Synovial Cyst of the Little Finger Originating From a Degenerative Wrist Joint.

A 67-year-old woman had a painless tumor in the pulp of her left little finger, which was diagnosed as a synovial cyst. She underwent 2 surgeries to remove the cyst; however, she had a third recurrence. Magnetic resonance imaging revealed that the cyst originated from the flexor tenosynovitis associated with degenerative arthritis of the distal radioulnar joint and pisotriquetral joint. We performed flexor tenosynovectomy and a salvage procedure for the degenerative wrist joint with a Sauve-Kapandji procedure for distal radioulnar joint osteoarthritis and pisiformectomy for pisotriquetral joint arthritis. One year after surgery, the synovial cyst had not recurred, and the functional outcomes of the wrist joint were good. Flexor tenosynovectomy and concurrent joint salvage procedure may be good treatment choices for synovial cysts originating from the flexor tenosynovitis associated with a degenerative wrist joint.

Mallet Finger Fracture through Enchondroma of the Distal Phalanx.

A 46-year-old man injured his ring finger and developed a mallet deformity. Radiographs showed a mallet finger fracture through an osteolytic lesion of the distal phalanx. Magnetic resonance imaging showed low intensity on T1-weighted imaging and high intensity on T2-weighted imaging, which suggested the clinical diagnosis of enchondroma. The bone tumor was excised, and osteosynthesis was performed using Ishiguro's extension block pinning, and a flexion block pin was added to prevent flexor tendon avulsion fracture through the enchondroma, followed by an autologous iliac cancellous bone graft. One year after surgery, the patient had no pain or extension lag of the affected ring finger, and his quickDASH score was 0 points. Radiographs showed no recurrence and minimal arthritic change of the distal interphalangeal joint. One-stage treatment of a mallet finger fracture through an enchondroma using Ishiguro's method was effective.

Ulnar Subluxation of the Extensor Pollicis Longus Tendon as a Cause of Congenital Clasped Thumb: A Case Report.

A 15-year-old male patient presented with difficulty extending his right thumb due to subluxation of the extensor pollicis longus (EPL) tendon. Physical examination showed that active motion of the thumb's metacarpophalangeal (MP) joint was 76° in flexion and -58° in extension. During active extension, the EPL tendon shifted onto the ulnar aspect of the MP joint, and the extensor pollicis brevis (EPB) tendon shifted onto the central dorsal course of the MP joint. After repositioning by adducting the thumb into the palm to extend the MP joint (dynamic tenodesis effect), active extension of the MP joint increased to -12°. Corrective surgery was performed under local anesthesia and radial sensory nerve block. Following plication of the attenuated dorsal capsule and sagittal band between the EPB and EPL, we confirmed that the patient could flex and extend the thumb smoothly. One year postoperatively, the extension deficit of the MP joint had not recurred.

Insufficiency Fracture of the Radial Diaphysis Following a Sauve-Kapandji Procedure for Osteoarthritis of the Distal Radioulnar Joint: A Case Report.

The Sauve-Kapandji (SK) procedure for distal radioulnar joint osteoarthritis have complications including pain over the proximal ulnar stump, nonunion of the fused distal radioulnar joint, and less frequently, insufficiency fracture of the distal radius. We report a case of insufficiency fracture of the radial diaphysis as a rare complication of the SK procedure.

Complications of Intramedullary Fixation for Distal Radius Fractures in Elderly Patients: A Retrospective Analysis Using McKay's Complication Checklist.

