The Usefulness of Ultrasonography as a Guide for the Treatment of Delayed Diagnosed Tendon Injury in a 2-Year-Old Child

In children, flexor pollicis longus (FPL) tendon injuries are uncommon. In delayed diagnosed cases, CT and MRI are hard to perform, even though to confirm the location of the lacerated proximal tendon end is preferable for the planning of operation procedure. In such condition, ultrasonography is suitable because of its characteristic feature of easy-to-perform procedure even in children. In this report, preoperative ultrasonography was practical in the delayed diagnosis of FPL tendon in a 2-year-old child to schedule the primary repair because the precise location of both FPL proximal and distal ends was identified. In addition, routine postoperative ultrasonography was also useful to track its healing process without concern about mutual communication due to the patient’s age, which helped to promote active motion

Management of Intolerance to Casting the Upper Extremities in Claustrophobic Patients

Introduction. Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. Methods. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Results. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. Conclusions. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully

The Role of Electrophysiological Severity Scales for Decision-making with Regard to Surgery in Idiopathic Carpal Tunnel Syndrome

The distribution of electrophysiological severity of carpal tunnel syndrome (CTS) in an outpatient setting and whether electrophysiological severity could be an objective tool for decision-making regarding choice of surgery were investigated. During conservative treatment, 1079 outpatients with idiopathic CTS were classified according to the electrophysiological severity scale (Stage 1-5). The results were provided to the patients and explained, but they were not indicated a treatment protocol intentionally. We recommended surgery to those outpatients who presented with difficulty in pinching due to severe thenar atrophy and/ or showing poor response to conservative treatment. However, the decision-making of surgical or nonsurgical treatment remained with patients. In the distribution of severity stages, Stage 4 was the most common (34%). Two hands were not classifiable. Surgery was chosen in 443 of 1077 hands (41.1%): The operation selection rate increased with severity of the stage and the patients with Stage 5 showed the greatest preference among Stage 1-5 (p<0.0001). This was shown in both female and male groups in gender analysis, and in both ≤ 69 y.o. and ≥70 y.o. groups in the age analysis. There was no significant difference between female and male hands, and ≤ 69 y.o. and ≥70 y.o. hands. Among varied reasons for the decision-making process for surgical treatment in CTS, electrophysiological severity scale plays an important role as an objective tool without being influenced by subjective elements; gender and age

Recurrence of Enchondroma in a Middle Finger after Curettage and Back-filling with Calcium Phosphate Bone Cement: a Case Report

We report a case of recurrence of enchondroma in a middle finger after curettage and back-filling with calcium phosphate bone cement (CPC). The radiograph showed a lytic lesion around the CPC filling which showed no signs of absorption after 12 years. The tumor was curated easily, however, a steel bar was needed to remove the CPC mass in a carefully manner not to break the cortex. CPC has an advantage of immediate biomechanical stability, on the other hand, a disadvantage of being unabsorbed inside of bone. Although enchondroma has a low recurrence rate after surgery generally, in consideration of recurrence, we recommend the use of absorbable materials when a use of artificial bone substitute to fill the defect is planned

A Coincidental Anterior Interosseous Nerve Palsy after Volar Plate Fixation of a Distal Radius Fracture Diagnosed by 3D-CT

A case presented dysfunctional flexion of the thumb and index fingers after volar plate fixation for of distal radius fractures was diagnosed anterior interosseous nerve palsy and confirmed by 3D-CT. 3D-CT was useful to confirm the continuities of tendons, which excluded the most common complication of tendon ruptures after volar plate fixation. Also, it was superior to needle electromyography which is unreliable due to the accompanying damage of the pronator quadratus following volar plate fixation

A Coincidental Anterior Interosseous Nerve Palsy after Volar Plate Fixation of a Distal Radius Fracture Diagnosed by 3D-CT

A case presented dysfunctional flexion of the thumb and index fingers after volar plate fixation for of distal radius fractures was diagnosed anterior interosseous nerve palsy and confirmed by 3D-CT. 3D-CT was useful to confirm the continuities of tendons, which excluded the most common complication of tendon ruptures after volar plate fixation. Also, it was superior to needle electromyography which is unreliable due to the accompanying damage of the pronator quadratus following volar plate fixation