Comparison between O-arm Navigation and Conventional Fluoroscopic Guidance in Corrective Posterior Fixation for Cervical Spinal Injury.

Purpose : To compare the effectiveness of O-arm navigation with that of conventional fluoroscopic guidance in corrective posterior fixation for cervical spinal injury. Methods : This retrospective comparative study involved 11 consecutive patients who underwent corrective posterior fixation using O-arm navigation or conventional fluoroscopy for cervical spinal injury between February 2016 and May 2021. Patient-specific characteristics (age and sex), number of screws, number of pedicle screws, accuracy of pedicle screw insertion, number of vertebral bodies fixed, operating time, and length of hospital stay were analyzed using the t-test. A P-value < 0.05 was considered statistically significant. Results : Corrective posterior fixation was performed under O-arm navigation in 5 patients and under conventional fluoroscopic guidance in 6. A significantly greater number of pedicle screws was used in the O-arm group (6.4 vs 2.7, P = 0.046). According to the Neo classification for pedicle screw placement, there were no grade 2 or 3 breaches. No other items showed a significant difference between the groups (P > 0.05). Conclusion : O-arm navigation can improve the accuracy of cervical pedicle screw insertion. Its introduction could expand the indications for use of pedicle screws in posterior fixation of cervical spinal injury beyond those that are possible using conventional fluoroscopy. J. Med. Invest. 69 : 273-277, August, 2022.

Use of a Free Medial Femoral Condyle Periosteal Flap in Digital Reconstruction - A Report of Two Patients.

We reconstructed a segmental bone defect in a finger associated with a dorsal skin defect using a bone graft covered with a free medial femoral condyle periosteal flap and a skin graft in two patients. The vascularised periosteal flap (VPF) improved the survival of the bone graft and allowed the take of the skin graft. The use of a VPF can be considered in patients with crush injury of the digits with segmental loss of bone and dorsal skin Level of Evidence: Level V (Therapeutic).

An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion.

The patient was a 48-year-old female recreational triathlete who had been experiencing mild low back pain since high school. She had recently developed right leg pain and had gradually worsening difficulty in running. She preferred to undergo spinal surgery without fusion so that she could return to triathlons as soon as possible, and she was referred to our hospital. Plain radiographs showed Meyerding grade 3 isthmic spondylolisthesis at L5 and a slipped L5 vertebral body. Selective nerve root block at L5 relieved the right leg pain temporarily. The final diagnosis was right L5 radiculopathy due to compression by the ragged edge of the L5 pars defect from the posterior side and by the upside-down foraminal stenosis at L5-S1. An L4-L5 partial laminectomy was performed with resection of the ragged edge and one-third of the caudal pedicle at L5. Adequate decompression was achieved by exposing the L5 spinal nerve root from the branch portion to the outside of the L5 pedicle. The right leg pain disappeared postoperatively and she returned to participating in triathlons. One year after surgery, there was slight radiographic progression of the slip in 5 mm; however, there had been no recurrence of the right leg pain. Several studies have reported excellent outcomes after decompression surgery in patients with isthmic spondylolisthesis. To our knowledge, this is the first report of successful lumbar decompression surgery without fusion for high-grade isthmic spondylolisthesis in a triathlete, although in short-term results.

Consecutive double-level lumbar spondylolysis successfully treated with the double "smiley face" rod method.

We report a case of double-level lumbar spondylolysis at L4 and L5 that was successfully treated with the double "smiley face" rod method. A healthy 29-year-old man who presented with a 6-year history of chronic low back pain was referred to us for surgical treatment. Plain radiographs and computed tomography of the lumbar spine revealed bilateral pars defects at L4 and L5 without slip or scoliosis. The patient underwent direct repair of the pars defects using the double smiley face rod method at L4 and L5. There were no intraoperative or postoperative complications, and the patient had improved clinically by 1 year after surgery. The low back pain was completely disappeared and visual analog scale was 0. He restarted tennis again as the recreational level. While several techniques for direct repair of lumbar spondylolysis have been described, this is the first report of the double smiley face rod method being used to repair the consecutive double-level lumbar spondylolysis. J. Med. Invest. 67 : 202-206, February, 2020.

One-Stage Reconstruction for Re-rupture of Achilles Tendon with Soft Tissue Infection: Using an Anterolateral Thigh Flap Incorporating a Vascularized Muscle Flap and a Strip of Iliotibial Tract.

