Eiji Hirano

Vascularized toe-to-finger joint transplantation. 11 patients followed for 4 years.

Since 1983, we have transplanted 11 free vascularized joints in 8 men and 3 women, mean age 32 years. The causes of joint involvement were trauma in 9 cases and infection in 2. One MP and 10 PIP joints of the second toe were transplanted to 3 MP and 8 PIP joints of the fingers. After a mean postoperative follow-up period of 4 years, the mean postoperative range of motion was 31 degrees compared with 16 degrees preoperatively. Radiographs showed destruction of 4 PIP joints, probably caused by vascular failure in 2 joints and infection in 2. In spite of no evidence of arthrosis, some of the joints had gradually undergone a loss of extension. Although there are some problems that should be overcome, we advocate a free vascularized toe-joint transplantation for severe finger-joint destruction without extensive surrounding soft-tissue damage.

Treatment of Acute Stable Scaphoid Fracture Using the Herbert Screw with a Small Skin Incision

Acute stable scaphoid fracture (Herbert type A2) is generally managed conservatively with a plaster cast. However, long-term immobilization causes inconveniences of daily living and, more importantly, prohibits an early return to work even for the person who is not a heavy laborer and could resume working had the wrist not been fixed in a cast. Since the Herbert bone screw gives rigid internal fixation of bone fragments and allows early mobilization of the wrist, acute stable scaphoid fracture is treated using this screw, without requiring a cast, in order to solve the problems mentioned above. The screw is inserted into the scaphoid through a small skin incision just over the scaphotrapezial joint using a free-hand procedure monitored under an image intensifier. Thirteen wrists of 13 patients were operated upon from May, 1988 until November 1990. The average age of the patients was 29.4 years. The average time for returning to work after surgery was 3.2 weeks (range 1 day to 6 weeks). The average hand-grasping power was 94.6% and the average range of motion of the wrist was 98.1% compared with the non-affected side. According to Herbert’s assessment system, the results of all the cases were graded as excellent.