROM at the PIP joint was 60 degrees, 30 degrees at the DIP joint and 40 degrees at the IP joint of thumb. There were no specific complications except partial necrosis in 3 cases. CONCLUSIONS: An arterialized venous free flap is a useful procedure for single-stage reconstruction in soft tissue or combined defect of the finger; we consider that this technique could be applied to fingers despite avascular recipient beds if the periphery of recipient bed vascularity is good.

Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child : A Case Report

The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported to be irreducible as a consequence of flexor tendon entrapment. A 12-year-old male sustained a malunited base fracture of the proximal phalanx of the small finger on the right hand and was unable to flex the finger. 6 weeks ago he was treated with closed reduction and percutaneous K-wire fixation, at another hospital. In a subsequent operation, it was found that the flexor tendon was entrapped at the fracture site. Flexor tenolysis and realignment of the fracture and internal fixation with K-wires were performed. The patient could perform his work without discomfort in his hand and a normal range of motion was possible in the small finger 12 months after the operation.