Trigger Wrist

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.

Posterior-Posterior Dual Plates Fixation for the Distal Humerus Fractures

PURPOSE: Fractures of the distal humerus are one of the challenging injuries due to its complex anatomy and accompanied comminution. For dual plate fixation, orthogonal or parallel plating is widely used, but the better of the two is debatable. The purpose of this study was to report another fixation technique that yielded good clinical results with early bone union of distal humerus fracture, namely, posterior-posterior plate fixation. MATERIALS AND METHODS: From March 2003 to March 2012, 20 patients with distal humerus fractures were treated by posterior-posterior plate fixation. The triceps reflecting approach was used with anterior transposition of the ulnar nerve. The mean age at the time of injury was 45 years (range, 26 to 78 years). By AO classification of distal humerus fractures, there were one case of A2 and B3 respectively, two cases of each A3, C1 and C3, and twelve cases of C2. RESULTS: The mean period of complete bone union was 7.1 weeks (range, 4 to 11 weeks). The mean flexion-extension range of motion of the elbow joint at last follow-up was 116.2 degrees. The mean pronation was 81.2 degrees and supination was 83.1 degrees. Plates and screws were removed at about nine months after the initial surgery. No cases showed complications or required additional operation. CONCLUSION: Posterior-posterior dual plates fixation resulted in stable bicortical screw fixation, and insertion of lag screws were possible without interference. Posterior-posterior plating could be an easy and stable fixation method that provides good clinical results.

Treatment of Humeral Shaft Fracture with Retrograde Intramedullary Nail

PURPOSE: The purpose of this study was to report the outcome of treatment of humeral shaft fracture with retrograde intramedullary nail of advanced insertion opening. MATERIALS AND METHODS: From April 2005 and August 2012, 22 patients with a humeral shaft fracture were treated by a single surgeon using the technique of retrograde intramedullary nail at Department of Orthopedic Surgery, Yeouido St. Mary's Hospital (Seoul, Korea). To avoid causing fractures at the insertion site, the entry point was more distally located than conventionally, and was extended proximally to include the proximal marginal cortex of the olecranon fossa. The outcome was evaluated clinically and radiologically. RESULTS: The mean period of achievement of bony was 5.8 months (4-11 months). Additional fixations were needed in one patient with intraoperative lateral condylar fracture and 2 patients with postoperative nonunion. There were no limitations of movement or pain in the shoulder joint, and 8 cases had a 6.5degrees flexion contracture on average. CONCLUSION: This retrograde intramedullary fixation technique using a distal entry portal near the olecranon fossa is particularly useful in humeral shaft fractures without a neurovascular injury. The risk of an intraoperative fracture (supracondylar fracture or fracture around the entry portal) can be decreased using this treatment. We recommend this technique because of the safety and the satisfactory outcome.

Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

PURPOSE: Distal radius fractures involving distal radioulnar joint (DRUJ) are common. After the fracture treatment, pain on the ulnar side of wrist, limitation of forearm rotation and instabilities can be remained. The purpose of this study was to address the importance of anatomical reduction for DRUJ injuries. METHODS: Of 115 cases with a distal radius fracture involving DRUJ, 61 cases involving sigmoid notch of the radius or having a ulnar styloid process base fracture were evaluated. At an average of six months follow-up, their final outcomes were investigated using radiologic findings, functional disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) pain scores and wrist motion of pronation/supination. RESULTS: Satisfied radiologic reduction rate was 73.8%(45/61) in average, which was most favorable in external fixator group (82.4%, 28/34). The mean functional DASH score was 29.0 points and mean VAS for pain was 5.0. The mean range of wrist motions for pronation/supination was 59.5degrees/55.7degrees. CONCLUSION: Distal radius fractures involving DRUJ should be classified into the basic categories of unstable distal radius fracture, and immediate anatomical reduction is needed by operative treatment to avoid painful forearm rotation.

The Treatment of Thoracic Outlet Syndrome

PURPOSE: As clinical manifestations of thoracic outlet syndrome are vague pain or symptoms in upper extremity, the diagnosis of the disease is delayed or misdiagnosed as cervical HNP, shoulder pathologies, or peripheral neuropathies. In that reason, many patients spend time for unnecessary or ineffective treatments. We report the results of our thoracic outlet syndrome cases, which were treated by conservative care or surgical treatment. MATERIALS & METHODS: Twenty five cases, diagnosed as thoracic outlet syndrome since 1999, were reviewed retrospectively. Physical examinations including Adson's and reverse Adson's test, hyperabduction test, costoclavicular maneuver, and Roo's test, plain radiography of shoulder and cervical spine, MRI of neck or brachial plexus, and EMG were checked. If subjective symptoms were not improved after conservative treatments over three months, surgical treatment were performed. Nine patients were performed operative treatment and the others had conservative treatment in outpatient clinic. Postoperative improvement of symptoms and the follow up period, and the results of conservative care were reviewed. RESULTS: Among five physical examinations, mean 1.75 tests were positive, and EMG has little diagnostic value. MRI were performed in twenty cases and compression of brachial plexus were found in 6 cases (30%). Ten patients out of 16 conservative treatment group had excellent improvement of symptoms, and 5 had good results. Eight patients out of 9 operative treatment group had excellent improvement with mean 5.1 months of follow-up period. CONCLUSION: Diagnosis of thoracic outlet syndrome is difficult due to bizarre and vague symptoms. However if the diagnosis is suspected by careful physical examinations, radiologic studies, or nerve conduction studies, conservative care should be done as initial treatment and at least after three months, reassess the patient's condition. If the results of conservative treatment is not satisfactory and still the thoracic outlet syndrome is suspected, surgical treatment should be considered. Conservative treatment and operative technique are the valuable for the treatment of this disease.

Malignant Tumors of the Hand

PURPOSE: Malignant tumors of the hand occurred very rarely and optical surgical treatment and prognosis are not clearly established. We report the clinical characteristics and treatment outcomes of primary and metastatic bone and soft tissue tumors during last twenty years with a review of literatures. MATERIALS AND METHODS: We reviewed 20 cases of malignant tumors in the hand (7 cases of acrometastasis, 9 cases of malignant melanoma, 2 cases of chondrosarcoma and 2 cases of squamous cell carcinoma) retrospectively. RESULTS: Patients of early Clark stage (I to III) of malignant melanoma survived after wide resection or ray amputation. But patients with late Clark stage (IV to V) expired associated with distant metastasis. All seven patients with acrometastasis expired in 6.3 months after diagnosis of metastasis. Two patients with chondrosarcoma survived without recurrence. Among patients with squamous cell carcinoma, one patient is free of disease after wide resection, but the other was dead due to metastasis. CONCLUSION: Good results might be attained after surgical treatment of malignant tumors of the hand by proper surgical technique to minimize loss of hand function and systemic evaluation of metastasis.