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Background@#This study aimed to evaluate the clinical outcomes of three-column reconstruction of the lower leg using a singlebarrel contralateral vascularized fibular graft (VFG), medial locking plate, and the ipsilateral fibula for the repair of large tibial defects after tumor resection. @*Methods@#In this retrospective study, we reviewed 12 patients who underwent three-column reconstruction using a single-barrel contralateral VFG, medial locking plate, and the ipsilateral fibula between June 1996 and May 2020. These patients had large tibial bone defects following tumor resection. The mean age of the patients was 26.3 years (range, 11–63 years), and 7 of them were women. The mean follow-up period was 104.8 months (range, 26–284 months). The mean size of the tibial bone defect after tumor resection was 17.8 cm (range, 11–26.8 cm). The clinical and radiological outcomes were evaluated at the final follow-up. @*Results@#All patients survived beyond the final follow-up without recurrence of the primary bone tumor. The mean time from reconstruction to bony union at both host-graft junctions was 12.9 months (range, 4–36 months). The mean Musculoskeletal Tumor Society score was 82.3% (range, 60%–97%). All tibial defects were reconstructed with adequate bone healing. There were 4 cases of stress fracture and graft failure; these were resolved by using longer plates and more screws. All patients were ambulatory without assistance and showed no permanent complications. @*Conclusions@#Large tibial defects that occur after tumoral resection can be effectively reconstructed by three-column reconstruction using a medial locking plate, an inlay single-barrel VFG harvested from the contralateral side, and the intact ipsilateral fibula.This technique permits early weight-bearing before fibular hypertrophy and bony union.
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Grip strength has been used to evaluate the upper extremity functional status and clinical outcomes following upper extremity trauma or surgery. Understanding general recovery patterns of grip strengthening can be helpful in assessing the patients’ recovery status and in assisting in preoperative consultations regarding expectations for recovery. We summarize related studies on grip strength measurement and recovery patterns in common hand conditions, including carpal tunnel syndrome, cubital tunnel syndrome, triangular fibrocartilage complex injury, and distal radius fractures.
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We would like to thank the authors for their interest in our work. We are grateful for the opportunity to respond to their letter regarding the origin of Jamar dynamometers.We have been delighted to learn about the history and origins of the Jamar dynamometer and believe that this information will be of interest to clinicians and researchers who use dynamometers in clinical settings or for related research. If the authors had not informed us, we would not have known this from the literature. We thank the efforts of the pioneers for their excellent work, which made it possible to objectively evaluate grip strength, and hope that researchers continue their work regarding the accurate measurement of grip strength and its clinical significance.
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Background@#Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx. @*Methods@#We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients’ clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up. @*Results@#Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44–98.42). No patients required removal of the hardware. @*Conclusions@#Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.
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Background@#We hypothesized that concurrent temporary fixation of scapholunate ligament (SL) injury during volar locking plate (VLP) fixation of distal radius fractures (DRFs) would improve restoration outcomes based on both radiological and clinical results.Here, we performed a prospective, comparative study investigating the effectiveness of temporary percutaneous reduction/pinning during VLP fixation in DRFs. @*Methods@#The first 43 consecutive SL injuries were treated concurrently after VLP fixation by closed pinning (group 1); the next 36 consecutive injuries were treated nonoperatively (group 2). Patients were followed up for at least 5 years after treatment. Basic demographic data, radiological measurements, arthroscopic findings of SL injury, and other clinical outcomes were evaluated. @*Results@#The mean follow-up period was 7.2 years. No significant differences in basic demographic data were evident between groups. Fracture patterns were not distinctively different between groups. The initial scapholunate angle measured immediately after surgery was 23° ± 3° in group 1 and 38° ± 13° in group 2, indicating a significantly hyperextended scaphoid position in group 1.The final scapholunate angles were also significantly different between groups although the final angle in group 2 (58° ± 11°) was within normal limits. Final visual analog scale scores, Disabilities of the Arm, Shoulder and Hand scores, Gartland and Werley system scores, and wrist motions were not different between groups; however, grip strength at the time of final follow-up was closer to that of the contralateral uninjured wrist in group 1. Arthrosis was less advanced in group 1. @*Conclusions@#Temporary fixation for SL injury with a DRF can be an effective option for the maintenance of scapholunate angle.The non-fixed group exhibited a more pronounced collapse of the scapholunate angle although the angle was still within normal limits, and clinical outcomes were similar between groups regardless of the fixation status.
