Results of the Use of Bioabsorbable Magnesium Screws for Surgical Treatment of Mason Type II Radial Head Fractures.

Background: In Mason classification type II radial head fractures, compared to plate fixation, fixation with cannulated headless screws and absorbable pins has been reported to provide more favorable postoperative outcomes, including less postoperative limitation in range of motion. The fact that radial head fractures are less prone to weight-bearing during fracture union further supports the use of absorbable screws as a suitable alternative treatment option in radial head fractures. This study aimed to perform fixation through open reduction using bioabsorbable magnesium screws for Mason type II radial head fractures and to report radiographic and clinical results. Methods: Among patients who visited the orthopedic department from April 2017 to August 2021, 22 with surgical indications were selected for participation. Radiographic tests were conducted at 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and over 1 year after surgery to confirm the degree of bone union, reduction loss, and degree of H2 gas production. The Disabilities of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), hand grip power, and range of joint motion were measured at the 6-month follow-up to evaluate the clinical efficacy of the operation. Results: Bone union was confirmed in all 22 cases, and the mean time to union was 10.2 weeks. DASH score was 22.27 on average and no patients complained of significant discomfort after the surgery. The mean MEPS was 91.1. The hand grip power of the affected hand was similar to that of the unaffected hand, being 1.19% weaker on average. These differences reached statistical significance (p = 0.002). The range of elbow joint motion was measured: mean flexion, 146.1°; mean extension, 1.4°; mean pronation, 88.2°; and mean supination, 87.9°. Conclusions: In treating Mason type II radial head fractures, the use of bioabsorbable screws made of magnesium showed satisfactory results in radiographic and clinical evaluations. Magnesium bioabsorbable screws can maintain sufficient stability at the fracture site and have the advantage of avoiding secondary operation for the removal of internal fixation devices.

Effectiveness of locking compression plate for proximal humeral fracture in elderly patients without structural bone grafting: age group of 65-79 compared to 80 and above.

PURPOSE: This study shows the effectiveness of locking compression plate for proximal humeral fractures in elderly patients over 80 years old without structural bone grafting compared age group of 65-79 (Group 1) with 80 and above (Group 2). METHODS: This study included sixty-one patients who underwent using locking compression plate for proximal humeral fractures between April 2016 and November 2021. The patients were divided into two groups. The neck shaft angle (NSA) was checked at immediately after surgery, at 1 month and the final follow-up visit. The NSA changes in the two groups were compared using the independent t-test. In addition, multiple regression analysis was used to find out which factors affect NSA changes. RESULTS: In group 1, the mean difference between NSA immediately after surgery and 1 month after surgery was 2.74°, and group 2 was 2.89°. In group 1, the mean difference in NSA for 1 month after surgery and at the last follow-up was 1.43°, and group 2 was 1.75°. No significant difference was observed in the NSA changes between two groups (p = 0.59, 0.173). Bone marrow density and four-part fracture type were significant difference in NSA changes (p = 0.003, 0.035). The disabilities of the arm, shoulder and hand scale (DASH scale), age, medical support, diabetes and three-part fracture type were no significant in NSA changes. CONCLUSIONS: Using locking compression plate without structural bone grafting is a good option in elderly patients over 80 years old and can help achieve radiological results similar to patients which age group of 67-79.

Intramedullary fixation of metacarpal and phalangeal bone fractures with bioabsorbable Mg K-wire in 20 cases.

PURPOSE: The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium K-wire is thought to allow effective treatment upon insertion via intramedullary fixation by minimizing articular cartilage injuries without discomfort until pin removal and drawbacks, such as pin track infection and metal plate removal. Therefore, this study investigated and reported the effects of intramedullary fixation with the bioabsorbable magnesium K-wire in unstable metacarpal and phalangeal bone fractures. METHODS: This study included 19 patients admitted to our clinic for metacarpal or phalangeal bone fractures from May 2019 to July 2021. As a result, 20 cases were examined among these 19 patients. RESULTS: Bone union was observed in all 20 cases, with a mean bone union time of 10.5 (SD 3.4) weeks. Reduction loss was observed in six cases, all showing dorsal angulation with a mean angle of 6.6° (SD 3.5°) at 4.6 weeks as compared with that noted in the unaffected side. The gas cavity upon H2 gas formation was first observed approximately 2 weeks postoperatively. The mean DASH score was 33.5 for instrumental activity and 9.5 for work/task performance. No patient complained of notable discomfort after surgery. CONCLUSION: Intramedullary fixation with the bioabsorbable magnesium K-wire may be used for unstable metacarpal and phalanx bone fractures. This wire is expected to be a particularly favorable indication for shaft fractures, although care should be taken due to the possibility of complications related to rigidity and deformity.

Delayed Repair of Severed Thenar Branch with Transligamentous Variation after Open Carpal Tunnel Release.

A 49-year-old female patient with carpal tunnel syndrome at both hands was performed open carpal tunnel release. 4 months later, on the left hand, severance of the thenar branch was found by electromyography. On the 138th day, re-exploration was performed for direct nerve repair. During exploration, we identified the transligamentous variation of recurrent motor branch. Direct nerve repair was successful. At 6 months after direct repair, the nerve function began to return. At 2 years after direct repair, the nerve function has almost returned. There are some variations on the recurrent motor branch. And we overlooked transligamentous variation when we perform more decompression around the median nerve. It is important that recognize variations of thenar branch when we perform carpal tunnel release for not occurrence of severance of thenar branch.

Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system.

