Opponensplasty using the extensor indicis proprius tendon for severe carpal tunnel syndrome in 40 patients.

The aim of this study was to assess the clinical results after extensor indicis proprius opponensplasty in patients with carpal tunnel syndrome and severe thenar muscle atrophy. Forty patients who underwent this procedure during open carpal tunnel releases. The mean follow-up period was 17 months (range 10 to 36). Kapandji scores significantly improved from 5.5 before surgery to 9.6 at final follow-up. Thumb pronation angle also significantly improved from 111° before surgery to 149°. Side and pulp pinch strength significantly improved postoperatively, as well as DASH scores at final follow-up. In conclusion, the extensor indicis proprius tendon transfer technique represents a reliable opponensplasty procedure to achieve consistent results in patients with severe carpal tunnel syndrome.Level of evidence: IV.

Short- to Mid-Term Clinical Outcomes of Posterior-Stabilized Cementless Total Knee Arthroplasty with Trabecular Metal Components.

OBJECTIVE: This study aimed to evaluate the short- to mid-term clinical results of posterior-stabilized trabecular metal total knee arthroplasty (TKA) with cementless fixation of all components and investigate the radiographic changes of tibial and patellar components and cut bone surfaces over time. METHODS: We retrospectively collected the data of 128 knees from 88 consecutive patients who had undergone initial TKA with NexGen LPS-Flex TM implants. A total of 66 knees from 45 patients (mean ± standard deviation age: 70.3 ± 7.5 years) met the selection criteria, which had been employed cementless fixation of all parts and at least 3 years of postoperative follow-up duration. Clinical evaluations included range of motion, conventional knee score, function score, postoperative complications, and revision. For radiological evaluations, the bone contact surface of each implant was divided into 7 zones for tibial component and 2 zones for patellar component. Each region was examined immediately after surgery, at 6 and 12 months, and then every year afterwards. RESULTS: The mean observation period of 45 subjects was 4.2 years. Adequate fixation of tibial components was maintained during follow-up, although the patellar components of 2 knees required revision after repeated falls. No loosening was observed in any implants. The initial gap in tibial components disappeared in all knees, and a reactive line remained in 4 knees. There were no revisions, except for 2 cases, which were ascribed to patellar component fracture caused by repeated falls. CONCLUSION: Cementless posterior-stabilized trabecular metal TKA appears to be a good surgical option. Longer-term examination for revision cases is required to validate our results.

The incidence and risk factor of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction.

PURPOSE: To retrospectively analyze the incidence and risk factors of deep venous thrombosis (DVT) detected by ultrasonography after arthroscopically assisted Anterior Cruciate Ligament Reconstruction (ACLR). METHODS: We retrospectively reviewed medical records of arthroscopically assisted ACLR surgery performed at our institution between 2012 and 2015. Revision ACLR, bone patella tendon bone (BTB) graft reconstruction, and concomitant multiple ligament reconstructions were excluded. We performed a standardized double-bundle reconstruction procedure using hamstrings graft for ACLR. All patients routinely received DVT screening by using venous ultrasonography on postoperative day 7 from 2012 to 2013, and postoperative days 7 and 14 from 2014 to 2015. The prevalence of DVT was calculated and clinical factors such as age, gender, Body Mass Index (BMI), operative time, and duration of tourniquet application were evaluated in relation to the risk factor of DVT. RESULTS: Two hundred and fifty-six patients (129 men and 127 women) with a mean age of 28.9 were enrolled. Sixteen patients (6.6%) were detected with DVT on postoperative day 7. Among 146 patients who received venous ultrasonography on both postoperative days 7 and 14, DVT were detected in five additional patients on postoperative day 14. In a total of 21 patients who were diagnosed with DVT, two were proximal, the remaining 19 were distal, and no patient had progressed to pulmonary embolism (PE). In terms of predisposing factors for developing DVT on postoperative day 7, only age ≥30 showed a statistically significant higher risk of DVT (P = 0.03). CONCLUSION: Incidence of DVT after ACLR detected by ultrasonography on postoperative day 7 was 6.6%. Patients aged ≥30 years have a potentially higher risk for developing DVT. Great care for DVT should be taken if prolonged immobilization is applied after ACLR surgery. LEVEL OF EVIDENCE: Level Ⅳ.

Elastic modulus of the femoral trochanteric region measured by scanning acoustic microscopy in elderly women.

