Analysis of left hepatolithiasis treated with cranial-dorsal approach laparoscopic anatomic left hemihepatectomy / 中华肝胆外科杂志

Objective:To study the safety and feasibility of anatomic left hemihepatectomy via cranial-dorsal approach in the treatment of left hepatolithiasis.Methods:Clinical data of 47 patients with left intrahepatic bile duct stones who underwent cranial-dorsal approach laparoscopic anatomic left hemihepatectomy in Hunan People's Hospital from October 2016 to June 2022 were retrospectively analyzed, including 15 males and 32 females, aged (56.45±1.37) years old. The operative time, intraoperative blood loss, postoperative liver function and complications were analyzed. Patients were followed up by telephone and outpatient review.Results:All 47 patients successfully underwent laparoscopic surgery without conversion. The median operative time was 260 (range, 160-440) min. The median intraoperative blood loss was 100 ml (range, 20-400 ml). The total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were 15.7 (11.7, 21.9) μmol/L, 126.6 (91.7, 168.5) U/L, and 151.1 (98.0, 212.4) U/L on postoperative day (POD) 1, respectively, and decreased to 12.6 (9.6, 16.2) μmol/L, 97.9 (60.7, 156.9) U/L, 54.2 (40.0, 104.1) U/L on POD 3, respectively. The median postoperative hospital stay was 7 (range, 4-24) d. Postoperative abdominal effusion and infection occurred in one patient, and the complication rate was 2.1% (1/47). Postoperative CT review found residual stones in common bile duct in one patient [2.1% (1/47)]. No stone recurrence or death occurred during postoperative follow-up.Conclusion:Anatomic left hemihepatectomy via cranial-dorsal approach is a safe and feasible surgery for the treatment of left hepatolithiasis.

Operative strategy and clinical results of complex four part distal radius fractures by combined palmar and dorsal internal fixation / 中华外科杂志

Objective@#To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results.@*Methods@#From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months.@*Results@#Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively.@*Conclusion@#Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.

Anatomical Reduction with Brick-Work Technique in Comminuted Intraarticular Distal Radius Fractures

PURPOSE: This study examined the clinical outcomes of comminuted intraarticular distal radius fractures treated by an anatomical reduction using a brick-work technique. MATERIALS AND METHODS: Seventeen patients with AO/OTA type 23-C3 distal radius fractures were enrolled in this study. An anatomical reduction of the articular surface was achieved using a brick-work technique through the dorsal approach and dorsal plates were used for fixation. The postoperative functional results were assessed with the range of motion of the wrist and the modified Mayo wrist score (MMWS). In addition, the radial length, radial inclination, volar tilt, and Lidstrom score were evaluated from the radiology results. The mean postoperative follow-up period was 13.6 months. RESULTS: All patients showed bony union and the mean range of motion of the injured wrists was 94% (92% to 95%) of the uninjured side. The mean MMWS was 85.3, and the functional results were excellent in 12 patients, good in 4, and fair in one at the final follow-up. Based on the final radiographic measurements, the radial length, volar tilt, and radial inclination were 11.4 mm (10.0 to 13.5 mm), 6.6° (−1.8° to 9.2°), and 21.3° (20.1° to 25.7°), respectively. The radiologic results according to the Lidstrom score were excellent in 14 patients and good in three. CONCLUSION: An anatomical reduction with the brick-work technique is relatively easy, results in a reproducible clinical outcome, and could be a safe and effective treatment option for severe comminuted intraarticular distal radius fractures that are not amenable to volar plate fixation.

The relationship of the posterior interosseous nerve to the supinator muscle in the dorsal approach to the proximal radius: A descriptive and quantitative anatomic study of Filipino cadavers

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong>The posterior interosseous nerve (PIN) is vulnerable to injury in the dorsal approach to the proximal radius. The goal of this study is to describe the quantitative relationship of the PIN to the supinator muscle in the context of anatomic landmarks. Knowledge of superficial landmarks related to the PIN would hopefully minimize iatrogenic injury to the posterior interosseous nerve.<br /><strong>METHODS:</strong> 12 cadavers (22 forearms) were dissected and analyzed. The length of the supinator muscle was determined. The oblique distances of the PIN entry and exit points to the proximal and distal borders of the supinator muscle as well as their perpendicular distances to the lateral epicondyle-Lister's tubercle (LE-LT) reference line were measured and recorded. The number of PIN branches inside the supinator substance was recorded. Mean and median values were determined and subjected to statistical analysis.<br /><strong>RESULTS:</strong> Mean supinator length was 5 centimeters. Ninety-one percent of the cadaveric forearms had PIN branches inside the supinator muscle substance. Twelve of the 22 forearms (55%) had 2 branches. The mean oblique distances of the PIN from the lateral epicondyle to the entry and exit points in the proximal and distal borders of the supinator muscle was 3.52 and 7.31 centimeters, respectively. The mean perpendicular distances of the PIN from LE-LT reference line to the entry and exit points in the proximal and distal borders of the supinator muscle was 1.13 and 1.26 centimeters, respectively. An imaginary danger-zone 4 centimeters wide overlying the LE-LT reference line depicts the possible area where the PIN and its branches may most likely be located.<br /><strong>CONCLUSION:</strong> The dorsal approach to the proximal radius may allow a safe exposure without causing iatrogenic injury to the posterior interosseous nerve through the use of superficial anatomic landmarks and reference lines in combination with mean measurements from our study.</p>

