bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain Management With Continuous In Situ Diffusion of Ropivacaine Following Mini-invasive Locking Plate Fixation for Distal Radius Fracture
Authors: Candelier Gilles , Apard Thomas , Becuwe Laurent
Published: September 2016

Objective: The aim of this comparative and prospective study is to evaluate the results of pain management with the association of a mini-invasive pronator-sparing technique and in situ continuous diffusion of Ropivacaine following radius distal fracture treated with volar locking plate. Patients and Method: In group 1 (11 patients), there was no catheter placed but a suction drain for 3 of them. In group 2 (23 patients), an in situ catheter is placed in the surgical site for a continuous diffusion (flow 5 mL/h) of 270 mL of Ropivacaine 2% in an elastomeric pump. The catheter was removed by a nurse at home 48 hours after surgery. Pain was evaluated with pain Visual Analog Scale at days 1, 2, 3, 7, and 30. A radiological examination was performed at day 30. Results: In group 2, Visual Analog Scale (VAS; day 1/day 2) was significantly lower than in group 1: 4.8/3.5 versus 6.6/5.6 ( P < .05). There were no differences of the results of VAS at days 3, 7, and 30. No radiological sign of chondrotoxicity was observed at day 30. Conclusion: The association of the mini-invasive technique with an in situ diffusion of Ropivacaine is an effective procedure to control postoperative pain after treatment of distal radius fracture and then could authorize 1-day surgery.
Distal Radius Fractures—Lunate facet
Authors: Krimmer Hermann , Walters Roman , Schandl Rene
Published: September 2016

Introduction: Fractures of the radius distal to the watershed line show a significant risk factor for secondary dislocation especially when the lunate fossa is involved. These fracture patterns act as avulsion of the attachments of the strong radiocarpal ligaments and destabilize the carpus. If no proper fixation is done, the carpus pushes the fragments volarly leading to dislocation and carpal subluxation. Materials and Methods: Conventional plates usually cannot provide stable fixation. Depending on the size of the fragments, which is best analyzed by computed tomographic (CT) scan, decision making for fixation technique is done. In case of larger fragments, polyaxial plates preferably with the watershed design might be sufficient. New plates sparing the area of the flexor pollicis longus (FPL) tendon offer the advantage to mount the plate far distal without the risk for tendon irritation. However, when the fragments are very small, additionally fragment-specific devices are necessary. One option is small hook plates fixed with tiny self-drilling and self-cutting screws, which produce higher stability as K-wires. Nevertheless, after fixation, radiocarpal stability should be checked under x-ray control. If there are signs of instability, additionally temporary K-wire fixation dorsally through the radius into the lunate prevents carpal subluxation. Results: Analysis of 10 clinical cases demonstrates that when these guidelines are followed, risk for secondary dislocation can be significantly reduced, and vice versa if not frequently secondary dislocation occurs. Conclusion: The problem of the troublesome lunate facet should be recognized and needs adequate treatment. Secondary dislocation frequently causes fixed radiocarpal subluxation and arthritic changes with the need for salvage procedures like radio-scapho-lunate (RSL) fusion.
Patient-Perceived Outcome After Total Wrist Arthroplasty
Authors: Sagerfors Marcus , Brus Ole , Pettersson Kurt
Published: September 2016

Purpose: Total wrist arthroplasty (TWA) is an established surgical treatment for wrist arthritis. The aim of the investigation is to report patient-perceived outcome measures after TWA operated at a single referral center in Sweden. Methods: In a cohort study with prospective collection of data, we evaluated 193 consecutive patients with a TWA (223 wrists) preoperatively, 1 and 5 years postoperatively. The wrists were implanted between 2002 and 2014. Outcome measures studied were range of motion (ROM), visual analogue scale (VAS) pain scores, hand grip strength, and patient-related outcome measures. Secondary outcome measures included implant survivorship, which was estimated using the Kaplan-Meier method, and radiographic loosening 5 years postoperatively. Results: VAS pain scores and patient-related outcome measures improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except Universal 2. ROM improved somewhat, especially for the Biax and Maestro TWAs. Cumulative implant survival after 5 years was 99% for Remotion, 95% for Maestro, and 84% for Biax. Radiographic loosening was present in 26% of the Biax cases, 18% of the Remotion cases, and 2% of the Maestro cases. Conclusions: All TWA designs in this study offer a high level of patient satisfaction. The design of the implant may affect patient-perceived outcome 5 years postoperatively. Good mid to long-term results can be achieved in patients undergoing TWA.
The Effect of Cubital Tunnel Retinaculum Repair After In Situ Decompression
Authors: Kwak Sang Ho , Bae Jung Yun , Baek Goo Hyun
Published: September 2016