Reconstruction is challenging in a patient with loss of a segment of Achilles tendon and infection in the overlying soft tissue. Here the authors describe one-stage tendon reconstruction, using an anterolateral thigh free flap incorporating a vascularized muscle flap and a strip of iliotibial tract in a patient with re-rupture of an Achilles tendon and soft tissue infection. Postoperative immobilization of the affected ankle using an external fixator enabled us to observe the flap directly and reduce pressure on the flap. The patient had a successful outcome, with no difficulty in walking, running, or climbing stairs and no limitation of range of motion at the ankle joint postoperatively. This is a promising technique for reconstruction of the Achilles tendon and treatment of infection as a one-step procedure.

Swan neck deformity due to chronic radial collateral ligament injury of the little finger proximal interphalangeal joint.

We present seven cases of a relatively rare swan neck deformity resulting from chronic radial collateral ligament (RCL) injury of the proximal interphalangeal (PIP) joint in the little finger. All patients were middle-aged women (mean 51 years old, range 42-55), and the duration between the initial injury and surgery was 20 years (range 5-40). The chief complaint was painful snapping of the PIP joint. All patients had hyperextension and ulnar deviation of the PIP joint with mobile swan neck deformities that had not improved with conservative treatment. Radiographs revealed osteoarthritis and ulnar deviation of the PIP joints in all cases. We describe a method for reconstruction of both the palmar plate and the RCL of the affected PIP joint using a distally-based ulnar slip of flexor superficialis tendon. The prevention of PIP joint hyperextension was critical for successful resolution of symptoms; the aim of RCL augmentation was to prevent the recurrence of the deformity. LEVEL OF EVIDENCE: IV.

Restoration of the Active Forearm Rotation Using Vascularized Free Fibular Graft and Radial Head Arthroplasty for a Wide Defect of the Proximal Radius.

In this report we present a case of re-stabilization of the proximal radius using vascularized free fibular graft combined with anconeus arthroplasty to stabilize the transplanted fibula in a patient with large loss of the proximal radius due to Ewing's sarcoma. A 20-year-old woman had Ewing's sarcoma in the proximal three-fourths of the radius. The resection of large part of the radius containing radial head were necessary for removal of the sarcoma. Reconstruction of the proximal radius was performed using vascularized free fibular graft and the transplanted fibula was stabilized by attaching the anconeus to the proximal edge of the fibula. 2 years after surgery, she had neither recurrence nor metastasis, and achieved functional recovery. The combination anconeus arthroplasty with vascularized free fibular graft can be a good technique for re-stabilization of the elbow and recovery of the forearm function.

Pedicled unipolar latissimus dorsi flap for reconstruction of finger extensor.

We describe the use of a pedicled unipolar latissimus dorsi flap to restore finger extension. The patient had large defects in the radial nerve and extensor musculature. A long-tailed, 50-cm-long flap was prepared, which enabled the end of the flap to be sutured to the extensor digitorum.

Ulnolunate Ligament Avulsion Fracture of the Lunate: A Case Report.

Traumatic lunate fractures are very rare and those treatments require an understanding of anatomical features. We present a case of an ulnolunate ligament avulsion fracture of the lunate that was successfully repaired by surgical fixation with open reduction and internal fixation. We believe that restoration of ulnolunate ligament function is important to prevent further deterioration of wrist function after this injury.

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures.

Background The low-profile dorsal locking plating (DLP) technique is useful for treating dorsally comminuted intra-articular distal radius fractures; however, due to the complications associated with DLP, the technique is not widely used. Methods A retrospective review of 24 consecutive cases treated with DLP were done. Results All cases were classified into two types by surgical strategy according to the fracture pattern. In type 1, there is a volar fracture line distal to the watershed line in the dorsally displaced fragment, and this type is treated by H-framed DLP. In type 2, the displaced dorsal die-punch fragment is associated with a minimally displaced styloid shearing fracture or a transverse volar fracture line. We found that the die-punch fragment was reduced by the buttress effect of small l-shaped DLP after stabilization of the styloid shearing for the volar segment by cannulated screws from radial styloid processes. At 6 months after surgery, outcomes were good or excellent based on the modified Mayo wrist scores with no serious complications except one case. The mean range of motion of each type was as follows: the palmar flexion was 50, 65 degrees, dorsiflexion was 70, 75 degrees, supination was 85, 85 degrees, and pronation was 80, 80 degrees; in type 1 and 2, respectively. Conclusion DLP is a useful technique for the treatment of selected cases of dorsally displaced, comminuted intra-articular fractures of the distal radius with careful soft tissue coverage.

Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note.

Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors' hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient's symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.

Reconstruction of Extensor Tendon Dislocation Due to Chronic Sagittal Band Rupture of the Thumb Metacarpophalangeal Joint: A Case Report.

CASE: We report a case of recurrent dislocation of the extensor pollicis longus and extensor pollicis brevis tendons due to chronic rupture of the radial sagittal band of the metacarpophalangeal joint of the thumb. CONCLUSION: Successful restabilization of these tendons was achieved by transferring a half-slip of the abductor pollicis brevis tendon.

Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report.

Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon.

Radial head dislocation due to gigantic solitary osteochondroma of the proximal ulna: case report and literature review.

Developmental anterior dislocation of the radial head resulting from a congenital solitary osteochondroma of the proximal ulna is an extremely rare condition. We present a case of a 4-year-old girl with this condition affecting her right elbow, which was treated by a trapezoidal shortening osteotomy at the radial neck following an oblique ulnar osteotomy with angulation and elongation after a complete resection of the tumor mass. The child remained asymptomatic with symmetric carrying angles during 2.5 years of follow-up post-surgery. We discuss the nature of this condition and review the literature.

Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series: Modified Ilizarov Method for Correction of a Collapsed Thumb Deformity Due to Carpometacarpal Osteoarthritis.

A hyperextension deformity in the advanced stages of carpometacarpal (CMC) arthritis of the thumb could affect the outcomes of thumb CMC joint arthroplasty. We introduce the interesting approach for treating severely collapsed thumb deformities with gradual distraction and coordinated correction of the MCP and CMC joints by means of external fixators. We divided 8 cases into 3 groups according to the angle of passive flexion of the hyperextended MCP joint: group 1, 10-20°, group 2a, 20-40°, and group 2b, >40°, retrospectively. We first performed CMC arthroplasty with trapezium excision. In group 1, we corrected the MCP hyperextension deformity by manual passive flexion and fixed the joint with an extension block Kirshner wire (K-wire) for 2 months. However, deformities recurred in 2 of 5 cases after removing the K-wire. These patients received corrective percutaneous osteotomy with external fixators at the metacarpal neck. In groups 2a and 2b, we performed CMC arthroplasty and set external fixators at the same time. All cases in groups 1 and 2a have been without recurrence for more than 2 years, while a deformity recurred in group 2b. The results of this small case series encouraged us to propose an interesting approach for collapsed zigzag thumb deformity. Good outcomes with excellent maintenance of active MCP movement and no recurrence are highly anticipated if the hyperextended thumb has no obvious degenerative changes and can be corrected by <40° of passive flexion. Our results also indicate a risk of recurrence associated with extension block by K-wire.

Bilateral Proximal Radial Shaft Fracture Dislocations Resulting from 2 Separate Injuries with the Same Mechanism, Each Associated with Median Nerve Entrapment: A Case Report in a Gymnast Performing Back Hand Springs: Bony Entrapment of Median Nerve at Proximal Radius.

We report a rare case of entrapment of the median nerve following a closed fracture of the proximal one-fourth of the radius in an adolescent in failure of back hand spring. We proposed that the forearm pronation and the wrist extension in, "the Back Handspring position" made the median nerve close to the radius at one-fourth proximal radius, played an important role in this complication.

Irreducible Palmar Dislocation of the Distal Interphalangeal Joint Due to Closed Degloving of the Distal Phalanx of the Little Finger.

Since irreducible dislocation of the distal interphalangeal joint (DIP joint) is dorsal dislocation, irreducible palmar dislocation of the DIP Joint is very rare. This case was associated with a closed degloving injury of the distal phalanx of the little finger and required operative treatment.

Salmonella osteomyelitis of the distal radius in a healthy young adult patient: report of a rare case and literature review.

Salmonella osteomyelitis of the radius in a healthy individual is very rare. We present such a case involving the distal radius of a healthy 23-year-old man without underlying disease or possible episode. He had right wrist pain for approximately 3 years, and osteolytic lesion was seen in the right distal radius. He underwent surgical treatment, and salmonella was isolated from pus in the lesion. Postoperative antibiotics successfully treated his infection. He had no sign of recurrence, but the point of entry for infection remains unknown.