Minimally Invasive Carpal Tunnel Release Using a Hook Knife through a Small Transverse Carpal Incision: Technique and Outcome

Background@#Compared to the classic open technique, limited exposure techniques have the advantages of less scar pain, more grip and pinch strength, and earlier return to daily life. We evaluated the effectiveness and safety of our novel method of minimally invasive carpal tunnel release using a hook knife through a small transverse carpal incision. @*Methods@#This study included 111 carpal tunnel decompressions in 78 patients who underwent carpal tunnel release from January 2017 to December 2018. We performed carpal tunnel release using a hook knife through a small transverse incision just proximal to the wrist crease under local infiltration of lidocaine with tourniquet inflation in the upper arm. All patients were tolerable during the procedure and discharged following the procedure on the same day. @*Results@#At an average of 29.4 months of follow-up (range, 12–51 months), all but one patient (99%) revealed complete or near complete symptomatic recovery. The average of the symptom severity score on the Boston questionnaire was 1.31 ± 0.30 and the average of the functional status score was 1.19 ± 0.26. The final mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) score was 8.66 (range, 2–39). There was no superficial palmar arch injury or nerve injury of the palmar cutaneous branch, recurrent motor branch, or median nerve itself as a complication of the procedure. No patient showed any wound infection or wound dehiscence. @*Conclusions@#Our carpal tunnel release using a hook knife through a small transverse carpal incision performed by an experienced surgeon is a safe and reliable method that is expected to have the benefits of simplicity and minimal invasiveness.

Diagnostic conundrums of schwannomas: two cases highlighting morphological extremes and diagnostic challenges in biopsy specimens of soft tissue tumors

Schwannomas are benign, slow-growing peripheral nerve sheath tumors commonly occurring in the head, neck, and flexor regions of the extremities. Although most schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. Reporting pathologists should be aware that schwannomas can exhibit a broad spectrum of morphological patterns. Clinical and radiological examinations can show correlation and should be performed, in conjunction with ancillary tests, when appropriate. Furthermore, deferring a definitive diagnosis until excision may be necessary for small biopsy specimens and frozen sections. This report underscores these challenges through examination of two unique schwannoma cases, one predominantly cellular and the other myxoid, both of which posed significant challenges in histological interpretation.

Tumor Margin Infiltration in Soft Tissue Sarcomas: Prediction Using 3T MRI Texture Analysis

Purpose@#To determine the value of 3 Tesla (T) MRI texture analysis for predicting tumor margin infiltration in soft tissue sarcomas. @*Materials and Methods@#Thirty-one patients who underwent 3T MRI and had a pathologically confirmed diagnosis of soft tissue sarcoma were included in this study. Margin infiltration on pathology was used as the gold standard. Texture analysis of soft tissue sarcomas was performed on axial T1-weighted images (WI) and T2WI, fat-suppressed contrast-enhanced (CE) T1WI, diffusion-weighted images (DWI) with b-value of 800 s/mm², and apparent diffusion coefficient (ADC) was mapped. Quantitative parameters were compared between sarcomas with infiltrative margins and those with circumscribed margins. @*Results@#Among the 31 patients with soft tissue sarcomas, 23 showed tumor margin infiltration on pathology. There were significant differences in kurtosis with the spatial scaling factor (SSF) of 0 and 6 on T1WI, kurtosis (SSF, 0) on CE-T1WI, skewness (SSF, 0) on DWI, and skewness (SSF, 2, 4) on ADC between sarcomas with infiltrative margins and those with circumscribed margins (p ≤ 0.046). The area under the receiver operating characteristic curve based on MR texture features for identification of infiltrative tumor margins was 0.951 (p < 0.001). @*Conclusion@#MR texture analysis is reliable and accurate for the prediction of infiltrative margins of soft tissue sarcomas.

