Reverse Hemi-Hamate Autograft for Volar Proximal Interphalangeal Joint Fracture-Dislocations.

Volar proximal interphalangeal joint fracture-dislocations are rare injuries. Treatment is challenging when they are not identified acutely, with poor outcomes reported. We report a surgical technique to treat chronic volar proximal interphalangeal joint fracture-dislocations: a reverse hemi-hamate autograft.

The ulnohumeral arthroplasty: technical tips for safely managing the brachial artery.

One surgical option to manage idiopathic osteoarthritis of the elbow is an ulnohumeral arthroplasty. A potential complication to avoid during this procedure is inadvertent over penetration of the anterior cortex of the humerus. If this occurs, injury to the median nerve and brachial artery is possible as these structures may lie within 7 mm of the anterior humerus. This surgical technique describes technical tips in regards to patient positioning and specific instrument usage that serve to diminish the risk of this catastrophic complication occurring by allowing these critical neurovascular structures to fall away from the anterior humerus.

Rice Bodies and a Partial Flexor Tendon Rupture in a Patient with Juvenile Idiopathic Arthritis: A Case Report and Review of the Literature.

CASE: We present a case of rice-body formation and partial flexor tendon rupture in a 3-year-old child with seronegative juvenile idiopathic arthritis (JIA), which presented as a painless soft-tissue mass of the volar aspect of the hand. The diagnosis was not confirmed until histologic examination. The patient was managed with a tenosynovectomy and oral medication; he made a full recovery. CONCLUSION: JIA is one of the most common rheumatologic conditions of childhood. Establishing the diagnosis can be challenging in very young children, particularly when clinical presentation is atypical and serology is negative. Surgical intervention may be warranted in the appropriately selected patient with JIA.

Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes.

PURPOSE: Two common techniques for fixation of extra-articular fractures at the proximal phalanx base are transarticular (across the metacarpophalangeal joint) and extra-articular cross-pinning. The aim of this study was to assess the complications and outcomes of these 2 techniques. Our hypothesis was that transarticular and extra-articular closed reduction and percutaneous pinning of base of proximal phalanx fractures have similar complication rates and outcomes. METHODS: A retrospective chart review identified 338 patients with base of proximal phalanx fractures. We treated 50 isolated fractures with closed reduction and percutaneous pinning using 1 of 2 techniques: transarticular (25 fractures through the metacarpal head) or extra-articular (25 fractures cross-pinned through the base of the proximal phalanx). Outcome measures included total active motion and complications. RESULTS: We found a substantial overall complication rate in both groups. The mean total active motion for the transarticular group and cross-pinning group was 201° and 198°, respectively. Proximal interphalangeal joint motion was notably affected; nearly half of the patients in each group had flexion loss greater than 20° (average, 27°) at the proximal interphalangeal joint. Nearly a third of patients in both groups had fixed flexion contracture greater than 15° at the proximal interphalangeal joint. There were more secondary procedures in the transarticular group (6) than in the cross-pinning group (2). There was no statistical significance between groups in any of the outcome parameters used. CONCLUSIONS: Closed pinning minimizes additional soft tissue injury and allows for early motion, but neither fixation method was superior in terms of the measured parameters. In addition, overall results were not as good as what has been reported in the literature.

Ambulatory assistive devices in orthopaedics: uses and modifications.

Ambulatory assistive devices (eg, canes, crutches, walkers) provide advantages such as stability, augmentation of muscle action, and reduction of weight-bearing load. Although they are often prescribed, a detailed understanding of these devices is often lacking, which can lead to detrimental consequences. Comprehension of normal gait cadence, as well as the gait patterns used in both reciprocating and swinging gait, allows the orthopaedic surgeon to understand the limitations of the patient with gait abnormalities. Appreciating the types of assistive devices, their modifications, associated gait patterns, physiologic demand, proper fitting, and indications for use is essential in prescribing the proper device.

Two unusual cases of coronal lunate fracture.

Volar lunate fractures are rare injuries, usually seen as a result of high-energy trauma and often in association of other carpal injuries. We present 2 unusual cases of coronal volar lunate fractures. The first case involved a proximal pole scaphoid fracture in association with a volar lunate fracture. During surgical exposure, the lunate fracture was found to be rotated 180 degrees volarly. This displaced lunate fracture, although appearing small on radiographs, consisted of the entire volar half of the capitate facet of the distal lunate. Both the scaphoid and lunate fractures were anatomically reduced with fixation across the fractures. The second case was the result of a high-energy injury and included a transscaphoid, transtriquetral, translunate facture dislocation with a comminuted radial styloid fracture and a small ulnar styloid fracture. Operative reduction and internal fixation was performed of the scaphoid and lunate. The triquetral and comminuted radial styloid fractures were stabilized with K-wires. In both cases, following splinting and rehabilitation, an excellent functional outcome was obtained. Early recognition and operative treatment of these unusual lunate fractures in association with treatment of the concomitant injuries using an extended volar approach with open reduction internal fixation can lead to an excellent anatomic and functional outcome in these types of cases.