Treatment of 10-mm-Deep or Greater Uncontained Tibial Bone Defects in Primary Total Knee Reconstruction without Metal Augmentation: Autologous Oblique Structural Peg Bone and Cancellous Chip Bone Grafting.

BACKGROUD: In this study, we report satisfactory clinical and radiological outcomes after autologous oblique structural peg bone and cancellous chip bone grafting without metal augmentation, including the use of a metal wedge, block, or additional stem, for patients with ≥ 10-mm-deep uncontained medial proximal tibial bone defects in primary total knee replacement. METHODS: The study group included 40 patients with primary total knee replacement with ≥ 10-mm-deep uncontained tibial bone defects who underwent autologous oblique structural peg bone and cancellous chip bone grafting and were followed-up for at least 1 year. Tibial cutting was performed up to a depth of 10 mm from the articular surface of the lateral tibial condyle, after which the height and area of the remaining bone defect in the medial condyle were measured. The bone defect was treated by making a peg bone and chip bone using excised segments of the tibia and femur. In all cases, the standard tibial stem and full cemented fixation techniques were used without metal augmentation. Preoperative and final follow-up radiologic changes and clinical measures were compared, and prosthesis loosening and bone union were checked radiologically at final follow-up. RESULTS: The mean depth of the bone defects was 10.9 mm, and the mean percentage of the area occupied by bone defects in the axial plane was 18.4%. The mean mechanical femorotibial angle was corrected from 19.5° varus preoperatively to 0.2° varus postoperatively (p < 0.002). There was no prosthesis loosening, and all cases showed bone union at the 1-year postoperative follow-up. CONCLUSIONS: Even in patients with uncontained tibial bone defects ≥ 10-mm deep in primary total knee replacement, if the defect occupies less than 30% of the cut surface, autologous oblique structural peg bone and cancellous chip bone grafting can be used to achieve satisfactory outcomes with a standard tibial stem and no metal augmentation.

Delayed Repair of Severed Thenar Branch with Transligamentous Variation after Open Carpal Tunnel Release.

A 49-year-old female patient with carpal tunnel syndrome at both hands was performed open carpal tunnel release. 4 months later, on the left hand, severance of the thenar branch was found by electromyography. On the 138th day, re-exploration was performed for direct nerve repair. During exploration, we identified the transligamentous variation of recurrent motor branch. Direct nerve repair was successful. At 6 months after direct repair, the nerve function began to return. At 2 years after direct repair, the nerve function has almost returned. There are some variations on the recurrent motor branch. And we overlooked transligamentous variation when we perform more decompression around the median nerve. It is important that recognize variations of thenar branch when we perform carpal tunnel release for not occurrence of severance of thenar branch.

Comparison of the Outcomes Between Headless Cannulated Screw Fixation and Fixation Using a Locking Compression Distal Ulna Hook Plate in Fracture of Fifth Metatarsal Base.

The aim of the present study was to evaluate and compare the clinical and radiologic results of internal fixation with a headless cannulated screw versus a locking compression distal ulna hook plate for fractures at the base of the fifth metatarsal bone, zone 1. From April 2012 to April 2015, 30 cases (29 patients) were retrospectively evaluated. The mean follow-up period was 13 months. The patients were divided into 2 groups stratified by the fixation method: screw (group A, n = 15) or plate (group B, n = 15). We measured the displacement to diastasis of the fracture on the foot oblique radiographs taken pre- and postoperatively in each group, recorded the time to bony union, and measured the difference in the reduction distance in each group. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society midfoot score at 12 months postoperatively. In group A, the mean interval to union was 54.2 ± 9.3 days, the mean displacement to diastasis had improved to 0.3 ± 0.4 mm postoperatively (p < .001), and the mean reduction distance was 2.9 ± 1.0 mm postoperatively. In group B, the mean interval to union was 41.5 ± 7.0 days, the mean displacement to diastasis had improved to 0.06 ± 0.2 mm postoperatively (p < .001), and the mean reduction distance was 4.1 ± 1.6 mm. The American Orthopaedic Foot and Ankle Society midfoot scale score was 97.7 ± 3.4 in group A and 98.2 ± 3.2 in group B. The interval to union was significantly different between the 2 groups (p = .01). No complications were recorded. Our findings have shown that the plate is a reasonable and alternative method for the surgical treatment of fifth metatarsal base fractures.