Anatomical Relationships between Muscles Overlying Distal Transverse Carpal Ligament and Thenar Motor Branch of the Median Nerve

BACKGROUND: The purpose of the current study is to investigate anatomical relationships between the muscle overlying the distal transverse carpal ligament (TCL) and the thenar motor branch of the median nerve. METHODS: Of the 192 wrists that underwent open carpal tunnel release, a muscle belly overlying the TCL was observed on the distal margin of TCL in 25 wrists and ligament exposure could not be achieved without transection of it. We recorded surgical findings of these 25 wrists. The origin of the recurrent motor branch arising from the major median nerve was marked on the axial and coronal section diagrams of the wrist. RESULTS: The presence of muscle overlying the TCL was seen in 25 wrists (21 patients, 13%). The locations of origin were distributed not only on the radial side but anterior or ulnar side of the major median nerve. Abnormal branches originated from the unusual side in 14 cases (56% of those with a muscle overlying the TCL): central-anterior side in eight cases, ulnar-anterior side in five cases, and ulnar side in one case. These anomalous branches were frequently associated with the muscle belly overlying the TCL in our study regardless of the origin site. The branches were prone to cut if careless midline incision along the third web space was performed. Unusual origin and aberrant pathway of the recurrent thenar motor branch were associated with the presence of a muscle overlying the TCL. CONCLUSIONS: A thorough knowledge of the standard and variant anatomy of the muscle belly and recurrent motor branch in the carpal tunnel is fundamental to prevention of complications such as muscle wasting or atrophy by iatrogenic motor branch injury during carpal tunnel release.

Flexor Pollicis Longus Reconstruction in Patient with the Linburg-Comstock Syndrome

Linburg-Comstock phenomenon is defined simultaneous flexion of thumb and other fingers. The coupling of the flexor pollicis longus and flexor digitorum profundus tendons is the main pathognomonic feature of this lesion. Typically, pain is noted at the distal level of the forearm at the site of the abnormal connection. We describe a case of flexor pollicis longus tendon rupture who undergoes a carpal tunnel release, and report the Linburg-Comstock syndrome after the flexor tendon reconstruction.

Minimally Invasive Plate Osteosynthesis for Femoral Mid-Diaphyseal Fractures

PURPOSE: To investigate the surgical outcomes of patients with femoral mid-diaphyseal fractures treated with minimally invasive plate osteosynthesis (MIPO), which were difficult to intramedullary nailing. MATERIALS AND METHODS: We evaluated 11 patients with femoral mid-diaphyseal fractures who were treated with MIPO. There were 7 males and 4 females and the mean age was 47 years (20-85 years). According to AO/OTA classification, there were 1 type of A1, 5 types of A3, 1 of B2 and 4 of B3. The reason of plate fixation instead of intramedullary nailing is as follows: femoral vessel and severe soft tissue injuries-2 cases, polytrauma patients with chest injury-6 cases, and narrow medullary canal diameter-3 cases. Six out of 11 cases were treated with initial external fixation as a damage control orthopedics. RESULTS: The mean union time of 6 cases was 3.7 months (3-5 months). There were 5 cases (45%) of nonunion, which should be treated with autogenous bone graft. All cases of nonunion resulted from severe soft tissue damage and polytrauma, which needed initial external fixation. There was no case of malalignment and implant-related complication. CONCLUSION: In cases of difficult intramedullary nailing for the femoral mid-diaphyseal fractures, MIPO could be an alternative surgical option, but concurrent soft tissue injuries and multiple trauma may increase the risk of nonunion in spite of biological fixation.

Current Concept of Surgical Management for Rheumatoid Arthritis of the Wrist

Rheumatoid arthritis is a systemic inflammatory disorder inducing multiple joint destruction. The wrist joint is frequently involved in early stage and proper management can preserve the ability to maintain a daily living and to work. Advances in medical treatment modalities can halt most joint destruction, however, not in all instances of joint inflammation and deformities. Most patients want to improve their own functional disability, pain, aesthetic problems in addition to medication. We review the current concept of rheumatoid wrist surgery and discuss the surgical treatment strategies for optimizing outcomes for patients with rheumatoid wrist.

Mid-term Results of Patients with Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation / 대한고관절학회지

PURPOSE: To evaluate the mid-term results of patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) in the elderly. MATERIALS AND METHODS: Between March 2008 and February 2010, 93 patients with intertrochanteric femoral fractures were treated with PFNA. Of these patients, 43 could be followed for a mean of 19.1 months (range, 12-33 months). The mean age was 77.3 years (range, 62-93 years) and there were 6 males and 37 females. According to the AO/OTA classification, there were 14 cases of A1, 25 cases of A2, and 4 cases of A3. Radiological outcomes were assessed at the union period along with the sliding distance of the antihelical blade according to fracture type. Functional outcomes were assessed according to the Chanley hip pain scoring system, walking ability, and the Activities of Daily Living (ADL) index. RESULTS: All patients, except for one with a deep infection, had complete union at 3.5 months (range, 2-6 months). Postoperative X-rays showed a good or acceptable reduction in 43 cases(100%), and an ideal blade position without significant differences according to the fracture type. The mean sliding length of the blade was 6.1 mm (range, 0-21 mm) and mean Chanley hip pain score was 4.0 points (range, 0-6.0 points). 19 patients (44%) were restored to their preoperative walking ability. 22 patients(51.2%) were able to live independently without support. CONCLUSION: The PFNA is a very effective implant in the treatment of different patterns of intertrochanteric femoral fractures. But further studies are needed focusing on a functional recovery and rehabilitation to improve postoperative clinical outcomes.

Subdeltoid Bursa Chondromatosis Associated with Osteochondral Lesion of the Proximal Humerus and a Rotator Cuff Tear / 대한정형외과학회잡지

Synovial chondromatosis involving the bursa is uncommon, and those cases synovial chondromatosis within the bursa around the shoulder are especially rare. We report here a case of a 57-year-old male who had subdeltoid bursal subdeltoid bursal chondromatosis associated with osteochondral lesion of the proximal humerus and a rotator cuff tear. We also review the relevant literatures.

Arthroscopic Direct Repair for a Complete Radial Tear of the Posterior Root of the Medial Meniscus

We report here on a new arthroscopic direct repair technique for a radial tear of the posterior root of the medial meniscus (PRMM) using a posterior trans-septal portal. Radial tears of the PRMM are commonly observed in the elderly population of Korea and Japan, and the life style of these people requires squatting and kneeling down in daily life. A radial tear of the PRMM results in the loss of hoop tension and this accelerates degenerative changes in the knee joint and causes early osteoarthritis. Several reports in the medical literature have focused on various repair techniques for these tears by using pull out sutures. These techniques result in nonanatomic fixation of the meniscus, which may lead to disturbed meniscal excursion and failure to restore hoop tension. Arthroscopic direct repair may contribute to restoring hoop tension and preventing accelerated degenerative changes in the knee joint of these patients.