K. Sunago

New procedure on making a thumb—One-stage reconstruction with free neurovascular flap and iliac bone graft

A new method for reconstruction of an amputated thumb with a free neurovascular flap and an iliac bone graft in one stage is described. The method consists of fbur operative steps: (1) preparation of the recipient hand, (2) elevation of a free dorsalis pedis flap, (3) iliac bone graft, and (4) transfer of the flap with microvascular anastornoses. Four successful results with this operation are presented. The method, which reconstructs the thumb in a single operation, is suitable for patients who refuse other reconstructive methods which sacrifice uninjured digits or toes.

Surgical options for distal radial fractures: indications and limitations.

Abstract Distal radial fractures are common problems for the orthopedic surgeon, and various surgical treatments have been reported. However, each method has its indications, pitfalls, and limitations. It is important to select the appropriate procedure for the fracture pattern. We studied 115 consecutive patients including 45 patients with distal radial fractures treated with percutaneous pinning, 67 patients treated with external fixation, and 32 patients treated with assisted wrist arthroscopy. Percutaneous pinning was useful in extra-articular fractures and minimally comminuted intra-articular fractures, but was inadequate for patients with severe osteopenia and markedly comminuted intra-articular fractures. External fixation was indicated when intra-articular comminution was present. However, the dorsomedial fragment was often not reduced and maintained by this technique; additional pinning was needed to reduce this fragment. A dynamic-type fixator was feasible for younger patients who required early functional recovery. Arthroscopy provided accurate visualization of the wrist joint and the intra-articular fracture.