PURPOSE: Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure. METHODS: Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG. RESULTS: Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%-42%) at the end of DA, 40% (range, 30%-55%) at 1 month, 55% (range, 35%-85%) at 6 months, and 64% (range, 60%-100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months. CONCLUSION: Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.

Injury patterns and the role of tendons in protecting neurovascular structures in wrist injuries.

PURPOSE: The purpose of this study was to evaluate the anatomical features of injured structures, investigate the protection provided by the specific tendon of each corresponding important neurovascular structure (radial artery, median nerve, and ulnar nerve/artery) and to compare the results among the three categories of wrist injuries. METHODS: This study included 114 patients who underwent primary repair for damaged wrist structures; 40 patients sustained accidental damage without intention (group 1), 40 had self-inflicted damage (group 2), and 34 patients had a stab or penetrating wound caused by a sharp instrument during a conflict or violent event involving another person (group 3). The basic demographic factors, distribution pattern, area, and depth of the injured structures were investigated and compared. The barrier roles of the flexor carpi radialis (FCR) for the radial artery, palmaris longus (PL) for the median nerve, and flexor carpi ulnaris (FCU) for the ulnar nerve were estimated. RESULTS: In group 1, FCU injury was the most common single-structure injury. In group 2, PL±median nerve injuries were the most common. Multiple-structure injuries involving more than five structures occurred more frequently in group 3 than in the other groups. FCU±ulnar nerve injuries were more common in group 3 than in the other groups. Radial-side structures were injured most frequently in group 3, and central-side injuries occurred most frequently in groups 1 and 2. Superficial- and middle-layer injuries occurred at similar frequencies among the three groups. Particularly, deep-layer injuries were most weakly related to group 2 injuries. The barrier effects of the FCR, PL, and FCU were confirmed, respectively. CONCLUSIONS: Wrist soft tissue injuries showed particular patterns of injured structures and depths according to the injury mechanism. These patterns included features such as single-structure injuries and the locations and depths of multiple-structure injuries with or without neurovascular injuries. In addition, the roles of FCR, PL, and FCU in protecting important wrist neurovascular structures were confirmed. LEVEL OF EVIDENCE: Therapeutic III.

Results of arthroscopic partial meniscectomy for lateral discoid meniscus tears associated with new technique.

PURPOSE: To introduce and evaluate the clinical results of a new arthroscopic technique for partial meniscectomy of symptomatic lateral discoid meniscus using a knife. MATERIALS AND METHODS: From March 2005 to October 2010, 60 knees of 58 patients underwent arthroscopic partial meniscectomies for lateral discoid meniscus. The average age was 28.9 years (range, 12 to 63 years), and average follow-up was 26 months (range, 8 to 72 years). In this procedure, using a No. 11 knife holder inserted through the high far anteromedial portal, a stab incision on the anterior meniscal horn and following piecemeal meniscal excision were made. Clinical results were assessed using the scale of Ikeuchi and Lysholm score. RESULTS: Meniscus shape was complete in 32 knees (53.3%) and incomplete in 28 knees (46.6%). The shape of tears in complete type lesions was horizontal cleavage in 17 knees (53.1%), flap or complex degenerated tears in 10 knees (31.2%) and radial tears in 5 knees (15.6%). Clinical results assessed using the scale of Ikeuchi were excellent in 38 (63.3%), good in 13 (21.6%), fair in 8 (13.3%) and poor in 1 knee (1.6%). The average Lysholm score was improved from 82.8 preoperatively to 95.4 postoperatively. CONCLUSIONS: Our new arthroscopic technique in lateral discoid partial meniscectomy suggests convenient methods and successful clinical results.

[Effects on changes in femoral vein blood flow velocity with the use of lower extremity compression for critical patients with brain injury].

PURPOSE: This study was done to evaluate the mean venous velocity (MVV) response with knee and thigh length compression stockings (CS) versus intermittent pneumatic compression (IPC) devices in immobile patients with brain injuries. METHODS: We carried out a randomized controlled study. We analyzed both legs of a randomly chosen sample of 43 patients assigned to one of 4 groups (86 legs). The patients were sequentially hospitalized in the intensive care unit (ICU) in "S hospital" from November 2005 to December 2006. The base line and augmented venous velocity was measured at the level of the common femoral vein. We applied leg compression 42 times over 7 days (for 2 hours at a time at 2 hour intervals). RESULTS: There was a statistical difference among the 4 groups. The difference for the "IPC" group was more significant than the "CS" group. CONCLUSION: These results indicate that the application of IPC can be considered as an effective method to prevent deep vein thrombosis for immobile patients with brain injury.

Primary closure after a carotid endarterectomy.

PURPOSE: The prevalences of restenosis and stroke after a carotid endarterectomy (CEA) tend to differ substantially according to the surgeon. Primary closure after a CEA was the routine procedure in our institute. The primary objectives of this study were to compare the results of patients of a primary arteriotomy closure in CEA between our own and others' results based on the findings in the literature. METHODS: One hundred and sixty-six patients who underwent a primary closure were analyzed. Perioperative neurologic deficits were determined by the neurologist. Restenosis was defined as >50% stenosis on duplex scan. The range of follow-up was 7-112 months. RESULTS: Stroke including transient ischemic attack occurred within 30 postoperative days in 3 patients and after 30 postoperative days in 1 of the 166 patients. Five patients showed >50% asymptomatic restenosis. Two patients were treated with stent insertion and one underwent reoperation. One patient showed total occlusion during the follow-up period without any neurological deficits. One patient showed 50%-70% stenosis, and no intervention was done. CONCLUSIONS: The rates of recurrent stenosis and postoperative stroke were found to be sufficiently low following a primary closure to justify the continued use of this technique.