Volar locking plate fixation versus external fixation of distal radius fractures: a meta-analysis.

This meta-analysis evaluates reported outcomes of volar locking plates versus external fixation for management of distal radius fractures. A comprehensive literature search was carried out using PubMed, embase, MEDLINE, and the Cochrane Library. Multiple outcomes were analysed: study characteristics, objective/subjective outcome measures, radiographic parameters, and complication rates. Nine studies containing 780 participants met the outlined inclusion criteria. Disabilities of the arm, shoulder, and hand scores significantly favoured volar locking plates, but only at 3 months was the difference clinically meaningful. Grip strength, extension, and supination were better in the volar locking plates group in the early post-operative period, but were similar at 12 months. Ulnar variance was better restored by volar locking plates. The volar locking plates group was associated with higher re-operation rate, and the external fixation group had a higher infection rate. Current literature suggests that volar locking plates can provide better subjective scores and radiographic parameters, especially in the first 3 months, but may be associated with a higher re-operation rate.

Rerouting extensor pollicis longus tendon transfer.

Following radial nerve palsy, loss of the extensor pollicis longus (EPL), abductor pollicis longus and extensor pollicis brevis tendons results in loss of thumb extension and radial abduction. Multiple tendon transfers are described to address the loss of thumb extension following radial palsy utilizing the palmaris longus or flexor digitorum sublimis transferred to the EPL tendon. Owing to its ulnar vector of pull, the EPL tendon is a secondary adductor of the thumb, and in order to mitigate the tendency for thumb adduction, the EPL tendon is divided at the wrist and brought subcutaneously to the radial side of the wrist for repair to the donor tendon to improve the line of pull for the donor tendon. We describe the use of a technique to reroute the EPL tendon through the first compartment in a retrograde fashion prior to repair with the donor tendon on the radial side of the wrist. The use of the first dorsal compartment provides a pulley to maintain the position of the transfer and to prevent potential bowstringing of the tendon as wrist flexion and thumb extension are attempted. because the repair is performed proximal to the extensor retinaculum, the donor tendon length is not compromised. Because the tendon is redirected through the first dorsal compartment and inserts into the distal phalanx, a single transfer attempts to restores both thumb extension and radial abduction.

Large solitary glomus tumor of the wrist involving the radial artery.

Glomus tumors are neuromyoarterial glomus body neoplasms that most commonly occur in the subungual areas of the hand. These tumors typically present as painful solitary lesions with localized tenderness. Extradigital glomus tumors are rare and difficult to diagnose because of their varying symptoms and presentation. Misdiagnosis can result in significant chronic pain, disuse syndromes, and disability over prolonged periods. Timely diagnosis and surgical resection are generally curative with complete resolution of symptoms. Surgeons should be aware of this rare condition and consider it in the differential diagnosis when treating a painful soft-tissue mass of the wrist. We report a case of a large solitary glomus tumor that occurred on the volar-radial aspect of the wrist and involved the radial artery. The patient was successfully treated with complete surgical excision of the tumor. There were no symptoms or recurrence at 3-year follow-up. In the literature, this is the first case of large atypical wrist glomus tumor involving the radial artery to be reported with corresponding magnetic resonance imaging, intraoperative, histology, and immunohistochemistry findings.

Late reconstruction of ulnar nerve palsy.

Ulnar nerve palsy results in significant loss of sensation and profound weakness, leading to a dysfunctional hand. Typical clinical findings include loss of key pinch, clawing, loss of normal flexion sequence of the digits, loss of the metacarpal arch, and abduction of the small finger. Further deficits in hand/wrist function are seen in high-level ulnar nerve palsy, including loss of ring- and small-finger distal interphalangeal flexion, decreased wrist flexion, and loss of dorsal sensory innervation. This article reviews the clinical findings seen in low and high ulnar nerve palsies, and reviews surgical options for correcting certain motor and sensory deficits.

Epiphyseal bar resection and fat interposition for clinodactyly.

Clinodactyly, the angulation of a digit in the anteroposterior plane, is often due to a longitudinal epiphyseal bracket on the radial side of the middle phalanx of the little finger. Treatment options include observation, osteotomy, and epiphyseal bar resection. Epiphyseal bar resection is a simple surgery that requires neither postoperative pin fixation nor immobilization. The most appropriate indications are in children 3 to 6 years old with radial deviation of at least 25 degrees. The procedure reliably diminishes the extent of deformity.

Metacarpal osteotomy for correction of acquired phalangeal rotational deformity.

Symptomatic phalangeal rotation deformities require corrective osteotomy. Surgery at the phalangeal level is technically demanding and has a higher complication rate. We describe the surgical technique of metacarpal base osteotomy for rotation correction of the digit. This technique is simple, allows early rehabilitation, and has a lower complication rate.

Brodie's abscess of the distal radius: an unusual complication after percutaneous pinning.

We report a case of Brodie's abscess of the distal radius that presented 4 years after closed reduction and percutaneous pinning for a closed distal radius fracture. This condition has not been previously reported in the adult distal radius and we detail the clinical features and imaging findings. We also present a new way of management of Brodie's abscess using injectable bone substitute along with adjunctive parenteral antibiotic therapy.

Idiopathic avascular necrosis of the metacarpal head.

Avascular necrosis of the metacarpal head is a rare condition. Although the condition is associated with trauma, systemic lupus erythematosus, and steroid use, it can occur spontaneously without any obvious cause. Any metacarpal may be affected and the pathologic changes are similar to those described in other bones such as the femur. The diagnosis requires an index of suspicion in a young patient with spontaneous onset of symptoms localized to a metacarpophalangeal joint. Magnetic resonance imaging is a useful early diagnostic tool when the radiographic findings are nonspecific or absent. The natural history of the condition is not known. Although symptoms may resolve with nonoperative treatment, progressive collapse of the metacarpal head and subsequent degenerative arthritis is a possible long-term outcome. Curettage of the lesion and supplementary cancellous bone grafting has been reported to provide symptomatic relief in cases resistant to nonoperative treatment. A case is presented of idiopathic avascular necrosis of the head of the dominant ring finger metacarpal in a 27-year-old woman. The purpose of this report is to highlight the clinical presentation, radiographic features, pathologic findings, and outcome at 2 years after curettage and bone grafting.