Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

BACKGROUND: Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. METHODS: We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. RESULTS: At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. CONCLUSIONS: This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

Tenolysis after the Reconstruction of PIP Joint of the Finger using Second Toe PIP Joint Free Flap

PURPOSE: The second toe PIP joint free flap is a method of reconstruction used for abnormalities of the PIP joint of the finger. We report the results of the additional tenolysis in patients with a difference between passive ROM and active ROM after second toe PIP joint free flap. METHODS: From March 2001 to July 2008, tenolysis was performed in patients with a difference in their active and passive ROM after second toe PIP joint free transfer, performed on 14 fingers. We performed a retrospective analysis of the medical records, noting the clinical and radiological findings. In addition, we measured the preoperative and postoperative range of motion of the PIP joint. RESULTS: The average active ROM was 22.5degrees in three months after the joint transfer surgery, and was 38degrees after additional tenolysis from five months to twelve months after the joint transfer. CONCLUSIONS: Additional tenolysis, after the second toe PIP joint free flap, might be a good option with an improved results in patients with difference in active and passive ROM of a transferred PIP joint.

Fingertip Replantations by Only Arteriorrhaphy without External Bleeding

PURPOSE: Traditionally, external bleeding is needed when only an arteriorrhaphy can be performed in cased where a venorrhaphy cannot be done at the initial reconstruction for a zone I complete amputation. However, this salvage procedure has several iatrogenic complications. Therefore, we did not perform an external bleeding procedure, in cases where external bleeding was not appropriate due to the small size of the stump. METHODS: From September 2006 to August 2007, 19 fingertip amputations, among 18 patients, were performed using only arteriorrhaphy without external bleeding; In total 95 fingertip amputations, with venorrhaphy or external bleeding procedures were excluded. The results were reviewed retrospectively to compare survival and complication rates. RESULTS: The survival rate of only arteriorrhaphy without external bleeding is 84.2%. Additional operations for soft tissue problems of total or partial necrosis were performed in 5 cases. CONCLUSION: We found no differences in the survival and complication rates of only arteriorrhaphy without external bleeding compared to results of only arteriorrhaphy with external bleeding in other articles. Therefore, our results suggest that in some cases with a fingertip amputation, performing arteriorrhaphy only, without external bleeding, might be a better option than external bleeding due to reduced iatrogenic injuries and complications.

Clinical Analysis According to Treatment Methods in Simple Retinal Detachment

PURPOSE: To determine the difference among the results of three kinds of methods for the treatment of simple retinal detachment. METHODS: We analyzed the patients undergoing primary pars plana vitrectomy(Group I: January to June, 1997), scleral buckling(Group II: January to June, 1996) and pneumatic retinopexy(Group I: January to June, 1995) to treat simple retinal detachments with retinal breaks located in peripheral retina, smaller than one clock hour, breaks in the superior eight clock hours, multiple breaks extending less than two clock hours and no severe retinal traction. RESULTS: The final visual acuity was 5/200 or more(functional success) in 19 eyes(100%) of Group I, 19 eyes(100%) of Group cII and 20 eyes(90.9%) of Group I. Primary retinal reattachment(anatomical success) was in 17 eyes(89.5%) of Group I, 19 eyes(100%) of Group II and 18 eyes(81.8%) of Group I with no statistically significant difference among the three groups. The final retinal reattachment rate was 100% in all groups. CONCLUSIONS: This result suggests the scleral buckling might be a little bit better for the treatment of simple retinal detachment, though each of three surgical methods showed no statistical difference of functional and anatomical results.

The Efficacy and Safety of Mitomycin C and Releasable Suture in Glaucoma Triple Procedure

PURPOSE: To evaluate the clinical efficacy and safety of short-term application of mitomycin C and releasable scleral flap sutures. METHODS: The clinical outcome and complications were evaluated in 62 eyes undergone glaucoma triple procedure(Group A: with mitomycin C and releasable suture, Group B: with mitomycin C only, Group C: with releasable suture only, Group D: without mitomycin C and releasable suture). RESULTS: The mean postoperative intraocular pressure was relatively lower in group A and B than that of group C and D(p=0.868). The most common complication was posterior capsular opacity, and other complications were cystoid macular edema, hypotony, choroidal detachment and bleb leakage. CONCLUSIONS: The glaucoma triple procedure using mitomycin C and releasable suture could be recommended to be safe and effective on controlling the early postoperative and long-term intraocular pressure for treating the patients with coexisting cataract and glaucoma, and the use of releasable suture could lower the incidence of postoperative complications such as hypotony.

Surgical Correction of Congenital Epiblepharon: Lower Eyelid Crease Reforming Technique

Epiblepharon is a commonly encountered congenital anomaly in Asian infants and children. It causes symptoms of ocular irritation and inferior punctate corneal epithelial erosion. Surgical correction may be needed if ocular irritation symptom and corneal pathology persist with age. A series of 185 lower eyelid epiblepharon in 98 Korean children underwent lower eyelid crease reforming technique. Surgical treatment included excision of redundant skin and pretarsal orbicularis muscle with lid everting suture by anastomosis of the subcutaneous tissue and inferior tarsal border including capsulopalpebral fascia. With a minimum follow-up of 12 months, a total of 37 [20%]eyelids developed recurrence of cilia touch, and then 9 [4.8%]eye-lids needed further surgery.