Minimal Invasive Fixation Methods for the Metacarpal Fracture

Purpose@#This study compared the radiologic and clinical outcomes of metacarpal fractures treated with two minimally invasive surgical techniques: Kirschner wire (K-wire) fixation and headless screw fixation. @*Materials and Methods@#This study included 52 patients (46 males and 6 females; age 18-55 years) with distal metacarpal fractures (middle and distal shaft, including the neck) who had undergone K-wire fixation or headless screw fixation. All subjects were followed up for at least six months. The radiologic assessments were performed to evaluate the angular deformity and shortenings. The total active motion (TAM), grip strength, and patients’ subjective functional assessment were measured to evaluatethe hand function. The time taken to return to work (RTW) and adverse events were analyzed. @*Results@#Of the 52 cases, metacarpal fractures treated with headless screw fixation and K-wire fixation showed a significant difference associated with early RTW (p0.05). @*Conclusion@#After a six-month follow-up, minimally invasive K-wire fixation and headless screw fixation produced similar clinical and radiologic outcomes in subjects with metacarpal fractures. Compared to K-wire fixation, however, headless screw fixation led to earlier functional recovery and might be a better option for treating metacarpal fractures in this regard.

Intramedullary Stabilization Technique Using Headless Compression Screws for Distal Ulnar Fractures

Distal ulnar fractures are commonly accompanied by distal radial fractures, and several treatment options such as plate osteosynthesis and pinning with Kirschner's wires are used. In this study, we present a technique using headless compression screws to achieve bony union of distal ulnar fractures. From November 2016 to November 2018, we treated 11 patients with distal ulnar fractures combined with distal radial fractures with headless compression screws (DePuy Synthes). Patients were instructed to maintain a short-arm splint for less than two weeks after the treatment. The mean time to bony union was 6.5 weeks, mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14.6 points, and mean visual analog scale score was 1.09 points. Full range of motion was possible in all directions after surgery and no specific complications were observed. The suggested technique allows minimal incision and minimally invasive intramedullary fixation and can promote bony union in a simple way without specific complications.

Epidemiologic Study of Shoulder Injuries in the PyeongChang 2018 Winter Olympic Games

BACKGROUND: The purpose of this study is to describe and analyze the shoulder injuries in elite athletes during the 2018 Winter Olympics in Pyeongchang. METHODS: To collect the data of all Olympic athletes who visited venue medical centers, polyclinics, and Olympic-designated hospitals for shoulder injuries during the Olympic Games (February 9 through 25, 2018), we reviewed Olympic electronic medical records and patient information obtained from Olympic medical service teams about athletes who complained of shoulder pain. RESULTS: During the Olympics, a total of 14 athletes visited clinics for shoulder-related symptoms. Five athletes were injured in games and nine were injured in training. The injury was due to overuse in four patients. Ten patients had trauma-related symptoms: one after being hit by an opponent and the other nine after a collision with the ground or an object. There were no patients who complained of symptoms related to pre-existing shoulder conditions. The most common cause of shoulder pain was snow-boarding (one big air and three slopestyle). The most common diagnosis was contusion (n = 6), followed by rotator cuff injuries (n = 3), superior labrum from anterior to posterior lesion (n = 1), sprain (n = 1), acromioclavicular-coracoclavicular injury (n = 1), dislocation (n = 1), and fracture (n = 1). CONCLUSIONS: To the best of our knowledge, this study is the first epidemiologic study of shoulder injury conducted during a huge sports event involving a variety of competitions for elite athletes. If the risk factors of shoulder injury can be established by continuing research in the future, it will be helpful to prevent injury and to prepare safety measures for athletes.

A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study

BACKGROUND: We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. METHODS: We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. RESULTS: The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. CONCLUSIONS: The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Intermittent Claudication due to Cystic Adventitial Disease of the Popliteal Artery: Importance of Multiple Imaging Modalities

No abstract available.

