Ayuko Shimizu

Open reduction and internal fixation for dorsal fracture dislocations of the proximal interphalangeal joint using a miniplate.

Various operative techniques have been described for unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint with articular involvement. However, this injury still remains a therapeutic challenge for hand surgeons because no single technique guarantees successful outcomes. We performed a novel procedure using a low-profile miniplate, which allows for anatomic reduction, rigid internal fixation, and early finger joint motion. Between March 2003 and May 2009, 18 consecutive patients who suffered from 19 dorsal fracture dislocations of the PIP joint with volar articular fracture of the middle phalanx involving more than 40% of the articular surface were treated using this technique. The postoperative follow-up period averaged 16.6 months (range, 12-18 mo). Bony union was obtained in all cases. No patient showed residual dorsal subluxation. Active motion of the PIP joint averaged 85.0 degrees (range, 62-105 degrees), flexion contracture averaged 5.4 degrees (range, 0-17 degrees), and percent total active interphalangeal joint motion averaged 89.0% (range, 60%-100%). Two patients had restricted active distal interphalangeal joint flexion owing to tendon adhesion resulting from the use of a relatively long plate in the first few cases of this series. No major complications were reported for the other 16 patients. We describe the surgical technique, indications, complications, and postoperative management for this technique.

CARPAL TUNNEL SYNDROME CAUSED BY A GANGLION IN THE CARPAL TUNNEL WITH AN ATYPICAL TYPE OF PALSY: A CASE REPORT

Carpal tunnel syndrome caused by a ganglion is a rare condition. We report a case which presented with a rapidly progressive onset of symptoms and subsequent thenar palsy.

Carpal Tunnel Syndrome with Wrist Trigger Caused by Hypertrophied Lumbrical Muscle and Tenosynovitis

We present a case of carpal tunnel syndrome involving wrist trigger caused by a hypertrophied lumbrical muscle with flexor synovitis. The case was a 40-year-old male heavy manual worker complaining of numbness and pain in the median nerve area. On active flexion of the fingers, snapping was observed at the carpal area, and forceful full grip was impossible. Tinels sign was positive and an electromyographic study revealed conduction disturbance of the median nerve at the carpal tunnel. Magnetic resonance imaging revealed edematous lumbrical muscle with synovial proliferation around the flexor tendons. Open carpal tunnel release was performed under local anesthesia. Synovial proliferation of the flexor tendons was found and when flexing the index and middle fingers, the lumbrical muscle was drawn into the carpal tunnel with a triggering phenomenon. After releasing the carpal tunnel, the triggering phenomenon and painful numbness improved.

Conservative treatment using a newly designed custom-made wrist splint for ulnocarpal abutment syndrome

Background: Immobilization of the wrist joint with a splint is an established approach for ulnar-sided pain due to ulnocarpal abutment syndrome. However, patients have a tendency to stop wearing the splints because of its inconvenience and there have been no reports based on splint therapy. Objective: We investigated the usefulness of a newly designed custom-made aluminum splint for ulnar-sided wrist pain.Study design: This was a cohort study of the aluminum splint therapy for the patients who had been primarily treated with a conventional splint but ceased to use it because of the inconvenience in activities of daily living. Methods: The subjects included 10 female patients (mean age = 44.2 years). The outcome was assessed using the visual analogue scale score for pain, the disabilities of the arm, shoulder and hand score, range of motion of the wrist, and the grip strength. The mean follow-up period after wearing the aluminum splint was 8.8 months. Results: All parameters, including the visual analogue scale pain and disabilities of the arm, shoulder and hand scores, improved significantly (p < 0.05) following use of the aluminum splint relative to the pretreatment scores. Seven patients continued to use the aluminum splint, and three of the seven had complete remission from related pain. Conclusion: Constant use of the aluminum splint during the study period was associated with improvement in the ulnar-sided wrist pain scores, which reconfirmed that increased adherence to splint use in daily activities is an important intentional behavioral strategy. Clinical relevance Although the custom splint is effective for alleviation of wrist pain in ulnocarpal abutment syndrome, continuity of splint use is a key element of conservative treatment. This study showed that a splint that patients were willing to wear in their daily life was a useful device for alleviation of pain.