PURPOSE: We have devised a method that can obtain continuous detailed distributions of the elastic modulus along the measurement line in a non-decalcified specimen of human bone tissue. The aim of this study was to determine whether local variations exist in the distribution of mechanical properties within the trochanteric region of the femur of elderly females using a newly developed form of scanning acoustic microscopy (SAM) technology. METHODS: Human proximal femurs were harvested from seven female cadavers aged between 67 and 88 years at death. Using data collected with SAM, the elastic modulus of cortical and trabecular bone tissue of the lateral and medial trochanter was calculated and statistically analyzed. RESULTS: The longitudinal and transverse elastic moduli in cortical bone tissue of the lateral trochanter were found to be significantly lower than those of the medial trochanter in all specimens from individuals over age 70 (p < 0.05). Compared to that of the distal region, the longitudinal and transverse elastic moduli of trabecular bone tissue of the proximal region of the lateral trochanter were significantly lower in all specimens from individuals over age 80 (p < 0.05). CONCLUSION: Our new method allows obtaining detailed distributions of the elastic modulus of bone tissue.

Myositis ossificans occupying the thenar region: a case report.

INTRODUCTION: Myositis ossificans is a benign, self-limiting, tumor-like lesion that usually affects the elbow and thigh; occurrence in the hand is uncommon. We report a rare case of a patient with myositis ossificans in the thenar region. CASE PRESENTATION: A 15-year-old Japanese girl presented to our hospital with a 2-month history of a painful mass in the right thenar region without previous trauma. The clinical and radiological examination findings suggested an osteoblastic malignancy. A diagnosis of myositis ossificans was made on the basis of an incisional biopsy. Despite the location of the lesion in the thenar region, a normal functional outcome was achieved after marginal resection of the mature lesion. CONCLUSIONS: Clinicians should consider myositis ossificans as a possible diagnosis for a soft tissue mass in the hand, thereby avoiding unnecessarily aggressive therapy.

Mechanical evaluation of hip pads to protect against fracture of elderly femurs in falls.

Hip fracture in the aged easily occurs by falls and may cause these persons to become bedridden. Hip pads are effective in protecting hip fracture as they directly deflect and absorb the impact forces by falls. It is necessary for the material and the structure of hip pads to be designed to realize both high impact absorption and compliance (comfort during wearing). In this report, an impact testing system was developed to test the impact absorbing performance of hip pad with air cushions designed by the research group. The impact absorbing performance was evaluated by the impact load, collision time, and maximum load. To confirm the effectiveness in protecting against hip fracture, an impact force was applied to the greater trochanter of the human femur and the degree of fracture was measured by X-ray examination. As a result, the hip pad with air cushions had a high impact absorbing performance and was sufficiently effective to protect against hip fracture.

Recurrent granulomatous tenosynovitis of the wrist and finger caused by Mycobacterium intracellulare: a case report.

We report a 65-year-old man with tenosynovitis of the wrist and finger caused by Mycobacterium intracellulare. The diagnosis was made after subsequent recurrence, when a specimen of synovial fluid was subjected to specific polymerase chain reaction and mycobacterial culture. Synovectomy and susceptibility-guided antituberculous therapy permitted complete healing of tenosynovitis.

A novel function of N-cadherin and Connexin43: marked enhancement of alkaline phosphatase activity in rat calvarial osteoblast exposed to sulfated hyaluronan.

In this study, we examined the interaction of the osteoblast which forms bone and sulfated hyaluronan (SHya). For the purpose of the creation of a new functional polysaccharide, we introduced a sulfate group in hyaluronan (Hya) of high molecular weight, and SHya of high molecular weight could be obtained for the first time. When rat calvarial osteoblast (rOB) cells were cultured with a high concentration of SHya, they formed aggregated spheroids after 4h and the spheroids grew to about 200microm after 24h. We examined the expression of cell adhesion molecules in order to clarify the mechanism of aggregate formation. The N-cadherin (N-cad) and Connexin43 (Cx43) expression level of rOB cells cultured with SHya remarkably increased after 2h. A difference in the expression of Integrin beta1 (Intbeta1) could not be observed between the SHya addition and control group. The alkaline phosphatase (ALPase) activity of rOB cells cultured with SHya after 8h was significantly enhanced in comparison with control. Therefore, the sulfate group of SHya seems to enhance expression of cell adhesion protein such as N-cad and Cx43, resulting in aggregate formation and further remarkable induction of the ALPase activity of rOB cells.