Tendon Problems of the Ulnar Wrist / 대한정형외과학회잡지

It is challenging for orthopedic surgeons to diagnose pain at the ulnar aspect of the wrist due to the small and complex anatomical structures involved. Ulnar-sided wrist pain can also result from tendon problems, including extensor carpi ulnaris tendon and flexor carpi ulnaris tendon. Disorders of the extensor carpi ulnaris tendon include subluxation, dislocation, stenosing tenosynovitis, and tendinopathy. Unlike the extensor carpi ulnaris tendon which is prone to subluxation, dislocation and stenosing tenosynovitis from passing through as sheath, a flexor carpi ulnaris tendon is unsheathed, and calcific tendinitis and crystal deposition disease can occur at the distal tendinous portion of the flexor carpi ulnaris tendon.

Scaphoid Fractures and Nonunion

Fracture of scaphoid is relatively common, and accurate and prompt diagnosis leads to bony union with good clinical outcome. However, it can be easily missed due to vague symptomatic complaints by patients, which in turn leads to negligence of a doctor in making the diagnosis or anatomical shape of scaphoid that causes minute fracture to be ignored while viewing simple radiography. When missed, nonunion of scaphoid gradually progresses to arthritic change in the wrist. Thus when fracture of the scaphoid is suspected, further evaluation should be initiated with care, and if the diagnosis is confirmed, a proper treatment plan must be set with assessment of stability of the fracture fragment. Internal fixation is usually proposed since solid fixation of the fracture provides early return to daily activity. When nonunion of the scaphoid is present, most patients can achieve bony union with avascular bone graft and internal fixation. However, if there is sclerotic change, large bone cyst or avascular necrosis of the fracture fragment, internal fixation with bone graft that includes vascular supply should be introduced in order to achieve bony union.

Comparison of Distal Radius Fractures with or without Scaphoid Fractures

PURPOSE: Distal radius fracture is one of the most common factures, but incidence of concomitant scaphoid fracture is rare. The rarity makes diagnosing the concomitant scaphoid fracture often delayed. Thus, in this study, the authors examined the frequency of concomitant scaphoid injury in distal radius fracture and the type of distal radius fracture that is more commonly associated with simultaneous scaphoid fracture. METHODS: We examined a total of 212 patients who had received treatment for the fracture in our institution. They were divided into two groups, isolated distal radius fracture group and distal radius fracture group with simultaneous scaphoid fracture, and their age, gender, body mass index and distal radius fracture type in accordance with AO classification were compared between the two groups. RESULTS: Concomitant scaphoid fractures were found in 12 (5%) patients, and among them 10 cases were associated with type C distal radius fracture. Statistical comparison between the group with isolated distal radius fracture and the group with both distal radius and scaphoid fractures was made, and only comparison of distal radius fracture types showed statistical significance. CONCLUSION: It is imperative to make timely and appropriate diagnosis of accompanying scaphoid fracture, since delay in making the diagnosis usually lead to many complications. We conclude that further diagnostic imaging such as computed tomography is necessary to make the correct diagnosis of concomitant scaphoid fracture, especially in type C distal radius fractures.

Snakebite in Korea: A Guideline to Primary Surgical Management

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.

Extranodal natural killer/T-cell lymphoma of the tenosynovium of the hand

No abstract available.

First Report of Nocardia farcinica Bursitis in a Patient with Diabetes Mellitus

No abstract available.

Rupture of Finger Flexor Tendon Due to Needle Tip Injury During Steroid Injection Therapy: A Case Report / 대한정형외과연구학회지

While injuries of finger flexor tendons are relatively commonly encountered trauma in orthopedic clinics, a closed rupture of these tendons is known to be rare due to their large flexibility and tension. Closed rupture of the finger flexion tendons can occur due to repeated movements following the fracture or malunion of the fingers or distal radius, and it also occurs nonspecifically among patients with autoimmune diseases. We report a case of spontaneous rupture of flexor digitorum tendons in a 49-year-old male who was diagnosed with carpal tunnel syndrome after received several sessions of steroid injection at the wrist joint; he was monitored for two-months and recovered well following operation.