Objective: Cubital tunnel syndrome is the second most frequent nerve entrapment syndrome in upper extremity. Among treatment options, in situ decompression is an effective and safe procedure. However, nerve stretching or subluxation is a potential problem. In this study, we want to identify in situ decompression with cubital tunnel retinaculum repair that can relieve ulnar nerve stretching. Materials and Methods: In total, 35 patients (30 male, 5 female; mean age, 53.1 years) presenting with primary cubital tunnel syndrome operated by in situ decompression with cubital tunnel retinaculum repair were included in the repair group. Twenty-six patients (19 male, 7 female; mean age, 54.6 years) treated with in situ decompression were included in the control group. Intraoperatively in the repair group, the ulnar nerve length (UNL) from intermuscular septum to the first motor branch was measured before and after the cubital tunnel retinaculum repair. Ulnar nerve position at elbow extension and flexion was recorded by ultrasonography postoperative 1 year in both groups. The UNL before and after the retinaculum was analyzed by t test, and ulnar nerve position between the two groups was analyzed by Fisher’s exact test. Results: UNL at elbow extension was not different significantly before and after the retinaculum repair (before repair, 11.4 ± 0.7 cm; after repair, 11.4 ± 0.7 cm), but UNL at elbow flexion was significantly decreased after the retinaculum repair ( P < .001; before repair, 12.5 ± 0.7 cm; after repair, 11.8 ± 0.7 cm). The ulnar nerve position at both extension and flexion was different between groups ( P < .001). Conclusion: UNL was decreased after cubital tunnel retinaculum repair. In situ decompression with cubital tunnel retinaculum repair can be an effective procedure to relieve irritation due to ulnar nerve stretching.
Arthroscopically Assisted Osteosynthesis of Coronoid Process Types I and II Fractures in Terrible Triads of the Elbow
Authors: Jiménez Isidro , Delgado Pedro J. , Figueredo Federico A. , de Rozas Mario Gil , Martmez Sergio , Truan Juan R.
Published: September 2016

Background: The coronoid process has not received much attention in the treatment of traumatic injuries of the elbow until recent years. In addition, there are few studies in the literature that explore the arthroscopic treatment thereof. Purpose: To study the feasibility of arthroscopically assisted treatment of coronoid process types I and II fractures. Materials and Methods: From February 2009 to October 2015, 11 patients underwent surgery for a coronoid process fracture associated with other injuries. There were all males with a mean age of 43 (28-61) years and follow-up of 14.5 (4-28) months. In all patients, arthroscopic reduction and transosseous fixation of the fracture were carried out using a FiberWire (Arthrex, Naples, Florida) suture, and the associated bony and ligamentous injuries were also repaired. After surgery, a splint was used for 18 days, and physical therapy was started after its removal. Range of motion was measured, function was assessed with the Mayo Elbow Performance Scoring (MEPS) questionnaire, pain by Visual Analogue Scale (VAS), and disability using the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire. Results: Ten fractures were type II and 1 fracture was type I. Nine patients had an associated injury of the radial collateral ligament, whereas 1 had an associated injury of the ulnar collateral ligament. Six had an associated fracture of the radial head (5 osteosynthesis and 1 fragment excision). Six patients were diagnosed as terrible triad of the elbow. Mean time to bone healing was 5 weeks. All patients had a stable elbow. The range of flexion and extension at the end of follow-up was 131.5° (120-140) to 9.5° (0-25), and pronosupination was 89° (80-90) to 86° (70-90). MEPS was 90.7 (70-100) points, VAS at rest 0 points, active VAS 0.6 (0-2), and force VAS 2.6 (0-5); finally, DASH questionnaire was 13.6 (4.5-20.5) points. No postoperative complications were reported. One patient developed mild residual pain. Conclusions: Although our series presents a limited number of cases, we believe this work shows the feasibility of an arthroscopically assisted treatment in fractures of the coronoid process using a high strength transosseous suture fixation and repairing the associated injuries when necessary.
Three-Dimensional Analysis of the Fracture Location of the Radial Head
Authors: Saka Natsumi , Matsui Hirotada , Tsuji Hideki
Published: September 2016

Three dimensional analysis of the fracture location of the radial head: comparison between simple radial head fracture and radial head fracture with complex elbow instability. Hypothesis: It is suggested that the anterolateral quadrant of the radial head with the forearm in neutral position is the most common location of fracture in Mason type 2 radial head fractures, but in some cases, fracture is observed in other quadrant, especially in the fracture with instability. Knowing the location of the fracture part in radial head is of paramount importance for planning the placement of implant for internal fixation. However, it is difficult to predict the exact location of the fracture before the internal fixation because the location can vary by the forearm rotation. The purpose of this study is to investigate the difference of the fracture location of Mason type 2 radial head fracture between simple radial head fracture and radial head fracture with complex elbow instability. Methods: From the 19 cases of Mason-type radial head fracture, three-dimensional computed tomography (CT) model was created. Along the axis made from the center of the radial head to the center of the radius at the biceps tuberosity level, corresponding point of the biceps tuberosity on the articular surface was defined as 0° point. Proximal articular surface was divided into a clock face of 360°. Fracture location was measured by the angle from the 0° point to the fracture line. The location of the start and end of the fracture was investigated and compared between the group with simple radial head fracture (group 1; n = 11) and the group with complex elbow instability (group 2; n = 8). Average start point, end point, and subtend of the fracture were evaluated using t test. Anterolateral quadrant was defined between 138° to 228°. Results: The average angle subtended by the fracture line was 143.8° (SD, 19.0) in all cases. The average start point of the fracture was 114.9° in group 1 (SD, 50.4; range, 29°-211°) and 108.8° in group 2 (SD, 30°; range, 75°-151°) ( P = .763). The average end point of the fracture was 255.8° in group 1 (SD, 40.2°; range, 204°-327°) and 256.6°in group 2 (SD, 34.8°; range, 207°-302°) ( P = .964). The average angle subtended by the fracture line was 140.9° in group 1 (SD, 21.1°; range, 116°-1T5°) and 14T.9° in group 2 (SD, 16.0°; range, 119°-172°) ( P = .445). Summary: Location of the radial head fracture, using the biceps tuberosity as a standard was evaluated between the group with simple radial head fracture and the group with complex elbow instability. No difference of the fracture distribution was observed between the 2 groups. In both groups, fracture extended from the anterolateral quadrant to the anteromedial quadrant. Those findings can affect the approach and planning of the internal fixation of the radial head fracture.
Correlation Between Grip Strength and Forearm Bone Mineral Density in Women Over 60 Years of Age
Authors: Furukawa K. , Zenke Y. , Menuki K. , Kurinomaru N. , Yamanaka Y. , Sakai A.
Published: September 2016