Sarcomas in Teachers Using Three-Dimensional Printers: A Report of Three Patients and Literature Review

Background@#While low-cost, small-scale, desktop three-dimensional (3D) printers are gaining popularity in the education sector, some studies have reported harmful emissions of particles and volatile organic compounds during the fused deposition modeling (FDM) process, posing a potential health risk. Sarcomas are rare tumors, constituting a group of diverse rare malignant tumors. While some genetic and environmental factors contribute to the development of sarcomas, most cases are idiopathic and sporadic. @*Methods@#We secured the medical records and statements about work environment from teachers diagnosed with sarcomas after frequent use of 3D printers in high schools, reviewed the cases, and described them in narrative format. Furthermore, popularization of FDM 3D printers, worrisome emissions released during the printing process, and related precautions and countermeasures were discussed through literature review. @*Results@#Exceptionally, the cases of sarcomas, such as Ewing’s sarcoma, malignant peripheral nerve sheath tumor, and well-differentiated liposarcoma, arose in a common specific condition. All the teachers regularly operated 3D printers in poorly ventilated spaces for at least 2 years. They had no past or family history of relevant diseases. @*Conclusions@#We first reported three cases of sarcoma in teachers who used 3D printers in poorly ventilated conditions. Although a relationship between the use of 3D printers and the development of sarcomas has not been determined yet, it is important to come up with measures to protect teachers and students using 3D printers from the potential hazard.

Effectiveness and Biocompatibility of Decellularized Nerve Graft Using an In Vivo Rat Sciatic Nerve Model

BACKGROUND@#Decellularized nerve allografting is one of promising treatment options for nerve defect. As an effort to develop more efficient nerve graft, recently we have developed a new decellularization method for nerve allograft. The aim of this study was to evaluate the effectiveness and biocompatibility of nerve graft decellularized by our newly developed method. @*METHODS@#Forty-eight inbred male Lewis rats were divided into two groups, Group I (autograft group, n = 25), Group II (decellularized isograft group, n = 23). Decellularized nerve grafts were prepared with our newly developed methods using amphoteric detergent and nuclease treatment. Serum cytokine level measurements at 0, 2, and 4 weeks and histologic evaluation for inflammatory cell infiltration at 6 and 16 weeks after nerve graft. @*RESULTS@#There was no significant difference in mean maximum isometric tetanic force and weight of tibialis anterior muscle or ankle angle at toe-off phase between two groups at 6 and 16 weeks survival time points (p > 0.05). There was no inflammatory cell infiltration in either group and histomorphometric assessments of 6- and 16-week specimens of the isograft group did not differ from those in the autograft group with regard to number of fascicle, cross sectional area, fascicle area ratio, and number of regenerated nerve cells. @*CONCLUSION@#Based on inflammatory reaction, axonal regeneration, and functional outcomes, our newly developed decellularized nerve grafts were fairly biocompatible and had comparable effectiveness to autografts for nerve regeneration, which suggested it would be suitable for nerve reconstruction as an alternative to autograft.

Benign versus Malignant Soft-Tissue Tumors: Differentiation with 3T Magnetic Resonance Image Textural Analysis Including Diffusion-Weighted Imaging

Purpose@#To investigate the value of MR textural analysis, including use of diffusionweighted imaging (DWI) to differentiate malignant from benign soft-tissue tumors on 3T MRI. @*Materials and Methods@#We enrolled 69 patients (25 men, 44 women, ages 18 to 84 years) with pathologically confirmed soft-tissue tumors (29 benign, 40 malignant) who underwent pre-treatment 3T-MRI. We calculated MR texture, including mean, standard deviation (SD), skewness, kurtosis, mean of positive pixels (MPP), and entropy, according to different spatial-scale factors (SSF, 0, 2, 4, 6) on axial T1-and T2-weighted images (T1WI, T2WI), contrast-enhanced T1WI (CE-T1WI), high b-value DWI (800 sec/mm2 ), and apparent diffusion coefficient (ADC) map. We used the Mann-Whitney U test, logistic regression, and area under the receiver operating characteristic curve (AUC) for statistical analysis. @*Results@#Malignant soft-tissue tumors had significantly lower mean values of DWI, ADC, T2WI and CE-T1WI, MPP of ADC, and CE-T1WI, but significantly higher kurtosis of DWI, T1WI, and CE-T1WI, and entropy of DWI, ADC, and T2WI than did benign tumors (P < 0.050). In multivariate logistic regression, the mean ADC value (SSF, 6) and kurtosis of CE-T1WI (SSF, 4) were independently associated with malignancy (P ≤ 0.009). A multivariate model of MR features worked well for diagnosis of malignant soft-tissue tumors (AUC, 0.909). @*Conclusion@#Accurate diagnosis could be obtained using MR textural analysis with DWI and CE-T1WI in differentiating benign from malignant soft-tissue tumors.