Ulnar-styloid nonunion and partial rupture of extensor carpi ulnaris tendon: two case reports and review of the literature.

Two unusual cases of symptomatic partial rupture of the extensor carpi ulnaris tendon associated with ulnar-styloid nonunion are described. Intraoperative findings suggested that the jagged surface of the distal ulna was the cause of flaying. In one case, debridement of the frayed extensor carpi ulnaris tendon and fixation of the ulnar styloid were effective for the relief of symptoms. But after the same procedure in another case, osteosynthesis of the ulnar-styloid could not be attained and tenodesis of the extensor carpi ulnaris tendon to the ulnar head was needed. Partial rupture of the ECU tendon should be taken into account in the differential diagnosis of a patient with ulnar wrist pain after ulnar-styloid fracture.

Mechanism of limitation of pronation/supination of the forearm in geometric models of deformities of the forearm bones.

OBJECTIVE: To clarify the mechanism of limitation of pronation/supination of the forearm associated with the angular deformity of the forearm bones and narrowing of the interosseous space. DESIGN: A three-dimensional geometric model of the forearm bones with the interosseous membrane and its axial section were used. BACKGROUND: Limitation of pronation/supination associated with the deformity of the forearm bones is one of the significant problems encountered in the treatment of the forearm fracture. Elucidation of its mechanism is important for its prevention and treatment. METHODS: In the axial section, the effects of the positional relationship between the axis of pronation/supination and the forearm bones on the range of pronation/supination was studied using analytic geometry in each model with non-narrowing or narrowing of the interosseous space. Subsequently, in the three-dimensional model each forearm bone with the same angular deformity, the direction and magnitude of the angular deformity which would lead to limitation of pronation/supination were calculated using analytic geometry. Each parameter of the models was obtained by the radiographic measurements of the normal forearms. RESULTS: When the axis of the pronation/supination passed through the interosseous region (less than 2 cm radioulnarly and 0.8 cm anteroposteriorly) in the model of the axial section without narrowing of the interosseous space, more than 40 degrees of pronation and supination were possible. When the axis deviated from this region, significant loss of pronation/supination was observed associated with restriction by the interosseous membrane rather than impingement. Furthermore, the area of this region decreased according to narrowing of the interosseous space with shortening of the interosseous membrane. In the three-dimensional model, the direction and magnitude of the angular deformity which would lead to significant loss of pronation/supination was more than 14 degrees radially, 7 degrees ulnarly, 5 degrees anteriorly, 4 degrees posteriorly. CONCLUSIONS: The positional relationship between the axis of pronation/supination and the forearm bones with the interosseous membrane may play an important role regarding pronation/supination of the forearm. RELEVANCE: Evaluation of the bone deformities based on understanding this mechanism of limitation of pronation/supination would lead to an appropriate treatment of malunion of the forearm bones.

Diagnosis of thoracic outlet syndrome by magnetic stimulation of the brachial plexus.

The abductor pollicis brevis (APB) and abductor digiti minimi (ADM) compound muscle action potential (CMAP) latencies, and median and ulnar motor conduction velocities (MCVs), obtained by magnetic stimulation of the brachial plexus, were evaluated for the diagnosis of thoracic outlet syndrome (TOS). These measurements were compared in three groups of limbs: (1) the symptomatic limbs of patients with TOS (symptomatic group), (2) the asymptomatic con-tralateral limbs of these patients (asymptomatic group), and (3) the limbs of healthy control subjects (control group). Although no significant differences were observed in MCVs among the three groups, the APB CMAP latency in the sym-ptomatic group (12.0 +/- 1.2 ms) was significantly prolonged compared with that in the control group (10.4 +/- 0.64 ms; P < 0.01), and the ADM CMAP latency in the symptomatic group (11.0 +/- 0.82 ms) was also significantly prolonged compared with that in the control group (10.1 +/- 0.59 ms; P < 0.01). The possibility is suggested that the evaluation of APB and ADM CMAP latencies by magnetic stimulation of the brachial plexus may be helpful for the diagnosis of TOS.

Osteochondral fracture of the triquetrum: a case report.

A case of osteochondral fracture of the triquetrum associated with pisiform subluxation in a 21-year-old woman is described. The fracture was diagnosed by tomography and magnetic resonance imaging. We consider that the fracture resulted from shear force produced by the pisiform subluxation. Excision of the pisiform provided complete relief of pain and a good functional result.