Mini-plate Fixation for Comminuted Radial Head Fracture

Purpose: The recommended treatment of displaced or comminuted radial head fracture has been excision with or without prosthesis replacement. Excision of radial head will result in valgus deformity, and proximal migration of radius. Long term follow up of prosthesis also can induce valgus instability, synovitis, dislodging or wearing of prosthesis. This study presents the clinical reports of open reduction and internal fixation with miniplate and screws. Materials and Methods: From May 1999 to October 2002, 10 patients with Mason type III (7 cases), type IV (3 cases) were treated with mini-plate and screws. Operative indication were head and neck dissociation fracture, fracture extended to radial tuberosity, children’s fracture, dominant side Mason type III, IV injury of highly young active patient. The patients were 7 males and 3 females. Average age was 32 years (14∼4 8 years). Average follow up period was 15.8 months. All fractures were tried to fix at the safe zone with straight, T or L shape miniplate. Extracorporeal reduction of radial head was done in 4 cases. Additional fixation was done in 7 cases. Herbert’s screw was used in 3 cases, mini-screw in 4 cases, buried K-wires in five cases. Only mini-plate and screws was used in one case. Auto distalradial bone graft to the neck was done in one case. Average duration of immobilization was 4 weeks (3∼6 weeks). Removal of internal fixation was done in three cases and second stage arthrolysis was done in two cases. Results: At the last follow up, average range of motion was 9°∼123°, 58°in pronation and 55°in supination. By the functional rating index (Modified after B.F.Morrey et al.), 3 cases were excellent, 4 cases were good, and 1 case was fair, 2 cases were poor. Each case of K-wire migration, nonunion in neck and partial avascular necrosis of head was developed. But there were no discomfort of ADL. The result of Mason type III was better than type IV. Conclusion: Open reduction and plate fixation of radial head fracture is recommended for head and neck dissociation fracture or extended fracture line to the radial tuberosity, children’s fracture and dominant side of Mason type III, IV fracture in highly young active patientope

Fracture and Dislocation of Carpometacarpal Joint Excluding Thumb

Purpose : We present our operative experiences with uncommon carpometacarpal (CMC) injuries, excluding the thumb. Materials and Methods : Twenty four fractures and dislocations of the CMC joint excluding thumb, which were followed up for an average of 18 months were reviewed retrospectively. Emphases were placed on associated injuries, radiographic findings, treatment and complications. Results : The average age of patients was 35 years with 14 cases of indirect trauma as an injury mechanism. Eighteen of 24 cases involved the 4-5th CMC joint, one case involved the 2-3rd joint and one case involved the 3-4th joint. In addition, there were 4 cases that involved all of the CMC joints. Seven cases were operated upon by closed reduction and percutaneous pinning, 16 cases were treated by open reduction and internal fixation, and 1 case received fusion for neglected injury. Eighteen cases had satisfactory results, 2 cases had residual pain, 2 cases showed a limitation of motion and 2 cases had grip weakness. Conclusion : Proper diagnosis and treatment of CMC joint injuries can reduce complications and avoid additional procedures.ope

Dislocation of the Extensor Tendons at the Level of the Metacarpophalangeal Joint

Purpose: To present our operative experiences in uncommon dislocation of the extensor tendons at the level of metacarpophalangeal joint Materials and Methods: Eight cases which were followed up for an average 11.6 months (range, 6 to 24 months) were reviewed. The causes were traumatic dislocation in 5 cases, spontaneous dislocation in 2 cases and dislocation in rheumatoid arthritis in 1 case. The location was index finger in 1 case, long finger in 3 cases, ring finger in 1 case, little finger in 3 cases. Six cases were dislocated to ulnar side and 2 cases to radial side. Result: All cases were operated; repair of intertendinous fascia in 1 case, repair of sagittal band in 2 cases, repair of sagittal band with intertendinous connection transfer in 2 cases, plication procedure in 2 cases and loop procedure in 1 case. Recurrent dislocation was not found except 1 case that did not have enough immobilization. Conclusion: Good results were made from operative treatment of dislocation of the extensor tendons at the level of metacarpophalangeal joint.ope

Retrograde Herbert Screw Fixation in Treatment of Nonunion of Porximal Scaphoid Fractures

We reviewed eight cases of patients who underwent retrograde Herbert screw fixation with autogenous bone graft for treatment of proximal pole scaphoid nonunions. Most nonunion of the carpal scaphoid can be treated with a high rate of success by use of conventional bone grafting techniques. However, fractures with a small proximal pole fragment may be difficult to treat by use of these techniques. Eight patients with proximal pole scaphoid fractures with nonunion were treated with retrograde Herbert screw fixation using the dorsal approach and autogenous bone grafting. All patients were immobilized after operation with cast immobilization for an average of seven weeks. Eight patients were all males, with ages ranging between 23 to 26 years. Among the eight cases, four patients were neglected for an average of 13 months, three patients were treated with cast immobilization for 8 weeks, and one patient had a previous surgical treatment. Union was achieved in all cases and average time to union was 15.3 weeks. Among 8 cases 4 had excellent results and 4 had fair results, according to Maudsley and Chen protocols. Retrograde Herbert screw fixation should be considered in the treatment of small proximal pole fracture of scaphoid with nonunion.ope

