Role of the interosseous membrane in post-traumatic forearm instability: instructional review.

PURPOSE: In the last two decades, a strong interest on the interosseous membrane (IOM) has developed. METHODS: The authors present a review of the new concepts regarding the understanding of forearm physiology and pathology, with current trends in the surgical management of these rare and debilitating injuries. RESULTS: Anatomical and biomechanical studies have clarified the anatomy of forearm constrains and their role in forearm longitudinal and transverse stability. The radial pull test, a new intraoperative test, has been developed that might increase the detection on IOM injuries. The forearm is now considered a "functional unit" and, consequently, a new classification has been proposed. Uncommon variants and rare patterns of forearm fracture dislocations have been reported in the literature and could not be classified to those commonly referred to using eponyms (Monteggia, Galeazzi, Essex-Lopresti). The new Artiaco et al. classification includes all injury patterns, thus avoids confusion in the nomenclature, and helps surgeon with detection of lesions and guiding surgical treatment. CONCLUSION: Based on the new classification and after current literature review, authors propose a management flowchart for treatment of forearm instability injuries.

Papillary Endothelial Hyperplasia (Masson Tumor) of the Hand. Surgical and Pathological Consideration from Seven Cases Using New Vascular Markers.

Although papillary endothelial hyperplasia may occur at almost any site, one of the most common sites is the hand. It is generally regarded as a reactive vascular proliferation i.e. exuberant form of organizing thrombus. Diagnosis of Masson tumor can be challenging due to its close clinical, radiological and even histopathological resemblance to angiosarcoma. We present seven cases of Masson tumor of the hand; wanting to reveal its nature using new vascular markers and discuss the treatment options and expected outcomes, present clinical and radiological features that may aid diagnosis and also offer treatment plans. A multicenter retrospective study was performed between January 2014 and November 2019. Immunohistochemical stains of Glut1, WT1, ERG, CD31 and alpha smooth muscle actin (ASMA) were performed on each cases. We found seven cases during the examined period. 4 out of 7 cases were women. All lesions occurred in the hands. 3 out of 7 cases appeared in a previously present vascular malformation. All cases were treated with surgical excision and the diagnosis of papillary endothelial hyperplasia was made by histology. Pre-operative testing (radiograph/MRI/US/fine needle aspiration biopsy) did not suggest the diagnosis of Masson tumor; however, aspiration cytology could rule out malignancy. The proliferative endothelial cells proved to be Glut1 negative and WT1 positive and the accompanying pericytic cells were ASMA positive in all cases. Though Masson tumor is a rare vascular lesion in the hand among other vascular tumors, it should be considered in the differential diagnostics even in the case of previously existing vascular malformation. WT1 positivity of the endothelial cells and the accompanying pericytic cells raises the question whether the initially reactive endothelial proliferation may transform into a true benign vascular tumor.

[Treatment of De Quervain's tendinopathy with conservative methods]. / A De Quervain-féle tendinopathia kezelése konzervatív módszerekkel.

Introduction: De Quervain's tendinopathy affects the region of the wrist and the hand. Thumb motion becomes painful. This illness is caused by a degenerative process rather than inflammation. Primary treatment methods are splinting, taking non-steroid anti-inflammatory drugs and different physical therapeutic modalities, administration of a steroid injection into the tendon sheath or surgical release of the tendon sheath may be performed. Aim: The aim of the present study was to investigate whether conservative treatment complemented by eccentric training could provide an adequate alternative to the currently accepted treatment options. Method: The eccentric training lasted for 8 weeks (if necessary for 12 weeks). Following the introduction to exercises, patients (n = 9) repeated the training several times a day, which was controlled during weekly meetings. At the 1st, 8th and 12th meetings, inspection and the following measurements were performed: range of motion, muscle strength, evaluation and number of painful regions including the completion of patient questionnaires. Data were analysed with paired samples t-tests and repeated measures ANOVA. IBM SPSS Statistics 25.0 and Microsoft Office Excel Professional Plus 2016 programs were used. Results were regarded significant at level of p<0.05. Results: Significant improvements were found in the intensity of pain (Numeric Pain Rating Scale p = 0.005, n = 9) and in the functionality of the hand and wrist (Quick Disabilities of the Arm, Shoulder and Hand questionnaire part 1. p<0.001, part 2. p<0.001, Patient-Rated Wrist Evaluation questionnaire p<0.001; n = 9). Conclusion: With careful patient selection, conservative treatment complemented by eccentric training could be an alternative to current treatment options. Orv Hetil. 2020; 161(11): 419-424.

[Osteoid osteoma of the hand - Diagnostics and operative treatment]. / A kéz osteoid osteomáinak kivizsgálása és mutéti ellátása.

Introduction: Osteoid osteoma is a rare benign bone tumor displaying typical clinical symptoms and radiological signs in most cases. Characteristic symptoms are nocturnal pain alleviated by non-steroid antiinflammatory drugs. Radiological findings are also characteristic, the central osteolytic 'nidus' is surrounded by reactive sclerosis. These lesions are rare in the hand, typical symptoms may be absent, furthermore, atypical symptoms may occur. Characteristic radiographic signs may also be missing. Therefore, diagnosis may prove difficult. In the case of radiological/clinical suspicion, HRCT (high-resolution CT) is recommended. Aim: Our aim is to summarize the pathophysiology, occurrence and clinical features of these lesions and also the difficulties that accompany diagnosis on the hand. Treatment options will also be discussed. Method: Retrospective analysis was performed at Semmelweis University, Department of Orthopedics, between March 2014 and December 2018. Inclusion criteria were: patients who had undergone treatment for osteoid osteoma during this period. Data from the 6 patients who have undergone open surgery for osteoid osteoma of the hand will be presented as case reports. Results: During this period, a total of 112 patients were treated for osteoid osteoma at our Department, 8 lesions were found on the hand (7%). Among the cases presenting on the hand, typical nocturnal pain was absent in 3 cases, and in 1 case the pain did not respond to non-steroid antiinflammatory drugs. Open surgery and curettage was performed in 6 cases with good results. Conclusion: Osteoid osteoma on the hand is rare, typical symptoms may be missing, and atypical symptoms may occur. Radiographic findings may be nondescript, HRCT is recommended in the case of clinical suspicion. Performing radiofrequency ablation for osteoid osteoma of the hand may pose difficulties, curettage is the gold standard of treatment. Curettage alleviates symptoms well. Orv Hetil. 2020; 161(7): 263-268.