Correction of long standing proximal interphalangeal flexion contractures with cross finger flaps and vigorous postoperative exercises.

PURPOSE: We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. MATERIALS AND METHODS: In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean followup period was 41.2 months. RESULTS: The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8 degrees to 8.4/95.4 degrees at the last follow-up. A mean of 19.5 degrees of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4 degrees. Near full ROM was achieved in 3 cases. There were no major complications. CONCLUSION: In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

Solitary intra-articular osteochondroma of the finger.

BACKGROUND: A solitary osteochondroma of the finger occasionally occurs intra-articularly and may cause clinical symptoms, including limited motion and deformity. The present report describes the clinical features and the results of operative treatment for a series of patients who had a solitary intra-articular osteochondroma of the finger. METHODS: Ten patients with a solitary intra-articular osteochondroma of a phalanx of a finger were managed surgically. Eight patients were male, and two were female. The average age at the time of surgery was fourteen years. Treatment consisted of mass excision for three patients and mass excision with corrective osteotomy for six. One additional patient had a boutonniere deformity and underwent extensor tendon reconstruction combined with mass excision. The average duration of follow-up was forty-four months. RESULTS: The proximal phalanx was affected in six patients, and the middle phalanx was affected in four. All tumors involved the distal epiphysis. All patients had postoperative improvement in terms of deformity and/or limitation of motion. Six patients had a preoperative mean coronal plane deformity of 29 degrees, which improved to 4 degrees after surgery. The preoperative mean arc of flexion-extension improved from 54 degrees to 78 degrees in four patients who had a motion deficit at the proximal interphalangeal joint and from 60 degrees to 80 degrees in one patient who had a motion deficit at the distal interphalangeal joint. Two patients had a residual flexion contracture, one with preexisting osteoarthritis and one with a longstanding progressive boutonniere deformity. There were no other complications or recurrences. CONCLUSIONS: Isolated intra-articular osteochondroma of the finger can cause deformity and/or motion limitation. Early mass excision and corrective osteotomy when indicated are recommended to restore full range of motion and to prevent osteoarthritis and secondary deformity.

Decompression of the ulnar nerve and minimal medial epicondylectomy with a small incision for cubital tunnel syndrome: comparison with anterior subcutaneous transposition of the nerve.

UNLABELLED: The objective of this study is to compare the results of ulnar nerve decompression and minimal medial epicondylectomy with a small incision (group I) and anterior subcutaneous transposition of the ulnar nerve (group II) for cubital tunnel syndrome. METHODS: Out of 56 patients with cubital tunnel syndrome, 29 were in group I and 27 were in group II. The mean age at the time of the operation was 48.9 years, and the mean follow-up period was 36.4 months. Preoperatively, the neuropathy was graded according to Dellon's criteria. RESULTS: There were no significant differences between the results of the two groups according to the modified Bishop's system at the last follow-up. However, four patients showed painful neuroma around the operation scar and one patient in group II had experienced acute deterioration of the symptoms after the procedure. CONCLUSIONS: Decompression and minimal medial epicondylectomy with a small incision seems to be more recommendable than anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome in terms of its simplicity and lesser invasiveness.

Radiographic changes and clinical results of osteochondral defects of the talus with and without subchondral cysts.

BACKGROUND: Subchondral cysts are a type of osteochondral defect of the talus and can be a source of chronic ankle pain. The treatment modality of this cystic lesion is similar to that of other osteochondral defects, but results from previous reports are controversial. Therefore, we compared the clinical results and radiographic changes in small subchondral talar cystic lesions (less than 1.5 cm2) to other noncystic defects after arthroscopic operations without bone grafting. METHODS: The review covered about 2 years (January, 2001 to April, 2003) and included 38 patients with an average age of 36.9 years. Followup ranged from 24 to 36 months. Arthroscopic microfracture or abrasion arthroplasty was performed on 20 defects with subchondral cysts and 18 defects without cysts. Clinical results were assessed by the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS); radiographic changes were assessed by the transverse long diameter and the area (mm2) of the cyst on digital radiographs using a PACS (Picture Archiving Communication System). RESULTS: At the last followup, AOFAS clinical scores improved similarly in cystic and noncystic defects. The average diameter of the cysts decreased from 8 +/- 2 mm to 6 +/- 2 mm (p < 0.01). The area attributed to the cyst also decreased, from 49 +/- 17 mm2 (24 to 84 mm2) to 23 +/- 8 mm2 (4 to 34 mm2) (p < 0.01). There were no differences in the clinical results between the cystic and noncystic defects. CONCLUSIONS: Good clinical and radiographic results were obtained after arthroscopic treatment of osteochondral defects with a small subchondral cyst. Our results suggest that a small cystic lesion can be treated by arthroscopic microfracture or abrasion arthroplasty and that the existence of a small cyst in an osteochondral defect lesion may not affect the postoperative prognosis.

Palmar divergent dislocation of scaphoid and lunate.

A 28-year-old man presented with a palmar divergent dislocation of the scaphoid and lunate. He was treated with an open reduction and an internal fixation with two Kirschner's wires after the 25th day of trauma due to a neurological injury. The results were satisfactory after 18 months follow up without any evidence of avascular necrosis and traumatic arthritis of the scaphoid and lunate. The patient had no limitation in motion or intermittent wrist pain. We reported this case with a brief review of relevant literatures.

Operative treatment for isolated distal ulnar shaft fracture.

This study retrospectively evaluated the effectiveness of an open reduction and internal fixation of a tension band wiring technique for treating displaced or unstable comminuted distal ulnar shaft fractures without a radial fracture. Ten patients were treated for an isolated distal ulnar shaft fracture. There were 6 cases of a fracture 2.5 cm below the lower end of the ulna, and 4 cases with the fracture being 2.5 cm to 5 cm away from the lower end of the ulna. The authors classified the fractures of the distal ulnar into 3 types: a type I-simple fracture, a type II-comminuted fracture without a distal radioulnar joint (DRUJ) involvement, and a type III- comminuted fracture with DRUJ involvement. There were 3 cases of a type I fracture, 4 of type II and 3 of type III. The open reduction and internal fixation using tension band wiring were performed in 10 of these cases. After the operation, the wrist was placed in a cast for six weeks before active movement was allowed. The clinical results were excellent in 7 cases, good in 2 and poor in 1. In conclusion, tension band wiring surgery is recommended for treating an isolated distal ulnar with unreduced displaced fractures, in a comminuted fracture that cannot be maintained by a closed reduction and when there is the potential encroachment of fracture fragments in the DRUJ.