Rupture of Finger Flexor Tendon Due to Needle Tip Injury During Steroid Injection Therapy: A Case Report / 대한정형외과연구학회지

While injuries of finger flexor tendons are relatively commonly encountered trauma in orthopedic clinics, a closed rupture of these tendons is known to be rare due to their large flexibility and tension. Closed rupture of the finger flexion tendons can occur due to repeated movements following the fracture or malunion of the fingers or distal radius, and it also occurs nonspecifically among patients with autoimmune diseases. We report a case of spontaneous rupture of flexor digitorum tendons in a 49-year-old male who was diagnosed with carpal tunnel syndrome after received several sessions of steroid injection at the wrist joint; he was monitored for two-months and recovered well following operation.

Surgical Management of Pisiform Bone Deformity Associated with Tendonitis of Flexor Carpi Ulnaris

PURPOSE: This study was performed to investigate the degree of symptom improvement after removal of bone fragment in patients with deformed pisiform bone associated with tendonitis of flexor carpi ulnaris. METHODS: Pisiform bone fragment removal was performed in 12 patients who had failed conservative treatment from January 2008 to December 2011. They were followed up at 2 weeks, 1 month, 2 months, 6 months, and 12 months after surgery. Their symptoms were assessed with Green score. RESULTS: Eleven of 12 patients who underwent bone fragment removal showed symptom improvement. Symptoms worsened in 1 patient due to pain and restricted range of motion caused by postoperative scar. CONCLUSION: The results of this study suggest that removal of bone fragment may be an effective treatment in patients with tendonitis of flexor carpi ulnaris accompanied by pisiform bone deformity whose pain does not improve with conservative management.

Comparison of Early Fixation and Late Fusion of 4, 5th Carpometacarpal Joint in the Intra-Articular Fractures of 4th and 5th Metacarpal Base

PURPOSE: To evaluate clinical results between early fixation group and delayed fusion group in treatment of intraarticular fracture of 4th, 5th metacarpal base. MATERIALS AND METHODS: From March 2002 to December 2006, 21 cases of early fusion and 11 cases of delayed fusion of 4, 5th carpometacarpal joint were reviewed retrospectively or were included in this study. Average follow up period is 39.9 months. Bony union was checked by plain films at follow up. DASH-questionnaire, VAS pain scale, grip power and range of motion of 4th, 5th metacarpophalangeal joint were also checked at last follow up. RESULTS: In radiologic study, bony union was confirmed in all cases of two groups. Early fixation group showed better outcomes than delayed fusion group in range of motion, DASH-questionnaire and VAS pain scale with statistical significant (p<0.004). CONCLUSION: Because early fixation group showed better clinical outcomes than delayed fusion group, early diagnosis and proper surgical treatment are important for better outcomes in treatment of intraarticular fracture of 4th, 5th metacarpal base.

Trans-scaphoid Perilunate Fracture Dislocations: Screw Fixation of the Scaphoid and Lunotriquetral Ligament Repair Using a Dorsal Approach