Objective: Our objective was to determine whether grip strength correlates with bone mineral density by body part. Participants and Methods: We studied the data on 86 forearms of 86 women, aged 60 years or older, who had been treated for distal radius fractures at our hospital between October 2007 and October 2013. All the patients underwent DXA (dual-energy x-ray absorptiometry) scans of the second to fourth lumbar vertebrae, the femoral neck, and the forearm bone (divided into 3 parts: ultra-distal [UD], mid-distal [MD], and proximal shaft [shaft]). The grip strength of the hand on the noninjured side was examined twice, and we used the average of the results for analysis. Statistical Analysis: Using Pearson product-moment correlation coefficients, we analyzed the DXA scan results (lumbar vertebrae, femur, and 3 forearm parts) for correlations with age, height, weight, body mass index (BMI), and grip strength. Results: The grip strength on the noninjured side correlated positively with the bone mineral densities of the forearm (UD, MD, and shaft) and the femur (neck), but not with those of the lumbar vertebrae. Discussion: The grip strength on the noninjured side had a stronger correlation with the bone mineral density of the proximal shaft (0.351), which has a high percentage of cortical bone than with those of MD (0.340) and UD (0.338). It also correlated with the mineral density of the femoral neck bone (0.263), but not with that of the lumbar vertebrae. Our results suggest a correlation between cortical bone amount and noninjured side grip strength. Conclusions: Our statistical analyses revealed that grip strength on the noninjured side correlated positively with forearm and femoral neck bone mineral densities, but not with lumbar vertebrae bone mineral densities, in middle-aged and elderly females with distal radius fracture. The resultant values indicated that 12.0 kg of grip is equivalent to −2.5 SD in DXA. Grip strength on the noninjured side can be a surrogate marker for screening osteoporosis.
The Surgical Outcomes of the Articular Shear Fractures of the Distal Part of the Humerus
Authors: Shin Dongju , Dan Jinmyoung , Lee Seongman , Han Jaehwi , Jeong Daegun , Kim Minguek
Published: September 2016

Background: Coronal shear fractures of the distal humerus have recently been identified as a “new” type of fracture. Ring and colleagues proposed a classification for this fracture with 5 increasingly complex subtypes. The purpose of this retrospective study is to classify the patterns of articular shear fractures of the distal part of the humerus, according to Ring’s classification, and to analyze the results of the surgical treatments. Method: Thirteen patients with a mean age of 59 (15-88) years underwent operative treatment and were then followed for an average of 21 (12-30) months. All but 2, treated with total elbow arthroplasty, underwent open reduction and internal fixation (ORIF). Results: According to Ring’s classification, there were three type 2, two type 3, five type 4, and three type 5. Average Mayo Elbow Performance Score was 85 (60-100): 5 patients had excellent, 4 had good, and 4 had fair results. Fracture union was achieved in all but 1. The average arc of motion was 103 with an average flexion contracture of 19. In the analysis of the ORIF group, the patients presenting fracture of the posterior aspect of the lateral column showed worse results than those that were not. It was the same for the patient presenting fracture of the posterior trochlea. A precise recognition of these fracture patterns is useful in surgical decision making and choice of surgical technique. Our results suggest that the type of fracture involvement with posterior aspect of trochlea or capitellum can make poor clinical outcomes.
Functional Outcome After Surgical Treatment of Intra-articular Distal Humerus Fractures in Patients 70 Years of Age or Older
Authors: Gonzalez Jorge López , Gerez Nelson , Guzman Nicolas , Rotella Pablo , Pacios Jorge
Published: September 2016