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Background@#Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx. @*Methods@#We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients’ clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up. @*Results@#Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44–98.42). No patients required removal of the hardware. @*Conclusions@#Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.
ABSTRACT
Background@#We hypothesized that concurrent temporary fixation of scapholunate ligament (SL) injury during volar locking plate (VLP) fixation of distal radius fractures (DRFs) would improve restoration outcomes based on both radiological and clinical results.Here, we performed a prospective, comparative study investigating the effectiveness of temporary percutaneous reduction/pinning during VLP fixation in DRFs. @*Methods@#The first 43 consecutive SL injuries were treated concurrently after VLP fixation by closed pinning (group 1); the next 36 consecutive injuries were treated nonoperatively (group 2). Patients were followed up for at least 5 years after treatment. Basic demographic data, radiological measurements, arthroscopic findings of SL injury, and other clinical outcomes were evaluated. @*Results@#The mean follow-up period was 7.2 years. No significant differences in basic demographic data were evident between groups. Fracture patterns were not distinctively different between groups. The initial scapholunate angle measured immediately after surgery was 23° ± 3° in group 1 and 38° ± 13° in group 2, indicating a significantly hyperextended scaphoid position in group 1.The final scapholunate angles were also significantly different between groups although the final angle in group 2 (58° ± 11°) was within normal limits. Final visual analog scale scores, Disabilities of the Arm, Shoulder and Hand scores, Gartland and Werley system scores, and wrist motions were not different between groups; however, grip strength at the time of final follow-up was closer to that of the contralateral uninjured wrist in group 1. Arthrosis was less advanced in group 1. @*Conclusions@#Temporary fixation for SL injury with a DRF can be an effective option for the maintenance of scapholunate angle.The non-fixed group exhibited a more pronounced collapse of the scapholunate angle although the angle was still within normal limits, and clinical outcomes were similar between groups regardless of the fixation status.
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Handgrip strength (HGS) is associated with several chronic diseases, cognitive decline, length of hospital-stay, and mortality. More importantly, HGS is one of the diagnostic criteria of sarcopenia and gaining attention because of its relevance to bone mineral density (BMD) and osteoporotic fractures. As the measurement of HGS is widely used in clinical practice as well as in research, its accurate measurement and interpretation are becoming more crucial. This review describes how to use different types of dynamometers accurately, the impact of body and arm positions and anthropometric parameters on HGS, the current reference values of HGS for sarcopenia research, and the updates on the relationship between HGS and BMD and osteoporotic fractures.
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The term ‘Nerve Transfer’ means the transfer of a normal or nearly normal fascicle or nerve branch to an important sensory or motor nerve that has sustained irreparable proximal damage. It is a kind of salvage procedure performed when the proximal part of a peripheral nerve is totally damaged and impossible to be repaired. In case of irreparable preganglionic injury, it is difficult to recovery the nerve function by only nerve graft. In this case, the uninjured nerve around the brachial plexus could be transferred to restore the function of the upper extremities. Previous studies have reported a high recovery rate for the function of the upper limb above the elbow and recent efforts have been made to restore the function of the upper limb below the elbow including hand functions. The purpose of this article is to review the type of nerve transfer to restore upper extremity function, operative technique, outcomes and complication.
Subject(s)
Brachial Plexus , Elbow , Hand , Nerve Transfer , Peripheral Nerves , Transplants , Upper ExtremityABSTRACT
BACKGROUND: To determine whether olecranon fractures have osteoporotic features such as age-dependent, low bone attenuation and low-energy trauma as a cause of injury. METHODS: Elbow computed tomography (CT) and medical record review were performed in 114 patients (53 males and 61 females) with acute olecranon fractures. The mean age was 57 years. Bone attenuation was measured on the central part of the olecranon on sagittal CT images avoiding the fracture, and on the distal humerus (distal metaphysis and medial and lateral condyles) on coronal CT images. We compared bone attenuation and causes of injury (high or low energy trauma) between younger (<50 years) and older (≥50 years) patients in each gender. Multiple regression analysis was performed to determine the effect of age and gender on bone attenuation. RESULTS: Mean bone attenuation in older male and female patients was significantly lower than in younger patients, except at the medial condyle in men. The proportion of low-energy trauma in older male patients was significantly higher than in younger male patients. In female patients, low-energy trauma was predominant in both younger and older patients. Age and female gender had significantly negative effects on bone attenuation. CONCLUSIONS: This study demonstrated that olecranon fractures have osteoporotic features, including age-dependent low bone attenuation and low-energy trauma as the predominant cause of injury. Our results suggest that osteoporosis evaluation should be considered for patients aged 50 years or more with olecranon fractures.
