Treatment of type III middle phalangeal neck fractures through a palmar approach: a case report / 中华创伤杂志(英文版)

Phalangeal neck fractures occur almost exclusively in children. We present the case of a 49 years old man with a dislocated fracture of the neck of the middle phalanx with the distal fragment rotated at 180? due to a traumatic circular saw injury to the left index, which was solved by anatomical reduction and bone fixation with two 1.5 mm Synthes screws and a temporary transarticular K-wire at the distal interphalangeal joint. Zone I flexor digitorum profundus repair was performed using a modification of the Kessler 4-strands core suture and a full-thickness skin graft from the hypothenar eminence was taken to cover the skin gap. At 6-month follow-up the patient was pain-free and with a total active movement equivalent to 190? No radiological signs of avascular necrosis of the head of the middle phalanx or nonunion of the distal fragment was detectable with recovery to the previous manual work. Owing to the position of the phalangeal head maintained in position by the collateral ligaments an anatomic reduction from dorsal approach is difficult to be performed and a longitudinal traction can render the reduction harder too. The volar approach permits an easier reduction of the fracture through a derotation of the distal fragment facing palmar.

Transient bone resorption following finger replantation: a report of 3 cases / 中华创伤杂志(英文版)

Radiographic changes consisting of alterations in mineral content, osteopaenia or destructive neuropathy that occur following successful finger replantation have already been described. We report our experience about four fingers in three individuals in whom bone changes developed in the first three months postoperatively with complete "restitution ad integrum". Three patients, 21-49 years old (average 36 years) sustained a clean-cut amputation of four fingers. The first patient had an amputation at the base of the middle phalanx of the index finger and the second patient at the base of the proximal phalanx of the ring finger. The third had an amputation at the base of the first metacarpal bone and the proximal phalanx of the small finger in a five finger amputation. In the first case, two dorsal veins and two palmar digital arteries and nerves were repaired. In the second case, one palmar artery and one dorsal vein were reanastomosed. In the third case at the thumb, two dorsal veins and two palmar digital arteries and nerves were reconstructed. At the small finger, one dorsal vein, one palmar digital artery and two digital nerves were reconstructed. Bone fixation was achieved with two and three K-wires or tension-band wiring. Replantation was successful in all cases. Three weeks after replantation, the X-rays showed rapid development of osteopaenia in the juxtaarticular region and metaphyses of the bone. These changes were followed by subperiosteal, intracortical and endosteal bone resorption. No further surgical procedures or splintage were needed and hand therapy was not discontinued. At 10-13 weeks (average 12 weeks) postoperatively, the X-rays showed a complete recovery with new periosteal bone formation. We suggest that the radiographic changes after finger replantation are transient, first evident subperiosteally and progressing centrally. They may reflect small-vessel compromise and microinfarction and transient hyperemia secondary to neurovascular damage or to sympathetic progressive recovery.

Fracture of the radial sesamoid bone of the thumb: an unusual fracture / 中华创伤杂志(英文版)

The hand consists of five sesamoids. Two of them are present at the metacarpophalangeal (MCP) joint of the thumb. Fracture of the sesamoid bones of the thumb is a rare injury and the literature on the radial side is seldom reported. We reported a case of a patient with a fracture of the radial sesamoid at the MCP joint of the thumb in order to increase attention regarding this type of injuries. A 44-year-old male, high level gymnastic trainer, was helping one of his athletes during an exercise while he reported a hyperextension trauma to the MCP joint of the right thumb. One week after trauma, he presented to the hand surgeon complaining of a painful thumb at the MCP joint level on its palmar aspect. Standard A-P and lateral X-rays revealed a fracture of the radial sesamoid and the fracture was treated with a splint for 3 weeks. He was able to resumed his entire work 6 weeks after the injury. The sesamoid fractures is an indicator of the magnitude of the hyperextension injury and sometimes associated with tears of the volar plate ligament of the MCP joint. And a failure to recognize the ligament injury may lead to a long-term hyperextension instability on pinching.

Is early hardware removal compulsory after retention of angled drill guides in palmar locking plates? The role of pronator quadratus reconstruction / 中华创伤杂志(英文版)

Palmar plate fixation is becoming a well recognized treatment for distal radial fracture. Tendon ruptures or irritations have been reported after this procedure. Inadvertent retention of angled drill guides useful for easy placement of locking screws in proper direction in volar plating can represent a high risk of secondary tendon rupture. In this case, we presented our experience in one patient in whom drill guides removal could be delayed for one year and summarized our techniques to prevent the aforementioned complications.

Unstable mallet fractures: a comparison between three different techniques in a multicenter study / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures: Kirschner wire fixation with extension block pinning (EBP) of the distal interphalangeal joint, Kirschner wires used as joysticks (KWJ) and interfragmentary mini-screws for open reduction and internal fixation (ORIF).</p><p><b>METHODS</b>Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old (average 42 years) were operated upon by EBP, 16 patients 22 to 56 years old (average 56 years) were operated upon using KWJ and 22 patients 22 to 54 years old (average 36 years) received ORIF. Follow-up time was 6 to 58 months (average 21 months). The following intraoperative parameters were considered: intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion (ROM) test with a goniometer. Based on these measurements, a functional Crawford score was established.</p><p><b>RESULTS</b>All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider (72 degree vs 58 degree and 54 degree; in the ORIF group, return to work was faster (2.7 weeks vs 7.2 weeks and 6 weeks) but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar.</p><p><b>CONCLUSIONS</b>We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs of osteoarthritis. Screw fixation is more technically demanding (longer intraoperative time and more complications) but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.</p>

Surgical vacuum-assisted closure for treatment of dramatic case of stonefish envenomation / 中华创伤杂志(英文版)

Skin necrosis of the foot, oedema and lymphangitis from stonefish (Synanceia verrucosa) sting are complications well known for a long time and with potential long-term sequelae. Literature reports of stonefish envenomation give no specific reference on soft tissue management and surgical reconstruction. This is the first report describing a case of foot stonefish envenomation treated by vacuum-assisted closure therapy as an easy to use, accessible and simple adjuvant tool for management of large soft tissue necrosis.

FK-506 ointment: an effective adjuvant therapy to treat a dramatic case of pyoderma gangrenosum of unilateral hand / 中华创伤杂志(英文版)

Pyoderma gangrenosum (PG) is a cutaneous ulcer developing so rapidly that may mimic a fulminating infection. The correct treatment is nonsurgical, and surgery may get the condition worse.1 FK-506 ointment (0.1% Protopic, Astellas Pharma AG, Fribourg) is usually indicated for inflammatory skin diseases, such as atopic dermatitis and psoriasis2 or for acute rejection reversal of human hand transplantation 3. A few reports of PG affecting the functions of hands can be found in the scientific literature and this report describes the first case treated by FK-506 ointment as an adjuvant therapy.