Introduction and Objectives: Distal humerus fractures in elderly people are associated with great comminuted fractures due to poor bone quality. The increased complexity caused by comminuted fractures is accompanied by difficulties in the fixation of osteosynthesis materials, thus facilitating the implant failure and altering the consolidation process. The objective is to analyze functional and radiological results and associated complications in patients 70 years of age or older, after surgical treatment of intra-articular distal humerus fractures. Materials and Methods: In total, 13 patients were evaluated between February 2012 and February 2015, treated with open reduction and internal fixation. Eight of these patients had C-type fractures and 6 A-type (Arbeitsgemeinschaft für Osteosynthesefragen [AO] classification). All patients were treated with double locking plate using a posterior approach with olecranon osteotomy. Radiological and functional assessments were made. Results: The average flexion range was 118°, though the loss of extension was 25°. Eighty-two percent of the patients had grade 1 arthrosis. We found 2 cases of pseudoarthrosis (one distal humerus and the other of olecranon) and 3 cases of neuropraxias (2 ulnar and 1 radial, which fully recovered). Three reinterventions were made (2 for material removal and 1 for reosteosintesis-vocabulario). The average Quick Disabilities of the Arm, Shoulder and hand Score was 19.87, and the Mayo Elbow Performance Score was 85. Discussion: Treatment with open reduction and internal fixation using two locking plates for A and C types of distal humerus in patients 70 years of age or older gave satisfactory functional results, according to patients’ demands, and do not significantly change the quality of life.
Radial Nerve Injury at Transverse Fracture of Humeral Shaft
Authors: Kim Jeong Hwan , Lee Young Ho , Kim Jihyeung , Baek Goo Hyun
Published: September 2016

Background: Radial nerve palsy associated with fractures of the humeral shafts is the most common nerve lesion complicating fractures of long bones. Transverse fracture and fractures of the middle or middle-distal shaft had higher associations of radial nerve palsy. Most of the patients were recovered without surgery, but early exploration should be considered in some patients with long-segment nerve defect. We evaluated the correlation of distraction of fracture gap in humeral shaft fracture with long-segment injury of radial nerve. Method: We evaluated 10 patients of radial nerve palsy with transverse humeral shaft fractures, who showed the distraction gap at the fracture site on preoperative radiograph. The mean age was 31 years, and the mean follow-up period was 2.1 years. Most common mechanism of injury was a traffic accident. We evaluated the lengths of the nerve defect under microscope and the functional recovery at the time of final follow-up. Results: Long-segment injury was detected in 9 patients (90%), and mean size of nerve defect was 12 cm (range, 9-15 cm). All patients were treated with sural nerve grafting. Motor powers of wrist and finger extension were recovered more than grade IV in all patients at the final follow-up. One patient who showed no injury of radial nerve was recovered to normal in 6 months after trauma. Conclusion: In our study, the distraction of fracture gap in preoperative radiograph often correlates with long-segment radial nerve injury. Therefore, patients of radial nerve palsy with transverse humeral shaft fractures, and with the distraction gap at the fracture site on the preoperative radiograph, often need early exploration and preparation of nerve graft at the time of surgery.
Which Technique for Treatment of Chronic Thumb MCP Joint Instability? Comparison of 3 Techniques With a Mean Follow-up of 84 Months
Authors: Agout Charles , Bacle Guillaume , Marteau Emilie , Laulan Jacky
Published: September 2016

Objective: Injuries to the thumb collateral ligament are common whose acute surgery gives good functional results. But they are often unrecognized and surgical procedures for chronic instability are still being discussed. The aim of this study was to compare retrospectively the clinical and radiological results of the 3 main treatments for chronic instability of the metacarpophalangeal (MCP) joint of the thumb to identify trends and optimize outcome. Materials and Methods: In this retrospective and monocentric study, we included all the patients operated between 2000 and 2012 from a chronic posttraumatic instability of the MCP joint of the thumb by 1 of 3 techniques: primary repair (37 cases), ligament reconstruction (14 cases), and arthrodesis (43 cases). Patients with hyperextension instability, degenerative instability, and a follow-up less than 2 years were excluded from this study. Subjective and objective results and rates of complications and recurrence were compared at end of the follow-up. Results: Sixty-seven patients were included, 55 followed up for a mean 84 months (range, 24-164 months). Whichever the procedure, all patients considered themselves improved or healed. Forty-eight patients (87.3%) were satisfied or very satisfied. The relief of pain was significantly better in the arthrodesis group. The mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) for primary repair group were 17.4 (0-89.5), for ligament reconstruction group 25.7 (0-58.3), and for the arthrodesis group 17.8 (0-50). Pinch strength, on average of the value on the unoperated side, was 89% for primary repair group, 84% for ligament reconstruction group, and 94% for the arthrodesis group. Six of 10 ligament reconstructions had MCP joint laxity at end of follow-up. There were significantly fewer patients who considered themselves cured in the ligament reconstruction group. There were 4 failures by end of follow-up: 1 associated with primary repair, 1 with arthrodesis, and 2 with ligament reconstruction. Discussion and Conclusion: Surgery in treating chronic instability of the MCP joint of the thumb gives generally good results. Primary repair should be considered as much as possible. In contrast to literature report, ligament reconstruction does not give better results than arthrodesis.
Analysis of Nail Bed Injuries
Authors: Lee Kyu Hyeong , Kang Dong Hee
Published: September 2016

