ABSTRACT
PURPOSE: Since 2006, we have been performing minimally invasive plate osteosynthesis with a palmar locking plate and without division of the pronator quadratus muscle for repairing distal radial fractures. The purpose of this study was to present the surgical technique we have developed and to retrospectively evaluate the clinical outcomes. METHODS: Twenty patients were treated with this technique between January and December 2007. The range of motion of the wrist and forearm, grip strength, and the quick disability of the arm, shoulder, and hand score were assessed at the latest follow-up examination, and postoperative complications were evaluated. RESULTS: The average ranges of flexion and extension of the wrist were 55° and 60°, respectively. The average ranges of supination and pronation of the forearm were 88° and 86°, respectively. The average grip strength of the treated side was 71 % of that of the uninjured side. The average quick disability of the arm, shoulder, and hand score was 13.4 points. No patient had loss of fracture reduction, implant failure, deep infection, or tendon or nerve problems. CONCLUSIONS: The small skin incisions of this technique are advantageous from the aesthetic viewpoint. Minimally invasive plate osteosynthesis is one of the options for the treatment of distal radial fractures.
ABSTRACT
The technique of endoscopic submucosal dissection (ESD) has been developed for en bloc resection of early gastric cancer (EGC); however, little is known about the risk of metachronous cancer in the remnant stomach after initial ESD. In this study, we investigated the correlation between microsatellite instability (MSI) status and the incidence of metachronous recurrence of gastric cancer. According to the genetic/molecular background determined with MSI status and expression levels of hMLH1 and p53 tumour suppressor, 110 EGCs removed with ESD were subclassified into three groups: the mutator/MSI-type (8%), suppressor/p53-type (45%) and unclassified type (47%). Interestingly, patients with the mutator/MSI-type tumour had a high incidence (67%) of metachronous recurrence of gastric cancer within a 3-year observation after initial ESD, which was significantly higher than those with the suppressor/p53-type and unclassified type tumours (P<0.01). Although we investigated mucin phenotypes, there was no correlation between mucin phenotype and the recurrence of EGC. These findings suggest that subclassification of molecular pathological pathways in EGCs is required for the assessment of patients with a high risk of recurrent gastric cancer. The information delivered from our investigation is expected to be of value for decisions about therapy and surveillance after ESD.
