Kent K. Wu

Metastatic tumors of the hand: A report of six cases

Six metastatic tumors of the hand of mammary, renal, pulmonary, colonic, and humeral origins are described. The areas involved were the distal phalanges, the metacarpal bones, a carpal bone, the nail bed, and the soft tissue of the dorsum of the hand. All six patients died within a few months after the metastatic lesions were diagnosed correctly. Metastases to the bone can cause destruction, pain, and swelling and may be misdiagnosed before operation as osteomyelitis. Metastases to the soft tissues tend to be asymptomatic and can closely mimic benign soft tissue tumors.

Ultrasound in the Diagnosis of Posterior Tibial Tendon Pathology

We retrospectively evaluated the effectiveness of ultrasonography as a diagnostic tool for investigating pathology in the posterior tibial tendon by comparing the preoperative ultrasonograms for 17 patients with their recorded surgical findings. In all cases, the surgical findings confirmed the ultrasonographic diagnoses: 3 inflammations, 4 partial tears, and 10 ruptures. Interestingly, two ruptures had been undiagnosed by magnetic resonance imaging. Ultrasonography, which seems to be a reliable means of visualizing the extent of pathology of the symptomatic posterior tibial tendon, may be a valuable tool in surgical planning.

Kirschner Wire Breakage after Surgery of the Lesser Toes

A retrospective review was made of all patients operated on by the two senior authors from January 1985 to January 1993 for problems with Kirschner wire breakage following forefoot surgery. Thirty-three broken K-wires in 27 patients were encountered. All of these were 0.045-inch K-wires that had been placed across the metatarsophalangeal (MTP) joint of the lesser toes. In no case was there breakage of a K-wire that was larger than 0.045 inches or that did not cross the MTP joint. The medical records and radiographs of 565 consecutive patients having fixation with 0.045-inch K-wires that crossed the MTP joints of the lesser toes were then reviewed. A total of 1002 K-wires were used with an overall failure rate of 3.2% (4.8% of the patients). All of these K-wires failed just proximal to the point of entry into the metatarsal head. No intra-articular retained fragments were noted. Twenty-five of the retained fragments were completely within the metatarsal head and shaft, and eight of these fragments pierced the cortex of the metatarsal proximally. Twenty-three patients with retained fragments were examined in follow-up and in no case could the retained fragment be palpated or directly related to postoperative symptoms. Of the three patients who complained of persistent pain, two had mild pain with persistent MTP synovitis and one had severe pain due to lateral deviation of the toe after surgery. Patients with rheumatoid arthritis who underwent metatarsal head excision were noted to have a higher rate of failure (10.3% of patients, 4.0% of K-wires) than those without rheumatoid arthritis or metatarsal head excision (3.3% of patients, 2.3% of K-wires). Also four of the six cases with multiple K-wire breakage in the same foot had rheumatoid arthritis.

Evolution of a case of multicentric giant cell tumor over a 23-year period.

A 17-year-old girl had a multicentric giant cell tumor originating in the sphenoid and sella turcica that was observed for 23 years. During the first 12 years, the same lesion also appeared in the right proximal tibia and left distal radius. Curettage of the tibial lesion and packing with processed bovine bone were followed by a chronic osteomyelitis with continued intermittent wound drainage. Curettage of the radial lesion and packing it initially with autogenous iliac bone graft and subsequently with methylmethacrylate bone cement were followed by local recurrences. The radial lesion eventually was eradicated by a segmental resection of the distal radius. The resulting bony defect was bridged with a bicortical autogenous iliac graft and stabilized with a bone plate to produce a painless solid wrist fusion. No further tumor recurrence has been noted for the past two years.

Modified Mitchell's bunionectomy (Wu's bunionectomy).

A standard Wus bunionectomy consists of an oblique first metatarsal neck osteotomy with a lateral, proximal, and plantar displacement of the first metatarsal head and firm fixation of the osteotomy site with two Herbert screws. The outstanding features of this surgical technique include its surgical simplicity, secure fixation of the osteotomy site, no need for subsequent screw removal, ease of screw insertion, complete absence of screw breakage, little postoperative pain, and a relatively greater degree of correcting the various deformities associated with a hallus valgus foot than those normally achieved by either a Mitchells bunionectomy or a Chevron bunionectomy.

Periosteal (juxtacortical) chondrosarcoma: Report of a case occurring in the hand

A rare case of periosteal (juxtacortical) chondrosarcoma of the hand is described. Inadequate excision was followed by recurrence which necessitated a transmetacarpal amputation to eradicate the malignant disease.

Torulopsis Glabrata Osteomyelitis: Report of a Case

This is possibly the first documented case of Torulopsis glabrata osteomyelitis. Torulopis glabrata is a common fungus similar to Cryptococcus. It is though to largely represent a contaminant in routine cultures. The patient was a 58-year-old severely debilitated woman with diabetes. To establish a definitive diagnosis, careful culture and positive identification of the causative pathogen from the fresh bone biopsy were required. Treatment with amphotericin B was successful; however, optimally amphotericin B combined with local surgical excision would be the treatment of choice.

Malignant hemangioendothelioma of bone: a clinical analysis of 11 cases treated at Henry ford hospital.

This article describes the clinical manifestations, roentgenographic appearance, gross and microscopic pathologic features, treatments, and long-term results of 11 cases of malignant hemangioendothelioma of bone. The authors recommend that surgery, radiotherapy, and chemotherapy be integrated carefully and tailored to meet the needs of each individual patient.

METASTATIC BRONCHOGENIC CARCINOMA TO THE FINGER SIMULATING ACUTE OSTEOMYELITIS

A case of metastatic bronchogenic carcinoma to the distal phalanx of the ring finger was initially misdiagnosed as osteomyelitis. The presence of constitutional symptoms, past history of malignancy, the milder and relatively protracted clinical course, the negative culture and lack of response to surgical drainage and antibiotics should make the diagnosis of hand metastasis a distinct possibility. Amputation of the involved digit is an effective palliative treatment and the other foci of metastases should also be treated with systemic chemotherapy.

Pigmented villonodular synovitis: a clinical analysis of twenty-four cases treated at Henry ford hospital.

This article describes the clinical findings, roentgenographic manifestations, gross and microscopic pathology, treatment, and results of 24 cases of pigmented villonodular synovitis treated at Henry Ford Hospital over a period of 25 years. We conclude that synovectomy is the treatment of choice, and we have experienced a 16.7% recurrence rate.