Pedicled adipose tissue for treatment of chronic digital osteomyelitis.

PURPOSE: To describe a surgical technique (pedicled vascularized tissue transfer) for treating chronic digital osteomyelitis. METHODS: Adipose tissue was obtained at the level of the proximal phalanx based on anterograde or retrograde flow. After bone debridement, we inserted the vascularized adipose tissue into the dead space. Eight patients were treated with this procedure from 2009 to 2012. One patient had chronic osteomyelitis in the thumb, 4 in the index finger, 2 in the middle finger, and 1 in the ring finger. Foci of chronic osteomyelitis were located at the distal phalanx in 2 patients, at the distal to middle phalanx across the distal interphalangeal joint in 4, at the middle phalanx in 1, and at the proximal phalanx in 1. Mean duration of follow-up was 41 months. We assessed the efficacy of the technique by clinical symptoms and imaging. RESULTS: We used retrograde pedicled adipose tissue transfer in 7 patients and anterograde pedicled adipose tissue transfer in 1. The pedicled adipose tissue was successfully transferred from the digit tip to its base. The postoperative courses were uneventful; no additional treatments were required. Postoperative physical data and follow-up images showed no evidence of chronic osteomyelitis. No functional loss was caused by procuring vascularized adipose tissue from the digits. CONCLUSIONS: Pedicled vascularized tissue transfer based on the digital artery was a reliable and reproducible technique. We recommend it as a treatment option for chronic digital osteomyelitis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The free true perforator flap.

Many reports about free perforator flaps have been published. Among them, the free true perforator flap (classified by Koshima) is the least invasive flap because the main vessels in both donor and recipient sites are preserved. Two cases of reconstruction with free true perforator flaps in the hand and forearm region are reported. This is the first report of free true perforator flaps.

Palmar plating for AO/ASIF C3.2 fractures of the distal radius with arthroscopically assisted reduction.

We performed a retrospective study of 15 patients with AO/ASIF C3.2 fracture of the distal radius. All patients were treated with arthroscopically assisted reduction of the radiocarpal joint followed by palmar plating with autologous bone graft, with a follow-up evaluation of 24 months. According to the demerit point system of Gartland and Werley, five patients had excellent results and 10 had good results. Grade 1 arthritic changes were found in 10 patients even though with no step-off on radiographs. In the current study, this combined treatment was challenging and useful for AO/ASIF C3.2 fractures.

Palmar plating system for Colles' fractures--a preliminary report.

PURPOSE: To present our results of the palmar plating system that we developed for the treatment of Colles' fractures. METHODS: By using the palmar plating system that we developed a consecutive series of 40 acute Colles' fractures were treated surgically. There were 12 men and 28 women with a mean age of 57 years at the time of the injury (range, 25-90 y). All patients had internal fixation using the trans-flexor carpi radialis tendon approach. The system has 3 main features. First, the plate is small in size, being 1.1 mm in thickness and 47 mm in length. Only a 3- to 4-cm skin incision is required for application of the plate. Second, the screw is cannulated and cancellous in type, with a low-profile head. Subchondral screw fixation is achieved both easily and safely by using a guidewire. Third, the plate has a window through which injectable bone cement can be placed. RESULTS: Union was achieved in all patients. The palmar tilt, radial inclination, radial length, and ulnar variance were maintained after surgery. According to the Gartland and Werley rating scale that was modified by Sarmiento there were 12 excellent and 28 good results. There were no extensor tendon injuries that could occur when the dorsal approach was used. CONCLUSIONS: This palmar plating system can make fixation of the distal radius easy, safe, and effective in the treatment of unstable Colles' fractures.

Paediatric Galeazzi-equivalent fracture: two case reports.

The authors present two rare cases of a paediatric Galeazzi-equivalent fracture. In contrast to Galeazzi's fracture-dislocation in adults, an epiphyseal separation of the distal ulna occurred instead of dislocation of the distal radioulnar joint (DRUJ) or both. A precise radiographic analysis of the epiphyseal separation of the distal ulna and its anatomical reduction were keys to obtaining a good result in the treatment of paediatric Galeazzi-equivalent fracture.

Glomangioma arising from the superficial palmar arch in the hand: case report.

A patient presented with a glomangioma that presented as an aneurysm of the superficial palmar arch. Throbbing pain, tenderness over the tumor, and cold intolerance were clinical features. Cold intolerance was the major problem. The pathologic diagnosis was glomangioma. Excision of the tumor provided a good result and there has been no recurrence.

Palmar plating with calcium phosphate bone cement for unstable Colles' fractures.

A prospective study was done in 20 patients with unstable Colles' fractures with metaphyseal bone defects and who were treated with palmar plating combined with injectable calcium phosphate bone cement. The patients were three men and 17 women with a mean age of 69 years (range, 65-86 years) at the time of the injury. The followup after the operation ranged from 6 to 24 months (mean, 12 months). Union was gained in all the patients. The records of radiographic parameters, including the palmar tilting angle, radial inclination, radial length, and ulnar variance had been maintained since the surgery. According to the rating scale of Gartland and Werley, 16 patients had excellent results and four had good results. There were no neurovascular and tendon injuries as complications.

Galeazzi-equivalent lesions in adolescence.

Two cases of a Galeazzi-equivalent lesion in adolescence are described. Accurate diagnosis of the epiphyseal injury of the distal ulna, rigid fixation of the distal radius, and stabilization of the distal radioulnar joint are keys in obtaining a good result in the treatment of Galeazzi-equivalent lesion in adolescence.

Palmar plating for dorsally displaced fractures of the distal radius.

Extensor tendon rupture and irritation caused by implants or surgical intervention are serious complications in the treatment of fracture of the distal radius when a dorsal approach is used. To prevent complications, the dorsally displaced fracture of the distal radius was treated using a palmar approach. The subjects were 18 men and 15 women with a mean age of 54 years at the time of the injury (range, 23-75 years). All the patients had internal fixation with a plate and screws using the palmar approach. Union was achieved in all patients. Radiographic parameters, including the palmar tilt, radial inclination, radial length, and ulnar variance have been maintained since the operation. According to the rating scale of Gartland and Werley, there were 12 excellent, 20 good, and one fair result. There were no extensor tendon injuries that occurred during use of the palmar approach in this small series of patients. Palmar plating can be safe and effective for treatment of a dorsally displaced fracture of the distal radius.

Irreducible dorsal subluxation of the first metatarsophalangeal joint: a case report.

We report a case of dorsal subluxation of the first metatarsophalangeal joint without dislocation of the sesamoids or destruction of the sesamoid complex. Closed reduction was unsuccessful. At surgery, the subluxation was found to be associated with locking of the abductor hallucis tendon onto the medial condyle of the metatarsal. After restoration of the tendon to its normal anatomic alignment, the joint was successfully reduced. One year after the injury, the patient was asymptomatic and had full range of motion of the metatarsophalangeal joint.