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

Autologous osteochondral plug transplantation for osteochondrosis of the second metatarsal head: a case report

<p>Abstract</p> <p>Introduction</p> <p>Osteochondrosis of the second or third metatarsal head is a rare condition called Freiberg's disease. To relieve foot pain, conservative treatment with a foot orthosis to reduce weight-bearing and immobilize the foot are recommended. In cases in which such treatments have proved to be ineffective, several surgical treatments have been performed. The appropriate surgical treatment for Freiberg's disease remains controversial.</p> <p>Case presentation</p> <p>We describe the case of a 20-year-old Japanese woman with a three-year history of right forefoot pain and no history of trauma. Two years after treatment by autologous osteochondral plug transplantation, she has neither complaints nor symptoms.</p> <p>Conclusion</p> <p>Autologous osteochondral plug transplantation represents a potentially successful surgical arthroplastic option in preserving the metatarsophalangeal joint in patients with Freiberg's disease.</p

Anterosuperior Dislocation of the Shoulder Joint in an Older Patient with Parkinson's Disease

An 83-year-old woman, subsequently diagnosed with Parkinson's disease, fell onher right shoulder. Radiographs showed the humeral head dislocated anterosuperiorly.The supraspinatus tendon was massively disrupted and judged irreparable. Thesubscapularis tendon was repaired, however re-dislocation of the humeral head wasconfirmed after the surgery but further treatment was rejected as she was almost painfree and had a low activity level. The patient was followed up for one year after surgeryand her shoulder became almost pain-free, but range of motion with active elevationwas limited. In such cases a goal of absence or reduction of pain rather than real repairmight be considered appropriate

Application of layered poly (L-lactic acid) cell free scaffold in a rabbit rotator cuff defect model

<p>Abstract</p> <p>Background</p> <p>This study evaluated the application of a layered cell free poly (L-lactic acid) (PLLA) scaffold to regenerate an infraspinatus tendon defect in a rabbit model. We hypothesized that PLLA scaffold without cultivated cells would lead to regeneration of tissue with mechanical properties similar to reattached infraspinatus without tendon defects.</p> <p>Methods</p> <p>Layered PLLA fabric with a smooth surface on one side and a pile-finished surface on the other side was used. Novel form of layered PLLA scaffold was created by superimposing 2 PLLA fabrics. Defects of the infraspinatus tendon were created in 32 rabbits and the PLLA scaffolds were transplanted, four rabbits were used as normal control. Contralateral infraspinatus tendons were reattached to humeral head without scaffold implantation. Histological and mechanical evaluations were performed at 4, 8, and 16 weeks after operation.</p> <p>Results</p> <p>At 4 weeks postoperatively, cell migration was observed in the interstice of the PLLA fibers. Regenerated tissue was directly connected to the bone composed mainly of type III collagen, at 16 weeks postoperatively. The ultimate failure load increased in a time-dependent manner and no statistical difference was seen between normal infraspinatus tendon and scaffold group at 8 and 16 weeks postoperatively. There were no differences between scaffold group and reattach group at each time of point. The stiffness did not improve significantly in both groups.</p> <p>Conclusions</p> <p>A novel form of layered PLLA scaffold has the potential to induce cell migration into the scaffold and to bridge the tendon defect with mechanical properties similar to reattached infraspinatus tendon model.</p

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

Arthroscopic Bony Bankart Repair Using Double-Threaded Headless Screw: A Case Report

We present a case of arthroscopic fixation for bony Bankart lesion using a double-threaded cannulated screw. A 39-year-old man sustained a left shoulder injury from a motorcycle accident. Radiographs showed bony Bankart lesion and CT revealed 40% defect of glenoid articular surface. Arthroscopic fixation was performed using double-threaded cannulated screw after the bony fragment was reduced by suturing the labrum at the edge with a suture anchor. Arthroscopic bony Bankart repair using double-threaded cannulated screw fixation is effective because compression force could be applied between bony fragments and the screw head is not exposed in the glenohumeral joint