Effectiveness and Biocompatibility of Decellularized Nerve Graft Using an In Vivo Rat Sciatic Nerve Model

BACKGROUND@#Decellularized nerve allografting is one of promising treatment options for nerve defect. As an effort to develop more efficient nerve graft, recently we have developed a new decellularization method for nerve allograft. The aim of this study was to evaluate the effectiveness and biocompatibility of nerve graft decellularized by our newly developed method. @*METHODS@#Forty-eight inbred male Lewis rats were divided into two groups, Group I (autograft group, n = 25), Group II (decellularized isograft group, n = 23). Decellularized nerve grafts were prepared with our newly developed methods using amphoteric detergent and nuclease treatment. Serum cytokine level measurements at 0, 2, and 4 weeks and histologic evaluation for inflammatory cell infiltration at 6 and 16 weeks after nerve graft. @*RESULTS@#There was no significant difference in mean maximum isometric tetanic force and weight of tibialis anterior muscle or ankle angle at toe-off phase between two groups at 6 and 16 weeks survival time points (p > 0.05). There was no inflammatory cell infiltration in either group and histomorphometric assessments of 6- and 16-week specimens of the isograft group did not differ from those in the autograft group with regard to number of fascicle, cross sectional area, fascicle area ratio, and number of regenerated nerve cells. @*CONCLUSION@#Based on inflammatory reaction, axonal regeneration, and functional outcomes, our newly developed decellularized nerve grafts were fairly biocompatible and had comparable effectiveness to autografts for nerve regeneration, which suggested it would be suitable for nerve reconstruction as an alternative to autograft.

Benign versus Malignant Soft-Tissue Tumors: Differentiation with 3T Magnetic Resonance Image Textural Analysis Including Diffusion-Weighted Imaging

Purpose@#To investigate the value of MR textural analysis, including use of diffusionweighted imaging (DWI) to differentiate malignant from benign soft-tissue tumors on 3T MRI. @*Materials and Methods@#We enrolled 69 patients (25 men, 44 women, ages 18 to 84 years) with pathologically confirmed soft-tissue tumors (29 benign, 40 malignant) who underwent pre-treatment 3T-MRI. We calculated MR texture, including mean, standard deviation (SD), skewness, kurtosis, mean of positive pixels (MPP), and entropy, according to different spatial-scale factors (SSF, 0, 2, 4, 6) on axial T1-and T2-weighted images (T1WI, T2WI), contrast-enhanced T1WI (CE-T1WI), high b-value DWI (800 sec/mm2 ), and apparent diffusion coefficient (ADC) map. We used the Mann-Whitney U test, logistic regression, and area under the receiver operating characteristic curve (AUC) for statistical analysis. @*Results@#Malignant soft-tissue tumors had significantly lower mean values of DWI, ADC, T2WI and CE-T1WI, MPP of ADC, and CE-T1WI, but significantly higher kurtosis of DWI, T1WI, and CE-T1WI, and entropy of DWI, ADC, and T2WI than did benign tumors (P < 0.050). In multivariate logistic regression, the mean ADC value (SSF, 6) and kurtosis of CE-T1WI (SSF, 4) were independently associated with malignancy (P ≤ 0.009). A multivariate model of MR features worked well for diagnosis of malignant soft-tissue tumors (AUC, 0.909). @*Conclusion@#Accurate diagnosis could be obtained using MR textural analysis with DWI and CE-T1WI in differentiating benign from malignant soft-tissue tumors.

Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist

BACKGROUND: The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. METHODS: Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between “the line of humeral long axis projected on the axial plane of the ulna” and “the line passing the center of the ulnar head and the center of the ulnar styloid” was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of “the volar-dorsal diameter of the ulnar head” and “the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid” was calculated (ulnar styloid location ratio). RESULTS: The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. CONCLUSIONS: The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated position on an axial CT/magnetic resonance imaging scan or a lateral radiograph of the wrist.

Neurologic Deficits after Surgical Enucleation of Schwannoma in the Upper Extremity

PURPOSE: Neurologic deficits after enucleation of schwannoma are not rare. To evaluate the neurologic deficits after surgical enucleation of schwannoma in the upper extremity, we performed a retrospective review of patients with surgically treated schwannoma over a 14-year period at a single institution. METHODS: Between March 2001 and September 2014, 103 patients underwent surgical enucleation for schwannomas; 36 patients of them had lesions in the upper extremity, and 2 out of 36 patients had multiple schwannomas. Each operation was performed by a single surgeon under loupe magnification. The postoperative neurological deficits were graded as major and minor in both immediate postoperatively and at last follow-up. The major deficit was defined as anesthesia or marked hypoesthesia, motor weakness of grade 3 or less and neuropathic pain. Minor deficit was defined as mild symptoms of mild hypoesthesia, paresthesia and motor weakness of grade 4 or more. RESULTS: There were 2 major (2 mixed nerve) and 12 minor (4 motor, 7 sensory, 1 mixed nerve) neurologic deficits after surgery. At the last follow-up, one major mixed neurologic deficit remained as major motor and minor sensory, and other major ones changed to mixed minor. And all minor deficits except 1 sensory deficit were recovered spontaneously. CONCLUSION: Even though high incidence rate of neurologic deficit after enucleation of schwannoma in the upper extremity (38.9%), about three fourths of them were recovered spontaneously. There were 3 permanent neurologic deficits, and one of them was major one. In some cases, surgeon cannot avoid to encounter a neurological deficit. So we recommend more delicate microscopic surgical procedure and preoperative planning and counseling. And surgery is indicated for only symptomatic lesions.

Clinical Characteristics and Continued Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Administration in EGFR-mutated Non-Small Cell Lung Cancer with Skeletal Metastasis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to analyze clinical characteristics of skeletal metastasis in epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) and treatment outcomes of continued EGFR tyrosine kinase inhibitor (TKI) therapy in patients presenting with skeletal metastasis progression. MATERIALS AND METHODS: Of the 216 patients treated with EGFR-TKI for management of stage III-IV NSCLC between 2006 and 2012 in Seoul St. Mary's Hospital, 76 patients with confirmed EGFR-mutated NSCLC with skeletal metastases during therapy were analyzed retrospectively. RESULTS: Of 76 patients with EGFR mutant lung cancer with skeletal metastasis, 37 patients developed first progressive disease (PD) in skeletal regions. EGFR-TKI was continued in these 37 patients after first PD in skeletal regions. Median time to first PD of skeletal regions was 8.9 months (95% confidence interval [CI], 4.8 to 13.0). Median time of continued EGFR-TKI after first PD of skeletal regions was 8.0 months (95% CI, 2.9 to 13.0) in patients with disease progression of preexisting regions, 5.6 months (95% CI, 4.5 to 6.7) in patients showing new localized regions, and 3.3 months (95% CI, 1.1 to 5.5) in patients with multiple new metastatic regions (p=0.006). Median time of postskeletal metastasis progression survival was 23.0 months (95% CI, 13.5 to 32.5), 15.0 months (95% CI, 3 to 34.7), and 7.0 months (95% CI, 6.0 to 8.0) (p=0.004) in the above described patient groups, respectively. Overall, seven patients (18.9%) had more than one episode of skeletal progression of disease without extraskeletal PD. CONCLUSION: Continued EGFR-TKI treatment with adequate local treatment after progression of skeletal metastasis may be considered for patients who show disease progression in preexisting regions or local progression.