The relationship of the posterior interosseous nerve to the supinator muscle in the dorsal approach to the proximal radius: A descriptive and quantitative anatomic study of Filipino cadavers

BACKGROUND AND OBJECTIVE:The posterior interosseous nerve (PIN) is vulnerable to injury in the dorsal approach to the proximal radius. The goal of this study is to describe the quantitative relationship of the PIN to the supinator muscle in the context of anatomic landmarks. Knowledge of superficial landmarks related to the PIN would hopefully minimize iatrogenic injury to the posterior interosseous nerve.METHODS: 12 cadavers (22 forearms) were dissected and analyzed. The length of the supinator muscle was determined. The oblique distances of the PIN entry and exit points to the proximal and distal borders of the supinator muscle as well as their perpendicular distances to the lateral epicondyle-Lister's tubercle (LE-LT) reference line were measured and recorded. The number of PIN branches inside the supinator substance was recorded. Mean and median values were determined and subjected to statistical analysis.RESULTS: Mean supinator length was 5 centimeters. Ninety-one percent of the cadaveric forearms had PIN branches inside the supinator muscle substance. Twelve of the 22 forearms (55%) had 2 branches. The mean oblique distances of the PIN from the lateral epicondyle to the entry and exit points in the proximal and distal borders of the supinator muscle was 3.52 and 7.31 centimeters, respectively. The mean perpendicular distances of the PIN from LE-LT reference line to the entry and exit points in the proximal and distal borders of the supinator muscle was 1.13 and 1.26 centimeters, respectively. An imaginary danger-zone 4 centimeters wide overlying the LE-LT reference line depicts the possible area where the PIN and its branches may most likely be located.CONCLUSION: The dorsal approach to the proximal radius may allow a safe exposure without causing iatrogenic injury to the posterior interosseous nerve through the use of superficial anatomic landmarks and reference lines in combination with mean measurements from our study.

Old trans-scaphoid perilunar dislocation treated with dorsal approach / 局解手术学杂志

Objective To evaluate the effectiveness of scaphoid fracture fixation through dorsal approach and dorsal joint capsule recon -struction in treatment of old trans-scaphoid perilunar dislocation .Methods From October 2010 to October 2013, 12 patients of old trans-scaphoid perilunar dislocation had been treated with open reduction and internal fixation as well as dorsal joint capsule reconstruction through dorsal approach.Among the 12 patients, 9 were males and 3 were females, and they were 22~54 years old (42.3 years old averagely). Preoperative and postoperative wrist functions were evaluated by visual analogue scale (VAS), range of motion (ROM), grip strength and Cooney's standard.Results All the 12 patients were followed-up for 15 to 28 months (24 months averagely).In the last follow-up, the aver-age VAS score was 1.6 point (0~6 point) , and 9 patients of them had no feeling of pain .According to the Cooney ’ s standard,the results were excellent in 2 cases, good in 8 cases, fair in 1 case,and bad in 1 case.The mean time of fracture union was 14~22 weeks (16.8 weeks averagely ) .Conclusion Scaphoid fracture fixation through dorsal approach and dorsal joint capsule reconstruction in treatment of old trans-scaphoid perilunar dislocation can receive good curative effect and satisfactory clinical effect .

Dorsal Approach for Distal Radius Fractures

Since the advent of volar locking plate, volar approach for internal fixation has become a major trend in the treatment for unstable distal radius fracture. However, dorsal approach is preferred for certain fracture pattern include AO type C3, dorsal Barton's fractures and concomitant intercarpal ligament injury, because it can afford excellent exposure of the articular surface. Although dorsal approach and plating technique has inherent disadvantages include extensor tendon irritation and rupture, improvements in implant design lead to decrease complication rate. Here, we provide overview of the pros and cons through historic perspective, indications, and surgical technique of the dorsal approach for the distal radius fracture.