Subject(s)
Female , Humans , Male , Elbow , Humerus , Medical Records , Olecranon Process , Osteoporosis , Osteoporotic FracturesABSTRACT
BACKGROUND: The purpose of the study was to compare the degree of degeneration of the articular and bursal layers of delaminated supraspinatus tendons based on histological examination. METHODS: Fifty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from the lateral torn edges of the articular and bursal layers of the delaminated tear. Harvested samples were stained with H&E dye and evaluated based on a semi-quantitative grading scale. RESULTS: There were no significant differences in the seven histological characteristics of tendon degeneration: fiber structure, fiber arrangement, round nuclei, regional variations in cellularity, vascularity, collagen stainability, and hyalinization between the articular and bursal layers of the delaminated rotator cuff tear (all p>0.05). Total degeneration scores of articular and bursal sides were 13.1 ± 3.85 points and 13.2 ± 3.42 points, respectively, and were not significantly different (p=0.958). CONCLUSIONS: The study demonstrates that tendon degeneration was similar in the articular and bursal sides of the delaminated fullthickness rotator cuff tear, suggesting that degeneration would be a main etiology for the rotator cuff tear not only in the articular side but also in the bursal side. Considering potential disadvantages of subacromial decompression, this study tentatively suggests routine use of subacromial decompression as well as the need for halting or recovery from rotator cuff degeneration for better rotator cuff repair.
Subject(s)
Humans , Collagen , Decompression , Hyalin , Rotator Cuff , Tears , TendonsABSTRACT
PURPOSE: The purpose was to evaluate fragment reduction feasilibty when applying extension block Kirschner-wire technique for bony mallet finger. METHODS: We treated 48 displaced mallet finger fractures by a two extension block Kirschner-wire technique. Among these operation group, we found dorsal rotation of fragment in 18 cases, making it difficult to get anatomical reduction. The patients were divided into two groups. One group of 30 patients did not show dorsal rotation of fragment and anatomical reduction was achieved easily. Another group of 18 patients showed dorsal rotation of fragment and additional methods was applied to achieve anatomical reduction. RESULTS: Joint surface involvement was significant greater in groups showing dorsal rotation of fragment than group which did not show (57.1% and 49.7%, respectively) (p=0.01). The groups whose joint surface involvement more than 50% had higher risk of dorsal rotation of fragment than the group less than 50%, with the odds ratio of 6.11. CONCLUSION: We could encounter the cases which showed dorsal rotation of the fracture fragment when treating the bony mallet finger with extension block K-wire technique especially the joint surface involvement was more than 50%. So if we can evaluate the extents of joint surface involvement and prepare additional method preoperatively when dorsal rotation of fragment is expected, it is possible to get more favorable results.
Subject(s)
Humans , Fingers , Joints , Methods , Odds RatioABSTRACT
BACKGROUND: The purpose of the study was to compare the degree of degeneration of the articular and bursal layers of delaminated supraspinatus tendons based on histological examination. METHODS: Fifty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from the lateral torn edges of the articular and bursal layers of the delaminated tear. Harvested samples were stained with H&E dye and evaluated based on a semi-quantitative grading scale. RESULTS: There were no significant differences in the seven histological characteristics of tendon degeneration: fiber structure, fiber arrangement, round nuclei, regional variations in cellularity, vascularity, collagen stainability, and hyalinization between the articular and bursal layers of the delaminated rotator cuff tear (all p>0.05). Total degeneration scores of articular and bursal sides were 13.1 ± 3.85 points and 13.2 ± 3.42 points, respectively, and were not significantly different (p=0.958). CONCLUSIONS: The study demonstrates that tendon degeneration was similar in the articular and bursal sides of the delaminated fullthickness rotator cuff tear, suggesting that degeneration would be a main etiology for the rotator cuff tear not only in the articular side but also in the bursal side. Considering potential disadvantages of subacromial decompression, this study tentatively suggests routine use of subacromial decompression as well as the need for halting or recovery from rotator cuff degeneration for better rotator cuff repair.