Objective/Hypothesis: The fingertip and nail bed are the most commonly injured parts of the hand and are important aesthetic and functional parts of the hand. Without proper treatment, injury to the nail complex has the potential to cause considerable dysfunction and/or deformity. Despite a high incidence, controversy remains around the appropriate management of nail bed injuries. This study is based on 549 nail bed injuries treated over a 6-year period and be to suggest an appropriate treatment. Materials and Methods: In the retrospective study, we analyzed data from 549 nail bed injuries in 536 patients operated over a 6-year period. At least 6 months follow-up patients were included, and other combined injuries inside the same hand were excluded. Age, type of injury, bony injury (fractures), nail substitute (treatment methods), and outcomes were reviewed. Results were determined for 549 nails after follow-up examination by the authors, and these were divided to identical to opposite group, major and minor abnormalities based on Zook’s criteria. The sum of the minor and major nail abnormalities for each finger was used to determine a grade of excellent (no abnormalities), very good (1 minor), good (2 minor), fair (3 minors and 1 major) or poor (more than 3 minors or 1 major). Statistical analysis was done between the injury category (type, site, nail substitute, and fracture) and the overall final grade. Results: The patients’ age ranged from 7 months to 83 years, with an average of 34 years. The long finger was the most common injured fingers followed by ring, index, thumb, and small finger. Lacerations were the most common type of injury, followed by crushes and avulsions. The most frequent area of nail injury was distal third, with the middle third, nail fold, and proximal third following closely. Fractures accompanied in 182 cases. The nail fold and nail repairs were most often covered with avulsed nail and with silicone sheet for 16 cases. About 50% were excellent (293 cases), 22.6% very good (124 cases), 11.3% good (62 cases), 6.2% fair (34 cases), and 6.6% poor (36 cases). There were no statistically significant differences identified between nail deformities and age, digit, nail substitutes. Crush and avulsive injuries were found to have significantly worse results ( P < .05) compared with lacerations. Poorer results were obtained in fold injuries than other parts ( P < .05). The presence of fracture was associated with poor results ( P < .05). Conclusions: It seemed that the poorer results were related to site of injuries (nail fold), presence of fracture, and type of injury and concluded that the cause were multifactorial. Overall outcomes were good. However, nail splitting, nail roughness, and nail adherence cause dirtiness, catching, bending, and various cosmetic problems. Careful suture and replacement of nail to nail fold were important to reach good results.
Therapy of Fingertip Injuries
Authors: Quadlbauer S. , Pezzei Ch. , Beer T. , Hausner T. , Leixnering M.
Published: September 2016

Objective/Hypothesis: Fingertip injuries are very common in emergency departments, and reconstruction is a central aim of their management. According to the literature, fingertip injuries in the level of Allen 3 and Allen 4 should be treated by local skin flaps. Main purpose of this study was to evaluate the outcome after semiocclusive dressing therapy in respect to soft tissue cover, recovery of sensibility, and duration of sick leave. Materials and Methods: One hundred fourteen fingertip injuries from 2009 to 2011, treated with semiocclusive dressing, were retrospective analyzed. In all of the cases, the injured fingers were only cleaned, debrided, and covered with an occlusive dressing. The bone was not shorted, even if the bone was up to the wound level. The primarily occlusive dressing was left as long as possible and had been, when necessary, obdurated. The different types of fingertip injuries were classified according to the levels set by Allen. Furthermore, the treatment time with the semiocclusive dressing and the period of disability were recorded. On every patient, a Semmes-Weinstein test was performed to document the sensitive outcome. Results: A total of 114 patients were treated with a semiocclusive dressing. The mean age was 36 ± 14 years, and the mean treatment duration was 21 ± 10 days. The mean period of disability was 30 ± 17 days. After taking off the semiocclusive dressing, the main period of disability was 8 ± 13 days. According to Allen, following composition of fingertip injuries occurred: 49% Allen 1, 33% Allen 2, 13% Allen 3, and 5% Allen 4. All patients developed a satisfactory tissue cover, and the sensibility, according to the Semmes-Weinstein test, was normal. There were no complications like tissue infections, neuroma, or osteitis. Also no secondary flap supply was necessary. Conclusion: The semiocclusive dressing is an ideal therapy for all kind of fingertip injuries, regardless of the amputation level. There may be even bone exposed on the wound level. It is an easy, cheap, and safe therapy with no complications and leads to an excellent result in function, sensibility, and carry capacity. The semiocclusive dressing is a suitable alternative in treating fingertip injuries.
Treatment of Proximal Phalangeal Fractures by Plate and Angular Stable Unicortical Screws
Authors: Leixnering M. , Pezzei Ch. , Reb P. , Quadlbauer S. , Hausner T.
Published: September 2016

