Eung Shick Kang

SCHWANNOMAS OF THE UPPER EXTREMITY

This study presented the clinical characteristics, MRI features and postoperative results of 20 schwannomas in the arms of 13 patients. Twelve tumours had a positive Tinel’s sign, one caused weakness of the wrist and another in Guyon’s canal caused hypothenar muscle atrophy. Of the nine cases which underwent magnetic resonance imaging preoperatively, six were correctly diagnosed as schwannomas. All masses were excised using microsurgical techniques and two transient neurological complications occurred.

Radiographic Changes and Clinical Results of Osteochondral Defects of the Talus with and without Subchondral Cysts

Background: Subchondral cysts are a type of osteochondral defect of the talus and can be a source of chronic ankle pain. The treatment modality of this cystic lesion is similar to that of other osteochondral defects, but results from previous reports are controversial. Therefore, we compared the clinical results and radiographic changes in small subchondral talar cystic lesions (less than 1.5 cm 2 ) to other noncystic defects after arthroscopic operations without bone grafting. Methods: The review covered about 2 years (January, 2001 to April, 2003) and included 38 patients with an average age of 36.9 years. Followup ranged from 24 to 36 months. Arthroscopic microfracture or abrasion arthroplasty was performed on 20 defects with subchondral cysts and 18 defects without cysts. Clinical results were assessed by the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS); radiographic changes were assessed by the transverse long diameter and the area (mm 2 ) of the cyst on digital radiographs using a PACS (Picture Archiving Communication System). Results: At the last followup, AOFAS clinical scores improved similarly in cystic and noncystic defects. The average diameter of the cysts decreased from 8 ± 2 mm to 6 ± 2 mm (p < 0.01). The area attributed to the cyst also decreased, from 49 ± 17 mm 2 (24 to 84 mm 2 ) to 23 ± 8 mm 2 (4 to 34 mm 2 ) (p < 0.01). There were no differences in the clinical results between the cystic and noncystic defects. Conclusions: Good clinical and radiographic results were obtained after arthroscopic treatment of osteochondral defects with a small subchondral cyst. Our results suggest that a small cystic lesion can be treated by arthroscopic microfracture or abrasion arthroplasty and that the existence of a small cyst in an osteochondral defect lesion may not affect the postoperative prognosis.

Complications of Operative Treatment for Mallet Fractures of the Distal Phalanx

Twenty-four of 59 (41%) surgically treated mallet fractures developed postoperative complications. The most common complication was marginal skin necrosis on the dorsal aspect of the distal phalanx, but recurrent extension lag, permanent nail deformities, transient infections along the Kirschner wires and pull-out steel wires and osteomyelitis were also observed.

Decompression of the ulnar nerve and minimal medial epicondylectomy with a small incision for cubital tunnel syndrome: Comparison with anterior subcutaneous transposition of the nerve

UNLABELLED The objective of this study is to compare the results of ulnar nerve decompression and minimal medial epicondylectomy with a small incision (group I) and anterior subcutaneous transposition of the ulnar nerve (group II) for cubital tunnel syndrome. METHODS Out of 56 patients with cubital tunnel syndrome, 29 were in group I and 27 were in group II. The mean age at the time of the operation was 48.9 years, and the mean follow-up period was 36.4 months. Preoperatively, the neuropathy was graded according to Dellons criteria. RESULTS There were no significant differences between the results of the two groups according to the modified Bishops system at the last follow-up. However, four patients showed painful neuroma around the operation scar and one patient in group II had experienced acute deterioration of the symptoms after the procedure. CONCLUSIONS Decompression and minimal medial epicondylectomy with a small incision seems to be more recommendable than anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome in terms of its simplicity and lesser invasiveness.

Correction of long standing proximal interphalangeal flexion contractures with cross finger flaps and vigorous postoperative exercises.

Purpose We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. Materials and Methods In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. Results The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8° to 8.4/95.4° at the last follow-up. A mean of 19.5° of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4°. Near full ROM was achieved in 3 cases. There were no major complications. Conclusions In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

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.

Three-Dimensional Reconstruction of the Carpal Bones

Three-dimensional reconstruction of the carpal bones was performed by using GE CT/T 9800, IBM PC/AT, and three-dimensional reconstruction software of hierarchical representation which was developed in our colleges. Four carpal reconstructions were performed: one normal wrist (elbow disarticulation specimen), one lunate volar dislocation with carpal tunnel syndrome (preoperative and postoperative evaluations), and one naviculocapitate syndrome which was associated with trans-scaphoid dorsal perilunate dislocation and carpal tunnel syndrome. After reconstruction, we observed the carpus from the dorsal and volar sides and from the radiocarpal and carpometacarpal joints. We then seperated the proximal and distal carpal rows, observed the midcarpal joint surface of both carpal rows, and removed the three ulnar-sided carpal bones (triangular, pisiform, and hamate) to evaluate the radioluno-capitate-third metacarpal axis.