Evaluation of the Foveal Involvement of the Ulnar Styloid Fracture: A Comparison of the Plain Radiography and Three-Dimensional Computed Tomography

PURPOSE: There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT). METHODS: We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared. RESULTS: On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation. CONCLUSION: Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.

Bone Reconstruction: Structural Allograft and Autograft / 대한정형외과학회잡지

Structural allograft or recycled autograft bone transplantation has been performed for reconstruction of bone defects caused by bone tumor resection. Knowledge regarding advantages and disadvantages of bone reconstruction using an allograft or recycled autograft, other alternatives such as reconstruction with tumor prosthesis, the understanding of biologic characteristics and fate of transplanted bones, functional results, and complications of reconstruction are important. The surgeon should also be accustomed to the major technical points of allograft or recycled autograft transplantation. Proper indication, selection of an appropriate allograft or recycled autograft, rigid fixation, accurate surgical skills, preventive measures of infection and efficient rehabilitation are necessary in order to obtain long term survival of grafted bones and good functional outcome. Here, I will discuss the bone reconstruction methods using structural allograft or recycled autograft transplantation after bone tumor resection and their clinical results.

Modified Split Ulnar Gutter Splint for Treatment of Fifth Metacarpal Neck Fractures

PURPOSE: To evaluate radiological results of the modified split ulnar gutter splint for the fifth metacarpal neck fracture. METHODS: Between December 2008 and May 2014, 17 patients (18 cases) with fifth metacarpal neck fractures were managed with our modified split ulnar gutter splint. Radiological outcomes in oblique and lateral radiographs were evaluated. Mean immobilization period was 4.9 weeks (range, 4-7) weeks. Mean follow-up period was 17.1 week (range, 8-80 weeks). RESULTS: All of 18 fractures were completely united. The average of prereduction dorsal angulation, 27degrees in the oblique radiographs and 21degrees in the lateral radiographs, were corrected to 17degrees in the oblique radiographs and 10degrees in the lateral radiographs after closed reduction. At the last follow-up, they were 14degrees and 11degrees respectively. The mean difference of angulation deformity between in postreduction and final follow-up radiograms were 3degrees in the oblique radiographs and 1degrees in the lateral radiographs, which was not significantly different. CONCLUSION: Immobilization using modified split ulnar gutter splint will be a reliable option for the fifth metacarpal neck fractures in selected patients, which will avoid the surgeries.

Mesenchymal Stromal Cells Promote Tumor Progression in Fibrosarcoma and Gastric Cancer Cells

BACKGROUND: Extensive evidence has accumulated regarding the role of mesenchymal stromal cells (MSCs) in tumor progression, but the exact effects and mechanisms underlying this role remain unclear. We investigated the effects of MSC-associated tumor progression in MSC-sarcoma models and a gastric cancer metastatic model. METHODS: We conducted an in vitro growth kinetics assay and an in vivo tumor progression assay for sarcoma cells and gastric cancer cells in the presence or absence of MSCs. RESULTS: MSC-cocultured human fibrosarcoma cells (HT1080) showed accelerated growth compared with HT1080 alone (79- vs 37-fold change, p<.050). For HT1080, human MSC-coinjected tumors showed significantly greater and highly infiltrative growth compared to those of HT1080 alone (p=.035). For mouse fibrosarcoma cells (WEHI164), mouse MSC-coinjected tumors had greater volume than those of WEHI164 alone (p=.141). For rat sarcoma cells (RR1022), rat MSC-coinjected tumors exhibited greater volume and infiltrative growth than those of RR1022 alone (p=.050). For human gastric cancer cells (5FU), tumors of 5FU alone were compact, nodular in shape, and expansile with good demarcation and no definite lung metastatic nodules, whereas tumors grown in the presence of human MSCs showed highly desmoplastic and infiltrative growth and multiple lung metastasis. CONCLUSIONS: We observed morphological evidence for MSC-associated tumor progression of fibrosarcomas and gastric cancer cells.