Application of a navigation system for contouring anatomical plasty of the distal end of the humerus

The effectiveness of navigation systems in performing accurate orthopaedic surgery has been reported previously, but there have been no reports on the application of navigation in surgeries involving bone resection around the elbow joint. In this study, anatomical plasty or bone resection was performed to restore anatomical morphology in 10 cases of osteoarthritis of the elbow and deformity of the distal end of the humerus. Bone resection was performed on the distal end of the humerus using navigation and on the proximal end of the ulna via freehand surgery. Postoperatively, the elbow function was evaluated and pre- and postoperative CT images were used to measure the bone resection. There were no complications arising from the use of navigation, and elbow function was improved in all cases. By evaluating the CT images, it was found that navigated resection of the fossae of the distal humerus was more effective than freehand resection of the processes of the proximal ulna, thus confirming the usefulness of navigation. In future, to fully confirm this finding, it will be necessary to conduct prospective controlled studies of cases in which navigation is used to perform arthroplasty, including those that involve the proximal end of the ulna.

Navigation-assisted debridement arthroplasty for osteoarthritis of the elbow: a preliminary report

Background Debridement arthroplasty is a widely accepted operative treatment for elbow osteoarthritis. However, it is sometimes difficult to define the extent of appropriate osteophyte resection. In the present study, a navigation system was used to resect the osteophytes. Methods Eight male patients (mean age, 62 years) were enrolled in the present study. When the osteophytes around the olecranon, coronoid and radial fossae of the distal humerus were removed, the operation was monitored using a navigation system. Pre- and postoperative clinical and radiographical assessments were performed with a mean follow-up of 29 months. Results There were no major complications during the operations. Postoperative computed tomography showed that the osteophytes were properly removed. The mean range of motion of the elbow improved from –21° to 110° pre-operatively to –13° to 130° at the time of follow-up (p < 0.05). The mean Mayo Elbow Performance Score improved from 75 points to 98 points (p < 0.05) and the mean Disabilities of the Arm, Shoulder and Hand score improved from 24.2 points to 8.7 points (p < 0.05). Conclusions The findings of the present study demonstrate that the osteophytes formed at the distal humerus could be precisely visualized using a navigation system. This system effectively defined the region and depth of the morphological configuration for resection.

Locked Elbow Joint Due to a Cartilage Flap Caused by Osteonecrosis of the Humeral Trochlea

Although osteonecrosis of the humeral trochlea is a well-known complication of supracondylar humeral fractures in childhood, its frequency is relatively rare1. We report a case of a young boy with a locked elbow joint due to a cartilage flap caused by osteonecrosis of the humeral trochlea. Osteonecrosis was confirmed by follow-up radiographic examinations. The patient’s mother was informed that data concerning the case would be submitted for publication, and she provided consent. A ten-year-old boy was referred to our hospital with the symptom of locking during left elbow extension, which was accompanied with pain. The locking occurred suddenly when he turned a doorknob with the left hand. The medical history included a left supracondylar humeral fracture when he was five years old, which was treated conservatively by a local physician (Fig. 1). Fig. 1 Nondisplaced supracondylar fracture of the left elbow (arrow) when the patient was five years old. On the initial examination, no swelling or tenderness was observed in the left elbow. Although the active elbow flexion range was up to 137°, the active and passive extension loss was 75°, with painful locking. Passive extension induced pain on the posterolateral side of the lateral humeral condyle. The range of forearm motion was 90° for pronation and 80° for supination without limitation. Radiographs revealed an irregularly contoured ossification of the epiphysis in the lateral humeral condyle (Fig. 2-A), and computed tomography (CT) revealed irregular ossification of the medial trochlea (Fig. 2-B). Magnetic resonance imaging (MRI) revealed an abnormal low-intensity shadow on the T2-weighted …