Objective/Hypothesis: Fractures of the proximal phalanges are the most common phalangeal fractures. The current state-of-the-art treatment is open reduction and internal fixation with a dorsal plate. Immobilization is not required. Immediate digital motion is possible, thus preventing peritendinous adhesions as well as arthrofibrosis. Bicortical plate fixation is a commonly used procedure. However, it is known to cause irritation of flexor tendons and consequent limitation of motion. The difference between unicortical and bicortical screws has been addressed in a small number of studies. In metacarpal bones, Dona et al. found no difference between unicortical and bicortical locking screws in terms of load failure and stiffness. They also observed no screw pullout. In a biomechanical study, Khalid et al. investigated the pullout force of unicortical and bicortical screws in proximal phalanges and found that unicortical screws have significantly higher pullout strength in the mid diaphysis, but less in the proximal and distal metaphysis. However, they only used screws without a locking plate system. The principal aim of the present study was to investigate the outcome after proximal phalangeal fractures treated by open reduction and dorsal stable fixation with angular stable locking screws. Material and Methods: All proximal phalangeal fractures from 2011 to 2012, treated by open reduction and internal fixation with plate and unicortical angular stable locking screws, were analyzed retrospectively. Data concerning age, sex, follow-up interval, range of motion (ROM) of the metacarpophalangeal (MCP), the proximal interphalangeal (PIP), and the distal interphalangeal (DIP) joint were collected for statistical analysis. To assess functional outcome, the Buck-Gramcko score was calculated for the range of motion. The last x-ray examination was analyzed in respect to screw or plate loosening. Fractures were assigned to the following categories: open, closed, transverse, oblique, comminuted, intra-articular, or extra-articular. Results: In all, 15 proximal phalangeal fractures were analyzed retrospectively. Union was achieved in all cases. Eleven patients (73%) were men and 4 (27%) were women. Their mean age was 35 ± 11 years and the mean duration of follow-up was 7 ± 5 months. Triple-joint fingers were involved in 80% and the thumb in 20%. The mean ROM of triple-joint fingers in MCP was 92° ± 10°, PIP 76° ± 20°, and DIP 72° ± 20°. For the thumb, the average ROM of the MCP was 67° ± 15° and the IP 53° ± 15°. The mean Buck-Gramcko score was 14 ± 1, which indicates an excellent outcome. No complication related to the osteosynthesis equipment was observed. Conclusion: Dorsal plating with unicortical angular stable screws is suitable for proximal phalangeal fractures. It is associated with a low complications rate and excellent clinical outcome.
Early Active Vector Adjustable Skin Traction (EAVAST) for Phalangeal Fractures
Authors: Dowd Michael , Fairclough Jason , Lam Jason , Chan Queenie , Wood Steven , Diab Jason
Published: September 2016

Background: Traction for phalangeal fractures utilizes the principle of “ligamentotaxis.” In Australia, a number of hand therapists and surgeons have contributed to the design of a skin traction method utilizing rigid sports tape, elastic, and hand-based thermoplastic splint. Aims: The study aims to determine the efficacy and outcomes of skin traction in the treatment of phalangeal fractures in comparison with surgical management. It also aims to define the vectors, force, types of phalangeal fracture, and degree of displacement that skin traction can improve. Method: A retrospective cohort trial is currently underway reviewing outcomes of 103 skin traction cases involving phalangeal and metacarpal fractures performed at the Nepean Hospital in New South Wales over a 3-year period and comparing these to surgical cases. Outcome measures being utilized include total active movement (TAM), grip strength, pain levels, and patient rated wrist and hand evaluation (PRWHE) scores. Radiological analysis is also being undertaken with the intention of developing an algorithm to match the type of fracture with recommended treatment method. We are currently in the process of collecting surgical group data and expect to be able to present this by the time of conference meeting. Results: Preliminary results according to Belsky’s criteria indicate an average of 227.50 total active motion for 54 phalangeal finger fractures treated with the technique. The results were excellent for 37 cases, good for 14 cases, and poor for 3 cases. Grip strength averaged 32.3 kg for the affected limb (99.3% of the non-affected limb). Gingrass criteria for thumb phalangeal outcomes in 6 cases showed average 82.2° TAM for five (5) cases. Excellent outcomes were achieved in 3 cases, and good outcomes were achieved in 2 cases. Pinch strength averaged 4.25 kg and was 79.7% of the non-affected thumb. Conclusion: Skin traction may provide a cost-effective and clinically effective tool for the management of phalangeal fractures.
Three-Dimensional Printing Models in the Preoperative Planning of Carpal Fractures and Academic Education
Authors: Grezzi María Lucía Barbieri , Castaño Virginia Giachero , Bastreri Oscar Jacobo , Rota Denisse Hartwig , Sanchez Gustavo Andrés Mantrana
Published: September 2016

Objective: We present the use of 3-dimensional printing models with fused deposition modeling for carpal fractures surgery, and its feasibility in the preoperative planning and academic training. Nowadays, our market provides stereolithographic printers for this purpose, but their higher costs had made them little known and difficult to access. Fused deposition modeling is a low-cost technology that creates 3-dimensional models with high quality and definition. Material and Methods: We studied two patients with carpal fractures, an hamate fracture, and a scaphoid pseudarthrosis. The initial assessment included computed tomography imaging study, and the digital file was processed into Stereo Lithography format. After this, the model was printed in polylactic acid, using an “open source” fused deposition modeling technology printer manufactured in Uruguay. The resulting models were carefully evaluated and used for academic training. Different preoperatory approaches were studied, analyzing fracture patterns, calculating and enabling a precise selection of bone graft and selection of osteosynthesis screws, according to the characteristics of each patient. Results: We achieved a real scale with a 1:1 proportion models. All measurements were concordant, and the screws had an accurate longitudinal measure. Total operative time was 20% reduced. Plastic surgery teachers and residents were satisfied using the models for preoperative clinical discussion and planning, emphasizing the advantage of manipulating real scale models compared with 3-dimensional imaging. The models allow us to analyze the fractures in complete way and not just seeing the face of the bone exposed by the surgical approach or by the x-ray intraoperative image. Conclusions: We have created models of low cost, high quality, and accuracy, for the preoperatory planning of carpal fractures, accomplishing to reduce surgical time and improving the academic learning of the plastic surgery residents.
Semi-occlusive Dressing for the Management of Fingertip Amputations
Authors: Verdugo Arturo , Casas Raúl , Droppelman Guillermo
Published: September 2016