Evaluation of Neoadjuvant Chemotherapy Effect in Osteosarcoma / 대한골관절종양학회지

PURPOSE: Various diagnostic imaging modalities have been used to evaluate the effect of neoadjuvant chemotherapy for osteosarcoma early and noninvasively. We evaluated the effectiveness of imaging studies of plain radiographs and positron-emission tomography/computed tomography (PET/CT) in predicting neoadjuvant chemotherapy effect for osteosarcoma and tried to establish a general principle in interpretation of PET/CT parameters. MATERIALS AND METHODS: Eighteen patients who underwent two cycles of neoadjuvant chemotherapy and surgical excision for osteosarcoma were enrolled. There were 13 males and 5 females, with a median age of 19 (11-63) years. Fifteen patients of 18 had the American Joint Committe on Cancer (AJCC) stage IIB. They had plain radiographs and PET/CT before and after neoadjuvant chemotherapy. The resected tumor specimens were pathologically examined to determine histological response grade using a conventional mapping method. Statistical analysis was performed to evaluate the correlation between histopathological necrosis rate, and radiographic finding category, post-chemotherapy maximum standardized uptake value (SUVmax), average standardized uptake value and metabolic tumor volume (MTV) as well as reduction rates of them. RESULTS: Eight patients were good responders to neoadjuvant chemotherapy based on histological evaluation. Median SUVmax reduction rate was 73 (23-77) % in good responders and 42 (-32-76) % in poor responders. Median MTV reduction rate was 93.5 (62-99) % in good responders and 46 (-81-100) % in poor responders. While radiographic finding category was not different according to histological response (p=1.0), SUVmax reduction rate was significantly different (p=0.041). Difference in MTV reduction rates approached statistical significance as well (p=0.071). CONCLUSION: While radiographic finding category was not reliable to assess neoadjuvant chemotherapy effect for osteosarcoma, reduction rate of SUVmax was a useful indicator in this study. As parameters of PET/CT can be influenced by various factors of settings, different centers have to make an effort to establish their own standard of judgement with reference of previous studies.

Radiologic Results in Accordance with the Number of Distal Locking Screws in Volar Plate Fixation for Distal Radius Fractures

PURPOSE: The purpose of this study was to determine whether the number of distal locking screws affected the final radiologic results after volar plate fixation for distal radius fractures. METHODS: We retrospectively identified 176 patients (male, 36; female, 140; average, 60 years) who had distal radius fractures treated with open reduction and volar plate fixation between 2011 and 2012. The number of screws used for distal fixation was determined according to the surgeon's preference and the type of plate used. Radiologic parameters and their displacements were measured postoperatively and at final follow-up. The results of using 4 or 5 distal locking screws were compared with those of using more than 6 distal locking screws. RESULTS: There was no significant displacement in fracture fragment when using 4 or 5 distal locking screws compared with using more than 6 distal locking screws. Mean displacement in ulnar variance was 0.6 mm in group with less than 5 screws, and the displacement was 0.4 mm in group with more than 6 screws (p=0.772). Secondary displacement was not correlated with fracture type or the number of distal locking screws. There was no fixation failure during the study period. CONCLUSION: It seems that 4 or 5 distal locking screws are strong enough to prevent a significant loss of fracture reduction. Filling every distal screw hole is not recommended to limit cost and avoid extensor tendon complications.

