Arthroscopically assisted Cancellous Bone Grafting and Percutaneous K-Wires Fixation for the Treatment of Scaphoid Nonunions

PURPOSE: The purpose of this study was to analyze the clinical results of patients with scaphoid nonunions treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation. METHODS: We retrospectively reviewed 20 patients with a scaphoid nonunions which was treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation from November 2008 to July 2012. Time from injury to treatment was 74 months (range, 3-480 months) in average. Functional outcome was evaluated using the modified Mayo wrist score and visual analogue scale (VAS) for pain, which were measured before operation and at the last follow up. RESULTS: All nonunions were healed successfully. The average radiologic union time was 9.7 weeks (range, 7-14 weeks). The average VAS score improved from 6.3 (range, 4-8) preoperatively to 1.6 (range, 0-3) at the last follow up. The average modified Mayo wrist score increased from 62.5 preoperatively to 85.7 at the last follow-up. CONCLUSION: Arthroscopically assisted bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion. It may provide more biological environment than open surgery as a minimally invasive procedure.

Versatile Applications of Anterolateral Thigh Perforator Flap in the Reconstruction of Upper Extremity Defects: Retrospective Analysis of 119 Cases

PURPOSE: The perforator flaps have established their role in the reconstruction of various soft tissue defects. For the last five years, we have extensively used anterolateral thigh (ALT) flap for the reconstruction of the complex tissue defects of the hand and upper extremity and report the clinical results and our experiences with the versatile applications of this flap. MATERIALS AND METHODS: From March 2003 through May 2008, 119 free ALT perforator flaps were transferred for reconstruction of the complex tissue defects of the elbow, forearm, wrist and hand after crushing or degloving injuries as well as severe scar contractures. There were 95 females and 24 males. The mean age of the patients was 37 years and mean size of the flap was 170 cm(2). In 20 cases, the flap was vascularized by septocutaneous and in 99 cases by musculocutaneous perforators. Intra-muscular dissection length averaged 3.4 cm. The total length of pedicle averaged 8.4 cm and the average arterial diameter was 0.84 mm. End-to-end arterial anastomosis was performed in 103 cases and end-to-side in 16 cases. RESULTS: Flap survival rate was 98.3%(117/119) and there were 6 cases of partial necrosis. Donor site was closed primarily in 41 cases and skin grafts were applied in 78 cases. CONCLUSION: The reliability and versatility of ALT flap makes it one of the foremost choices for the reconstruction of complex tissue defects of the upper extremity.

A Case of Isolated Aspergillus Sphenoid Sinusitis

Isolated Aspergillus infection originating within the sphenoid sinus is most often associated with the immunocompromised patient. A 53-year-old healthy woman presented with a 3-week history of headache and subsequent left 6th nerve palsy. Brain MRI demonstrated a space-occupying lesion within sphenoid sinus. Histological analysis through transnasal-transsphenoidal approach revealed numerous Aspergillus hyphae. Postoperatively, all symptoms resolved completely without anti-fungal treatment. Isolated Aspergillus sphenoid sinusitis should be routinely included in the differential diagnosis of patients with acute or subacute headache, even in nonimmunosuppressed patients.

Diffusion Weighted Magnetic Resonance Imaging in a Patient with Acute Wernicke Encephalopathy

We report a case of acute Wernicke encephalopathy in which diffusion-weighted imagings (DWI) revealed symmetrical high signal intensities in the medial thalamus, bilateral hemispheres of the cerebellum and periaqueductal gray matter. Calculation of the apparent diffusion coefficient demonstrated a mildly decreased diffusion on the affected regions. The high signal lesions were slowly resolved on the acute phase follow-up images with the administration of thimaine. We propose DWI should be included in the imaging protocols of patients suspected to suffer from Wernicke encephalopathy.