Objective: The objective of the study was to present an alternative therapeutic option that could replace local skin flaps in the management of fingertip amputations and to report the results from a functional, aesthetic, and general satisfaction point of view. Method: Descriptive study in adult population which included patients with fingertip amputations treated with semi-occlusive dressing consisting of a polyurethane adhesive. The injuries were classified according to the Allen classification. All lesions received a 3 liters of saline solution wash, debridement, administration of single dose of prophylactic antibiotic, tetanus vaccination by hospital policy, and application of a semiocclusive dressing under transient ischemia of the affected finger. There was no intervention in the exposed bone even though its exposition might be located at the level of amputation or beyond. At the time of discharge, all cases were studied with radiograph and ultrasound, measuring the thickness of soft tissue distal to the bone level. The 400 Points Test and QuickDASH, validated for the Chilean population, were applied 1 month after discharge. All patients were presented with the option of psychological check. For the data analysis, Stata 12.1 was used. Results: A total of 67 injuries were obtained. The average age of treated patients was 43 years old (SD = 14.7). According to Allen’s classification, lesions were: level 1 35.82%, level 2 37.31%, level 3 25.37%, and level 4 1.49%. All cases achieved full healing in the injured finger. The mean time of disability was 60.58 days (SD = 16.66). The length of soft tissue growth distal to the bone level as measured by ultrasound had an average of 3.66 mm (SD = 0.72). All patients achieved full functional and aesthetic satisfaction, with a median for 400 Points and QuickDASH Test of 90 and 12.6, respectively. There were no complications such as infection, scarring, neuroma, or osteitis. No supplementary flap or additional therapeutic action was required. Conclusions: Semi-occlusive dressing for the treatment of fingertip amputations is a valid option for obtaining satisfactory results from a functional, aesthetic, and global point of view. It is a very easy method to execute in emergency rooms and has a very low cost and a high reproducibility. No complications have been recorded, and it is an excellent alternative to local skin flaps. However, we believe that future studies that incorporate more complex methodological designs should be made to be able to present a greater external validity.
Two Reverse Pedicle Flaps for Repairing Soft Tissue Defects of the Finger
Authors: Xia Lei , Xu Yuben , Zhao Junzhang , Li Peng , Huang Liangku
Published: September 2016

Objective: The objective of this study was to evaluate and compare the effect of 2 reverse pedicle flaps for repairing soft tissue defects of the finger. Methods: In this prospective study, 46 patients with finger soft tissue defects planned for flap repair of soft tissue were enrolled from April 2011 to March 2015, and randomized to undergo either repair of reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery in group A (25 cases) or retrograde island flap of dorsal branch of the proper digital artery in group B (21 cases). The survive rate, hand function, postoperative complications, and appearance were compared between the 2 groups. Results: Patients were followed up for an average of 18 months in group A while 15 months in group B. All flaps in both groups survived, with satisfactory sensory function. The 2-point discrimination testing of group A was from 6.0 to 9.0 mm (7.1 ± 0.5 mm) while it was from 4.0 to 7.0 mm (5.2 ± 0.4 mm) in group B, significantly superior to that of group A ( P < .05). Motion of finger interphalangeal joint in both groups was not significantly different, nor was affected in comparison with the healthy side. As for complications, 2 cases of early venous congestion and 2 cases of superficial skin necrosis occurred in group A while 1 case of flap blister occurred in group B. In addition, we observed that the appearance of the flap was 5mm higher than normal skin in 5 cases in group A, while only in one case in group B. The difference was significative ( P < .05). Conclusion: Both reverse pedicle flaps were safe and reliable for repairing finger defects, while in consideration of sensory function and appearance, retrograde island flap of dorsal branch of the proper digital artery may suit better in fingertip defects repair than reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery.
Functional and Radiological Results of Phalanx Fractures Fixation with Intramedullary Cannulated Headless Compressive Screws
Authors: Undurraga Sebastián , Cifras Jose Luis , Bernal Nazira
Published: September 2016