Outcomes of the Sauve-Kapandji Procedure in Patients with Advanced Rheumatoid Arthritis

PURPOSE: We evaluated the clinical and radiographic outcomes of the Sauve-Kapandji procedure for the treatment of advanced rheumatoid arthritis. METHODS: Twenty-severn wrists in twenty-two patients were treated for advanced rheumatoid arthritis with Sauve-Kapandji procedure. Patients were evaluated in terms of wrist pain, bony union, instability of the ulnar proximal stump, ulnar stump pain, range of motion and other complications. Pain was evaluated using a visual analog scale. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. RESULTS: The average visual analogue scale score improved from 4+/-1.85 preoperatively to 0.78+/-0.91 at the last follow-up (p=0.003). Bone unions in distal radioulnar joint were obtained in all 22 patients, 27 wrists at mean 10.74 weeks (range, 6-28 weeks) after operation. The supination/pronation range of motion was changed from 55/50 degrees preoperatively to 79/73 degrees at postoperative 6 months follow up (p=0.32). The mean carpal translation index did not change after the operation. CONCLUSION: The Sauve-Kapandji procedure is a reliable methods of relieving pain, preserving range of motion (supination/pronation) and preventing ulnar translation of the carpus in managements of the severely destroyed distal radioulnar joints in rhematoid arthritis.

Scaphoid Nonunions Treated with 1, 2-Intercompartment Supraretinacular Artery Pedicled Vascularized Bone Graft and Headless Compression Screw Fixation

PURPOSE: The purpose of this study was to evaluate the clinical results of scaphoid nonunions treated with 1, 2-intercompartment supraretinacular artery (ICSRA) pedicled vascularized bone grafting (VBG) and headless compression screw fixation. METHODS: Since August 1, 2005, 11 scaphoid nonunions with avascular necrosis or bone marrow edema of proximal fragments were managed with 1, 2-ICSRA pedicled VBG combined with headless compression screw fixation. The mean age was 37.1 years (range, 21-66 years). 8 patients had avascular necrosis (AVN) of proximal fragments and 3 patients had bone marrow edema in proximal fragments. Serial radiographic evaluations were performed in every 4-8 weeks for bone union and follow up computed tomography scanning were checked in 8 patients. RESULTS: Bone unions were obtained in all 11 patients at 4.9 months (range, 3-9 months) after operation. At last follow up, the average range of motion was 82.5% and the grip power was 84.1% compared to the contralateral side. The mean New York Orthopaedic Hospital wrist score at last follow up was 83.2 (range, 58.1-93.3). CONCLUSION: Combined 1, 2-ICSRA pedicled VBG and headless compression screw fixation were reliable methods for managements of scaphoid nonunions even with AVN at proximal fragments.

MR Findings of the Osteofibrous Dysplasia

OBJECTIVE: The aim of this study was to describe MR findings of osteofibrous dysplasia. MATERIALS AND METHODS: MR images of 24 pathologically proven osteofibrous dysplasia cases were retrospectively analyzed for a signal intensity of the lesion, presence of intralesional fat signal, internal hypointense band, multilocular appearance, cortical expansion, intramedullary extension, cystic area, cortical breakage and extraosseous extension, abnormal signal from the adjacent bone marrow and soft tissue and patterns of contrast enhancement. RESULTS: All cases of osteofibrous dysplasia exhibited intermediate signal intensity on T1-weighted images. On T2-weighted images, 20 and 4 cases exhibited heterogeneously intermediate and high signal intensity, respectively. Intralesional fat was identified in 12% of the cases. Internal low-signal bands and multilocular appearance were observed in 91%. Cortical expansion was present in 58%. Intramedullary extension was present in all cases, and an entire intramedullary replacement was observed in 33%. Cortical breakage (n = 3) and extraosseous mass formation (n = 1) were observed in cases with pathologic fractures only. A cystic area was observed in one case. Among 21 cases without a pathologic fracture, abnormal signal intensity in the surrounding bone marrow and adjacent soft tissue was observed in 43% and 48%, respectively. All cases exhibited diffuse contrast enhancement. CONCLUSION: Osteofibrous dysplasia exhibited diverse imaging features ranging from lesions confined to the cortex to more aggressive lesions with complete intramedullary involvement or perilesional marrow edema.