Operative Treatment of Floating Shoulder

Purpose: Conservative treatment of displaced ipsilateral compound fractures of clavicle and scapula neck or gleonoid cavity, causing a floating shoulder, cannot expect satisfactory results in all of them. We reviewed 9 operative cases of floating shoulders and analyzed the results with review of literature. Mails and Methods: Nine patients with floating shoulders were operated from July 1996 to August 2000 were reviewed. Patients age was in average 38.3 years old. Associated injuries were 4 cases of rib fractures and 1 case of humerus shaft fracture. Other injuries included 3 hemothorax, 2 pneumothorax, 1 brachial plexus injury, and 1 ulnar nerve injury. Operation for both clavicle and scapula fracture was done in 6 cases, and surgery was done for only clavicle in 3 cases. Internal fixation for clavicle was done with 3.5 mm AO reconstruction plate in 4 cases and Dynamic Compression Plate in 5 cases. Results: Clinical results by Hardegger method showed 7 cases of excellent, 1 case of good, and 1 case of poor. Complications include 2 cases of limitation of motion of shoulder joint and one case of residual pain. Conclusion: Floating Shoulder is caused by high-energy trauma, therefore initial assessment of associated injuries should be done carefully. In evaluating the articular surface of the glenoid and positions of the fracture fragment, CT evaluation is very useful in planning the surgical treatment. Clinical results after surgery can give satisfactory results.ope

A Solitary Osteochondroma of the Hamate bone - A case report -

Osteochondroma of the carpal bones are rare. We recently treated a male patient in whom this lesion arose from the hamate bone. This study was conducted to recognize the clinical patterns of this rare disease entity and to evaluate the diagnosing modalities. A 39-year-old male patient who had bony protrusion of the wrist was treated by excisional biopsy. A plain x-ray film revealed a bony protrusion related to the distal carpal row, and a computed tomography of the wrist showed it to arise from the hamate bone. Pathologic finding confirmed the diagnosis of osteochondroma. There is no pain and no evidence of recurrence in last follow up at 12 months after excision.ope

Operative Treatment of Thumb Ulnar Collateral Ligament Injury

Purpose: We reviewed 12 operative cases with ulnar collateral ligament injury of the thumb, and evaluated about gender, age, etiology, injury mechanism, surgical method, prognosis. Materials and Methods: We had operated when there was avulsion fracture over 2mm and when abduction arc was over 30 degrees in the stress view. In the 12 cases, there were 5 men and 7 women. Average age was 26.5 years (from 10 to 57 years). There were 9 cases with avulsion fracture as injury pattern. In the avulsion fracture cases, epiphyseal injury were 3 cases. Results: Surgical methods were needle fixation 7 cases, pull out wire technique 1 case, Statak anchor 3 cases, loose body excision and primary closure 1 case. Average follow up period was 14 months. The clinical results were excellent in 8 cases, and good in 4 cases. In the good prognosis group, there was no joint instability, but there were pain, tightness, and slightly limitation of motion. Conclusion: If complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is left uncorrected, this lesion prevents proper healing and leads to chronic instability and subsequent arthrosis. We achieved satisfactory results after operative treatment in avulsed fractures and over 30 degrees instability in the stress view.ope

Enchondroma of a Digit Treated by Curettage Only

Purpose: Retrospectively, to evaluate the result of treatment by curettage only, enchondroma of the digits. Materials and Methods: Fifty-nine cases in 30 patients (male 11, female 19), from July 1997 to Febuary 2002, were reviewed with a minimum follow up of 1 year. Thirty patients were treated for enchondroma of the digits (including Oilier's disease 9, and Maffucci syndrome 2) by curettage only, and the degree of healing was evaluated radiologically. The average duration of follow up was 28.6 months (12-65 months). Results: The radiologic results were evaluated according to the degree of new bone formation by the criteria suggested by Tordai. Group I achieved 79.7% overall and 89.5% for solitary enchondroma, meaning complete healing with normal cortical thickness and a bone defect of less than 3 mm. The average duration of consolidation was 12.4 months, and 8.1months for solitary enchondorma. No recurrence or other complication occured. Conclusion: Curettage alone is a good treatment option for enchondroma of the digits as comparing with autogenous bone graft, which has the disadvantages of pain, infection, and immobilization.ope

Congenital Hypoplasia of Carpal Scaphoid Bone

Congenital hypoplasia or aplasia of carpal scaphoid bone without other abnormality is a rare disorder. We experience a case of congenital hypoplasia of carpal scaphoid bone without other abnormalityope

The Features and Treatment Results of the hmangioma in Upper Extremity

Purpose : To investigate the characteristics and treatment results of the hemangioma in upper extremity, we analysed the hemangioma in upper extremity. Materials and Methods : We retrospectively analysed 24 patients who have taken operative treatment for hemangioma of upper extremity from 1993 to 2000, and they were confirmed clinicopathologically. The patients were followed up by outpatient clinic and the follow up period was 12 months to 48 months. Female patients were predominant(17 cases). The age of initial visit to our hospital varied from 7 to 64 years old with the average of 32 years old. The most common symptom was palpable mass in 20 cases. Also, 5 patients visited our clinic due to recurrence. The sites of involvement were hand and wrist area in 8 cases, finger in 7 cases, forearm in 7 cases, upper arm in 1 case, and shoulder in 1 case. Results : The treatments were marginal resection in 21 cases, amputation in 2 cases, and embolization in 1 case. Partial resection was performed to preserve the function of hand. Recurrence was developed in 1 case in the finger area. Cavernous hemangioma was the most common(9 cases). Conclusion : We conclude that for the primary surgery of hemangioma the treatment of choice is complete marginal resection, preserving the affected area’s function to the fullest. This is the only way to prevent recurrence.ope