BACKGROUND: Intramedullary fixation for distal radius fractures is reported to be free of hardware irritation and less invasive than other fixation methods. Some specific complications associated with intramedullary fixation, such as radial nerve sensory neuritis, have been reported, but no study has focused on the complication rates of intramedullary fixation for distal radius fractures in the elderly population. Furthermore, no studies have analyzed common complications, such as carpal tunnel syndrome and flexor tenosynovitis including trigger finger, among patients with distal radius fractures treated by intramedullary fixation based on a comprehensive complication checklist. METHODS: We reviewed the medical records of 52 elderly patients with distal radius fractures treated with intramedullary nail fixation. We investigated the postoperative complications in these patients using McKay's complication checklist. RESULTS: 5 patients experienced radial nerve sensory disorder, and one patients developed carpal tunnel syndrome. All neurological symptoms resolved spontaneously, and these neurological complications were categorized as mild. Further, 3 patients developed trigger finger at the A1 pulley and needed triamcinolone injections for symptomatic relief. There were no tendinous complications around the implanted hardware. All tendinous complications were categorized as moderate complications and resolved with steroid injection therapy. Among skeletal complications, 1 case of postoperative volar displacement resolved with good functional outcome without the need for corrective osteotomy. This was considered a mild complication. The total complication rate was 19.2%. All complications were categorized as mild or moderate, and no patients experienced severe complications that needed further surgery such as hardware removal. CONCLUSIONS: Intramedullary fixation for distal radius fractures was free from tendinous complications such as tenosynovitis and tendon ruptures around the implant, which are frequently caused by volar locking plate fixation. However, this less invasive technique could not avoid common complications such as trigger finger and carpal tunnel syndrome associated with distal radius fractures.

Carpal Tunnel Syndrome and Trigger Wrist Caused by Localized Amyloidosis: A Case Report.

We report a case of carpal tunnel syndrome and trigger wrist caused by localized amyloidosis. A 37-year-old man, who worked as a manufacturer, presented with a 5-month history of tingling sensation in the three radial fingers of the left hand and a painful click at the volar aspect of the wrist during digital motion. We divided the transverse carpal ligament and detected diffuse tenosynovitis that was especially severe around the flexor digitorum profundus tendons. Histological findings led to a diagnosis of amyloidosis. Localized amyloidosis could thus be a cause of trigger wrist. Systemic amyloidosis may develop in patients with localized amyloidosis; therefore, patients with trigger wrist caused by flexor tenosynovitis should be investigated for the existence of localized amyloidosis, with biopsy of the flexor tenosynovium.

Intramedullary Nail Fixation for Displaced and Unstable Distal Radial Fractures in Patients Aged 65 Years or Older.

BACKGROUND: Distal radius fractures in elderly patients are now commonly treated with a volar locking plate, but flexor pollicis longus dysfunction caused by stripping of the muscle and tendon irritation and rupture caused by prominence of the implant have been reported. Intramedullary implants can stabilize distal radius fractures while minimally affecting the flexor and extensor tendons and muscles around the site, but osteoporosis in elderly patients might affect the radiographic and functional results of distal radius fractures treated by intramedullary implants. We investigated the radiographic and functional results of intramedullary implants for distal radius fractures in patients ≥65 years of age. METHODS: We reviewed medical records of 40 patients with extra-articular or simple intra-articular fractures with the sagittal fracture line treated by an intramedullary implant. RESULTS: All fractures achieved bony union, with an average radial inclination of 24.9 degrees, volar tilt of 9.2 degrees, and ulnar variance of 0.7 mm. We encountered one case of postoperative volar displacement of the distal fragment due to the small size of the intramedullary implant. The average range of motion was 69.8 and 59.9 degrees for dorsal and palmar wrist flexion, respectively. Average percentile grip strength of the uninjured side was 97%. The average Mayo modified wrist score at final follow-up was 91.9 points, with 20 patients graded as excellent, 16 as good, and 4 as fair. CONCLUSIONS: The findings of this study indicate that intramedullary implants for dorsally displaced extra-articular or simple intraarticular distal radius fractures may offer good radiological and functional outcomes without hardware irritation in elderly patients. Distal radius fractures with an osteoporotic, large medullary canal should be stabilized by implants of an appropriate size.

Flexor tendon rupture of the little finger caused by calcium pyrophosphate dihydrate crystal deposition disease of the pisotriquetrum joint.

We report a case of closed rupture of the flexor tendons of the little finger caused by calcium pyrophosphate dihydrate crystal deposition disease of the pisotriquetrum joint. The patient could not flex the little finger and did not have wrist pain. Plain radiographs of the affected wrist joint showed severe arthritic changes of the pisotriquetrum joint and calcification around the joint. At operation, the pisotriquetrum joint capsule was ruptured and involved the flexor tendon of the little finger. The distal stump of the flexor tendon was transferred to the flexor tendon of the ring finger, and the pisiform was resected. Histological examination with polarized light microscopy revealed crystals showing weakly positive birefringence in the calcification.