Objective: Unstable phalanx fractures are an indication for reduction and fixation. Classic fixation techniques include Kirschner wires (K wires) or plates for osteosynthesis. This investigation has an objective to compare functional and radiological results of patients operated with intramedullary cannulated no head compressive screw (IMS) with a control group of osteosynthesis with dorsal plate or K wire. Materials and Methods: A prospective follow-up of 15 patients operated with IMS between September 2014 and November 2015, with a mean follow-up of 5 months (range, 3-8 months). Patients included were between 18 and 70 years old and had diaphyseal or distal metaphyseal fractures of Proximal or Middle Phalanx; fracture lines transverse or short oblique; unique lesions, without other structure harmed. Those patients where compared with a control group of 15 patients operated with dorsal locking plate in diaphyseal fractures, or with K wire in cases with distal metaphyseal fractures. The final range of movement, immediate postoperative pain and pain at discharge, radiological consolidation, time of labor leave, complications, and satisfaction index at discharge were evaluated. The IMS group corresponded to 16 fractures: 6 diaphyseal and 3 of the distal metaphysis of the Middle Phalanx (P2). 16 fractures of the control group: 8 diaphyseal (treated with plate) and 2 of the distal metaphysis of the Proximal Phalanx (P1, treated with K wires); 3 diaphyseal (treated with plate ) and 3 of the distal metaphysis of the Middle Phalanx (P2, treated with K wires). Results: Total active range of movement of the IMS group P1 was 249° (240°-260°) and 225° (190°-240°) ( P = .01). Total active range of movement of the IMS group P2 was 240° (231-255) and 228° (190-250) ( P = .05). The mean return to work was 50 days (range, 15-64 days) for the IMS group and 60 days for the control group ( P = .1). All fractures of the IMS group had radiological consolidation at discharge, and there were no difference in the time of consolidation with the control group. There were no cases with secondary arthrosis at final follow up. Immediate postoperative pain (0/10) of IMS group was 3 and 0 at discharge and 100% of the IMS classified as “satisfied.” Conclusions: Transverse and short oblique fractures of P1 or P2 may fixate satisfactory with compressive cannulated intramedullary screw. They present a better functional result, less time of labor leave, and same consolidation rate as that of the control group. The index of satisfaction was outstanding. The presence of arthrosis should be evaluated with longer follow up where the screw site of entrance to the bone.
Differential Incidence of Cold Intolerance in Different Fingers After Performing Reverse Digital Artery Flaps for Finger Soft Tissue Defects
Authors: Yucheng Sun , Qingzhong Chen , Jinbo Tang , Jing Chen
Published: September 2016

Objective: Cold intolerance is a common complication after the reverse digital artery flap procedure. However, we observed that the incidence of cold intolerance of different fingers was different. Therefore, we investigated the differences in the incidence of cold intolerance in different fingers and attempted to elucidate the causes of this phenomenon. Method: We recruited 37 patients and divided them into 3 groups based on injured finger, namely, 13, 13, and 11 patients for the index, middle, and ring finger groups in our study, respectively. Cold intolerance was subjectively reported by patients themselves. Our surgical procedure was designed in such a way that the reverse digital artery flap (RDAF) was located at the lateral area on the proximal phalange of the injured finger (on the ulnar side of the index, middle, and ring fingers) in consideration of patient aesthetics. Results: At final follow-up, 17 of 37 patients reported cold intolerance (index: 8; middle: 8; and ring: 1). Among the symptoms of discomfort, 9 patients mainly complained about the lower temperature of the flap upon exposure to cold weather compared with that of the uninjured area. Meanwhile, 3 patients complained of pain, and 5 patients reported numbness of the flap. The rate of cold intolerance in index, middle, and ring finger were 62%, 62%, and 9%, respectively. The patients’ age and sex did not significantly differ among the 3 groups. Significant differences were observed when we compared the incidence of cold intolerance of the index and ring fingers or the middle and ring fingers. Conclusion: Cold intolerance on the ring finger was obviously lower than intolerance in the index and middle fingers. Cold intolerance had a tendency to occur on fingers that sacrificed the dominant artery. And blood supply is an important predisposing factor for cold intolerance.
Long-term Functional, Subjective, and Psychological Results After Digit Replantation
Authors: Chen Jing , Sun Yu Cheng , Chen Qing Zhong , Tan Jun , Tang Jin Bo
Published: September 2016

Objective: Some inconsistencies can be observed among subjective satisfaction, objective functional results, and psychological sequelae. The aim of this follow-up study was to present the long-term comprehensive results of successful digit replantation and to analyze the relevance among subjective satisfaction, objective functional results, and psychological sequelae. Materials and Methods: In 26 patients with successful digit replantation, 28 cases were reexamined after 36.9 months (range, 25–49 months postinjury). The range of active motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ), and psychological sequelae including depression, anxiety, and postraumatic stress disorder (PTSD) were assessed. A correlation analysis among variables was also performed. Results: According to the Strickland criteria, the active motion of digits was excellent in 4 (15%), good in 6 (5%), fair in 9 (35%), and poor in 9 (45%) digits. The mean value of the total grip, pinch strength, and the Semmes-Weinstein monofilament testing exceeded 80% of value of the healthy hand. However, the average value of static two point discrimination (s2PD) was less than half value of the healthy hand. The mean score for the DASH and MHQ was 6.9 and 58.9, respectively. The incidence of cold intolerance was 60%. Only 1 patient has showed the symptoms of depression and PTSD after 49 months postinjury as yet. Almost all patients returned to work and half of them did not change their former type of occupations. Conclusions: We concluded that the objective functional results of replanted digits did not affect the daily life and satisfaction of patients.