Extension Type Locked Metacarpophalangeal Joint of the Little Finger due to Hyperextension Injury / 대한정형외과학회잡지

The extension type locked metacarpophalangeal joint of the little finger is an extremely rare condition characterized by loss of flexion with little or no loss of extension. The most common cause for locking is entrapment of a strap of the ruptured palmar plate. We treated a locked metacarpophalangeal joint of the little finger due to a hyperextension injury. The mechanism of locking was a torn part of the palmar ligament that forcefully rides across the prominence of the radial condyle of the metacarpal bone together with the accessory collateral ligament. These dislocated parts of the ligament formed a constricting bundle that prevented closed reduction. Locking was released successfully by an open reduction using the dorsal approach of the metacarpophalangeal joint without complication.

Scaphoid Nonunion: Herbert Screw Fixation through Dorsal Approach

PURPOSE: To evaluate the clinical and radiographic outcomes of scaphoid nonunion patients who had treated by open reduction and internal fixation with Herbert screw through dorsal approach. METHODS: We reviewed prospectively a series of 102 consecutive patients with scaphoid nonunion (Mack-Lichtman stage I, II, III). All patients were managed with open reduction with dorsal approach and internal fixation with a Herbert screw and additional K-wires. Exclusion criteria included conservative treatment, percutaneous fixation, scaphoid nonunion advanced collapse wrist. There were 94 male and 8 female with an average age of 28 years (range, 13-65 years). The mean follow period was 35 months (range, 12-96 months). Postoperative radiographs were reviewed to assess the fracture union, carpal alignment, and screw position. Functional results were evaluated by modified Mayo wrist score. RESULTS: Ninety-eight of 102 patients (96.1%) showed radiographic union at an average time of 12.7 weeks. Modified Mayo wrist score was 87.5 points in an average. Ninety-two of 102 patinets (91.3%) showed more than good results. There was no major complications. There was no statistically significant difference between the preoperative and postoperative radiolunate angle, scapholunate angle, or height to length scaphoid ratio. CONCLUSION: Herbert screw fixation through dorsal approach was a reliable method for patients of scaphoid nonuinion to achieve bony union with high functional scores and without major complications.

Headless Autocompression Screw Fixation of Scaphoid Fractures Using Open Dorsal Approach

PURPOSE: We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach. METHODS: This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes. RESULTS: After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion. CONCLUSION: Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable.

Analysis clinical of 32 cases of volar locking compression plate fixation for dorsally displaced fractures of distal radiusin / 中国医师进修杂志

Objective To evaluate a preliminary outcome of volar surgical treatment of dorsally displaced fractures of distal radius with open reduction and internal fixation with T shape locking compression plate.Methods From January 2009 to January 2012,32 cases with dorsally unstable distal radius fractures were treated with open reduction and internal fixation with T shape locking compression plate.Results All patients were followed; the average follow-up period was 12 (8-18) months.The patients all healed well.According to Dienst scoring system,the results were excellent in 23 cases,good in 7 cases,fair in 2 cases,the excellent and good rate was 93.75％(30/32).Conclusions The volar fixation of T shape locking compression plate for dorsally displaced fractures of distal radius has advantage of stable and reliable,high healing rate,low rate of complications and early motion.It is especially suitable for osteoporosis patients.

Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach

PURPOSE: To evaluate the clinical and radiologic outcomes of the perilunate dislocation and the lunate dislocation which were managed surgically through a dorsal approach. MATERIALS AND METHODS: Retrospective reviews of the 13 patients who had minimum 1-year follow-up after surgical treatment through isolated dorsal approach for their perilunate dislocations or the lunate dislocations were performed. The case that dislocated lunate migrated proximally through the wrist was excluded in this series. We evaluated the DASH score in questionnaire method and Mayo wrist score to analyze the clinical outcomes. Radiologic results were investigated by measurement of the scapho-lunate angle, and fracture union was also evaluated in the case of trans-scaphoid dislocation. RESULTS: The mean DASH Score was 16.3 points (range, 10.8~26.7 points) and the mean Mayo wrist score was 79 points (range, 65~90 points) at the final follow-up. There were 2 cases of excellent, 7 cases of good and 4 cases of fair in the Mayo wrist score. On the radiologic analysis, the mean scapho-lunate angle was 49.0degrees (range, 35~55degrees) and all cases were within the normal range. All cases of the trans-scaphoid perilunate dislocation achieved bone union. CONCLUSION: Author's cases showed satisfactory outcomes in clinically and radiologically. Isolated dorsal approach could give anatomical reduction and appropriate internal fixation in treatment of the perilunate dislocations and the lunate dislocations except the rare case of proximal migration of the lunate through the wrist.