A biomechanical study of common mallet finger fracture fixation techniques

published_or_final_versionMedical SciencesMasterMaster of Medical Science

Evolving Treatment Modality of Hand Enchondroma in a Local Hospital: From Autograft to Artificial Bone Substitutes

Background/Purpose: Curettage followed by the application of iliac crest autograft was the traditional treatment of hand enchondroma in Princess Margaret Hospital, Hong Kong. Methods: We reviewed the results of 13 patients with hand enchondroma who were operated on in the past 15 years (1999–2013). Eight patients (1999–2009) received iliac crest autograft after curettage, whereas the other five patients (2009–2013) received artificial bone substitutes. Results: Both groups of patients had good functional outcome and bone graft incorporation. There was no recurrence. One patient in the autograft group had mild residual finger stiffness. One patient receiving artificial bone substitutes had a gouty attack, early wound infection, and finger stiffness. The use of artificial bone substitutes eliminated donor site morbidities, decreased operation time and, hospital stay. They took a longer time for radiological incorporation than autograft, but it did not translate into adverse clinical effects. Conclusion: Artificial bone substitute is a good alternative to iliac crest autograft in the treatment of hand enchondroma

Stainless Steel 2.0-mm Locking Compression Plate Osteosynthesis System for the Fixation of Comminuted Hand Fractures in Asian Adults

Objective: The aim of this retrospective study was to analyse the clinical outcome of the application of stainless steel 2.0-mm locking compression plate (LCP) system for the treatment of comminuted hand fractures in Asian adults. Methods: Six patients who had comminuted hand fractures were treated by open reduction and internal fixation with the application of stainless steel 2.0-mm LCP (AO Compact Hand System; Synthes, Oberdorf, Switzerland) from December 2009 to October 2010. The total arc of motion of fingers, grip power, complications, and additional surgery were recorded. Results: Three out of six patients eventually restored good hand functions in terms of the total arc of finger motion (>220°) and grip power. The commonest complication was skin impingement in finger region by the implant (4 cases). Another common complication was restricted range of motion (3 cases). One patient had minimal degree of malrotation of his left little finger. Additional surgery was required in all the patients for implant removal (6 cases), tenolysis (3 cases), and capsulotomy (2 cases). Conclusions: The stainless steel 2.0-mm LCP is useful for the fixation of unstable comminuted hand fractures, especially in metacarpal bones, because of its advantage of better stability, which allows more aggressive rehabilitation. However, its design is not very versatile and, therefore, limits its use in the finger region. Its bulkiness frequently causes implant impingement. The patients must be informed about the chance of implant removal later

Uncommon Dorsal Radiocarpal Fracture Dislocation Complicated With Median Nerve Palsy: Case Report, Review of the Literature, and a New Classification System Guiding the Management

We report the case of a 36-year-old lorry driver who sustained left dorsal radiocarpal fracture dislocation and left median nerve injury in a traffic accident in 2010. Emergency operation of closed reduction, cross-wrist-bridging external fixation, percutaneous transradial styloid Kirschner wire fixation, decompression of left median nerve, and repair of the partially torn palmar radiocarpal ligament were performed under general anaesthesia. Because of the persistent depressed dorsal articular rim fracture of left distal radius, another operation of open reduction, corticocancellous bone grafting, and dorsal buttress plating was performed 5 days after the initial operation. Six months after the operation, the patient enjoyed good range of wrist motion but weak twisting power, especially in supination. There was no radiological feature of radiocarpal subluxation

An Unusual Case of “Late” Central Protrusion of the Helical Blade of Proximal Femoral Nail Antirotation

Central protrusion, or “cut-through” of the helical blade in proximal femoral nail antirotation (PFNA), is a unique and novel complication. Cases reported in the literature were presented early in the postoperative period and were associated with no bone healing, and managed with either revision or total hip replacement. We reported a case that presented late in the postoperative period that showed some bone healing and was erroneously treated with removal of the implant, resulting in varus malunion after implant removal. Possible causes for late presentation, preventive measures, and the need for early surgical intervention are discussed

Role of microRNA-520h in 20(R)-ginsenoside-Rg3-mediated angiosuppression

Background: Ginsenoside-Rg3, the pharmacologically active component of red ginseng, has been found to inhibit tumor growth, invasion, metastasis, and angiogenesis in various cancer models. Previously, we found that 20(R)-ginsenoside-Rg3 (Rg3) could inhibit angiogenesis. Since microRNAs (miRNAs) have been shown to affect many biological processes, they might play an important role in ginsenoside-mediated angiomodulation. Methods: In this study, we examined the underlying mechanisms of Rg3-induced angiosuppression through modulating the miRNA expression. In the miRNA-expression profiling analysis, six miRNAs and three miRNAs were found to be up- or down-regulated in vascular-endothelial-growth-factor-induced human-umbilical-vein endothelial cells (HUVECs) after Rg3 treatment, respectively. Results: A computational prediction suggested that mature hsa-miR-520h (miR-520h) targets ephrin receptor (Eph) B2 and EphB4, and hence, affecting angiogenesis. The up-regulation of miR-520h after Rg3 treatment was validated by quantitative real-time polymerase chain reaction, while the protein expressions of EphB2 and EphB4 were found to decrease, respectively. The mimics and inhibitors of miR-520h were transfected into HUVECs and injected into zebra-fish embryos. The results showed that overexpression of miR-520h could significantly suppress the EphB2 and EphB4 protein expression, proliferation, and tubulogenesis of HUVECs, and the subintestinal-vessel formation of the zebra fish. Conclusion: These results might provide further information on the mechanism of Rg3-induced angiosuppression and the involvement of miRNAs in angiogenesis

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Mitochondrial diseases in Hong Kong: prevalence, clinical characteristics and genetic landscape

Abstract Objective To determine the prevalence of mitochondrial diseases (MD) in Hong Kong (HK) and to evaluate the clinical characteristics and genetic landscape of MD patients in the region. Methods This study retrospectively reviewed the phenotypic and molecular characteristics of MD patients from participating public hospitals in HK between January 1985 to October 2020. Molecularly and/or enzymatically confirmed MD cases of any age were recruited via the Clinical Analysis and Reporting System (CDARS) using relevant keywords and/or International Classification of Disease (ICD) codes under the HK Hospital Authority or through the personal recollection of treating clinicians among the investigators. Results A total of 119 MD patients were recruited and analyzed in the study. The point prevalence of MD in HK was 1.02 in 100,000 people (95% confidence interval 0.81–1.28 in 100,000). 110 patients had molecularly proven MD and the other nine were diagnosed by OXPHOS enzymology analysis or mitochondrial DNA depletion analysis with unknown molecular basis. Pathogenic variants in the mitochondrial genome (72 patients) were more prevalent than those in the nuclear genome (38 patients) in our cohort. The most commonly involved organ system at disease onset was the neurological system, in which developmental delay, seizures or epilepsy, and stroke-like episodes were the most frequently reported presentations. The mortality rate in our cohort was 37%. Conclusion This study is a territory-wide overview of the clinical and genetic characteristics of MD patients in a Chinese population, providing the first available prevalence rate of MD in Hong Kong. The findings of this study aim to facilitate future in-depth evaluation of MD and lay the foundation to establish a local MD registry