PURPOSE: To evaluate clinical and radiological results after screw fixation of the scaphoid and lunotriquetral ligament repair using a dorsal approach in the treatement of trans-scaphoid perilunate fracture dislocations. MATERIALS AND METHODS: From May 2003 to August 2007, 11 patients who underwent operative management of a trans-scaphoid perilunate fracture dislocation were included in this study. Average follow up period was 58 months. In all patients, screw fixation of the scaphoid and lunotriquetral ligament repair with a suture anchor after open reduction was performed. Clinical evaluation was done by measuring range of motion and grip power and disabilities of arm, shoulder and hand (DASH) score evaluation for functional recovery at the last follow up. Union of scaphoid, change in lunotriquetral distance, and development of any instability and arthritis of wrist joint were radiographically assessed. RESULTS: In clinical outcomes, 89.3% recovery of grip power and 87.5% recovery of range of motion compared to healthy side were observed at the last follow-up. Average range of motions of extension, flexion, ulnar deviation, radial deviation, supination and pronation were 51.8degrees, 58.4degrees, 21.2degrees, 16.2degrees, 74.3degrees, 75.1degrees respectively. Average DASH score was 13.2. Bony union of scaphoid was achieved in all cases at the average of postoperative 19.3 weeks. Lunotriquetral distance after the operation and at the last follow up were 1.9 mm and 2.0 mm, respectively. There were no radiographic evidence of instability or arthritis. CONCLUSION: Dorsal approach allows reduction of carpal bone, scaphoid fixation and lunotriquetral ligament repair in the treatment of trans-scaphoid perilunate fracture dislocations, providing satisfactory clinical and radiological results.

The Current Concepts for the Pathophysiology of Idiopathic Carpal Tunnel Syndrome / 대한정형외과연구학회지

Idiopathic carpal tunnel syndrome is the most common compressive peripheral neuropathy. Recently, the radiologic, histologic, biomechanical studies for idiopathic carpal tunnel syndrome have been performed in view point of its pathophysiology. Through this paper, Authors have reviewed the recent reported studies for the pathophysiology of idiopathic carpal tunnel syndrome and tried to suggest direction in future study.

Avulsion Fracture of Calcaneal Tubercle Treated with Cannulated Cancellous Screws and Wire: Surgical Technique

The incidence rate of calcaneal fracture consists about 2% of all fractures, and, of the fracture, calcaneal tubercle avulsion fracture is known to be rare. To treat non-displaced calcaneal tubercle avulsion fracture, conservative treatment such as cast fixation is applied. However, most cases accompany displacement of the avulsion fragment, and, usually, surgery is necessary to treat the displaced fracture. Although surgical fixation simply by cancellous screw or tension wire is widely used, fixation failure is potential complication in this method. Thus, this study wants to introduce a prospective and useful method that further strengthens the calcaneal fixation by using both cannulated screw and tension band wiring.

Ankle Arthrodesis Using Auto Fibula Bone Graft: Two Cases Report / 대한족부족관절학회지

Recently, development and improvement in joint replacement therapy, the need for arthrodesis has been decreasing. However, result of joint replacement is not always satisfactory, and most cases are rather indicative to ankle arthrodesis than ankle replacement. Often, ankle arthrodesis can be more beneficial salvage method to treat cases with failure in joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation. In cases with large bone defect that need to be treated with ankle arthrodesis using internal fixation, it is difficult to fill the defect with conventional auto-iliac bone or all-bone graft. Thus, we make a report on our experience in treating 2 cases with ankle arthrodesis using auto-fibular bone graft and plate fixation.

Treatment for Unstable Distal Radius Fracture with Osteoporosis: Internal Fixation versus External Fixation

PURPOSE: To compare the functional and radiological outcomes of volar plating to that of external fixation for treating unstable osteoporotic distal radius fracture. MATERIALS AND METHODS: From March 2006 to March 2008, 36 patients with osteoporosis over 60-year old were selected for this study. They were divided into two groups; group I (open reduction and internal fixation with volar fixed angle plate) and group II (closed reduction and external fixation). Clinical outcomes and radiologic outcomes were evaluated. RESULTS: There was no statistical difference between group I and group II in range of motion and DASH score, BMD score. However, the grip strength and PRWE score were found to be higher in group II (p<0.05). In radiologic evaluation, group I showed higher radial inclination, volar tilting angle (p<0.05). CONCLUSION: Internal fixation using Volar-fixed Angle Plate seems to give more stable fixation for distal articular fragments compared to external fixation. it could allow early postoperative exercise and could result in low incidence of postoperative complication such as pin track infections and joint stiffness. Therefore, the internal fixation could be more desirable treatment method to manage unstable distal radius fracture.