Kiminori Yukata

Early breakage of a titanium volar locking plate for fixation of a distal radius fracture: case report.

This report presents a case demonstrating the early breakage of a titanium volar locking plate implanted for internal fixation of a dorsally displaced distal radius fracture in which the dorsal cortex was severely comminuted. Careful selection of the proper plate and appropriate surgical technique and postoperative management are necessary to avoid this complication.

Sensory recovery of the hand with intercostal nerve transfer following complete avulsion of the brachial plexus.

Background: Restoration of sensory function is imperative when prehensile function is restored after irreparable brachial plexus injury. However, there are few reports that focus on the results of sensory recovery after brachial plexus reconstruction. The purpose of this article is to report the results of sensory recovery of the hand with intercostal nerve transfer following complete brachial plexus injury. Methods: Seventeen patients with complete brachial plexus injury underwent sensory reconstruction of the hand with intercostal nerve transfer to the median or ulnar nerve. All patients underwent double free-muscle transfer to restore the prehensile function of the hand. Sensory recovery of the hand was assessed with Semmes-Weinstein monofilament testing, two-point discrimination, vibration perception, temperature perception, and the location of perception of sensibility. The average follow-up period was 4.1 years. Results: All patients perceived at least the 6.65 filament at the territory of the median or ulnar nerve. Best result on Semmes-Weinstein monofilament test was perception of the 4.31 filament in two patients. None of the patients had two-point discrimination. Vibration with 30-cycles/second stimuli was perceived in 12 patients, whereas vibration with 256-cycles/second stimuli was perceived in only six patients. Eight patients had perception of warmth, and 13 patients had perception of cold. Seven patients felt sensation in the cutaneous distribution of the repaired nerve of the hand in situ. Conclusions: Sensory reconstruction with intercostal nerve transfer can provide limited sensibility of the hand. However, this limited sensory recovery is useful for activities of daily living in severely handicapped patients with brachial plexus injury.

Delayed rupture of extensor digitorum communis tendon following volar plating of distal radius fracture.

We present a case of delayed rupture of extensor digitorum communis tendon seven years after volar plating of distal radius fracture. Drill bit penetration during surgery and prominent screw tips into the fourth extensor compartment have a potential risk to damage the tendons. Careful and accurate use of internal fixation instruments is necessary to avoid this complication.

Vascularized Pedicled Bone Graft for Avascular Necrosis of the Capitate: Case Report

Avascular necrosis of the capitate is a rare disorder of unknown etiology that causes wrist pain and limitation of function. We present a case of a 15-year-old boy successfully treated with vascularized pedicled bone graft from the dorsal aspect of the distal radius.

Attritional Rupture of the Flexor Tendons to the Small Finger Caused By Osteophyte of the Ulnar Head: Case Report

We present a rare case of attritional rupture of the flexor tendons to the small finger caused by an osteophyte of the volar aspect of the ulnar head.

Isolated Salter-Harris Type III Physeal Fracture of the Distal Ulna

We describe a case of isolated physeal fracture of ulna distal end in a 13-year-old boy. This fracture type is uncommon, especially Salter-Harris type III of this injury has not been reported. Plain radiographs showed a small vertical fracture line at the ulnar distal end and an enlargement of epiphyseal plate at the base of ulnar styloid process. The present case was successfully managed with conservative treatment because of its minimal displacement.

Ulnar nerve palsy caused by synovial protrusion in synovial chondromatosis of the elbow: a case report and literature review

We describe an unusual case of ulnar nerve compression (cubital tunnel syndrome) caused by synovial protrusion in primary synovial chondromatosis of the elbow in a 59-year-old man. Magnetic resonance imaging is a useful tool for diagnosing this rare condition. Surgical excision of the intra-articular multiple loose bodies and ulnar nerve decompression were performed. The clinician should be aware of primary synovial chondromatosis as one of the causative factors of cubital tunnel syndrome.

The use of dynamic radiographs in trapeziometacarpal joint arthrodesis for accurate range of motion evaluation

BACKGROUND Increased motion at the scaphotrapeziotrapezoidal (STT) joint and compensatory hypermobility of metacarpophalangeal (MP) joint contribute to the total abduction and adduction motion of the thumb after trapeziometacarpal (TM) joint arthrodesis. However, there were no detailed studies to evaluate the contribution of motion of each joint towards total thumb mobility. METHODS We conducted a comparative study on thumb joint motion in 56 hands who underwent TM joint arthrodesis against that of 56 hands in normal subjects. Dynamic radiographs were performed and the angles subtended by the first (M1) and second (M2) metacarpals were to measure radial abduction and adduction, and volar abduction and adduction. In addition, angles subtended by the thumb proximal phalanx (P1) and M1 in abduction and adduction were measured to evaluate the hypermobility of the MP joint. RESULTS The average total arcs of M1M2 motion in normal subjects in radial and volar abduction-adduction planes were 24° and 35° respectively. The arthrodesis group averaged 9° of motion in the radial abduction and adduction plane and 8° in the volar abduction and adduction plane. P1M1 volar adduction angle was significantly larger in the arthrodesis group, suggesting that the arthrodesis group had larger compensatory motion of the MP joint in volar adduction compared to normal subjects. CONCLUSIONS These findings on the amount of hypermobility of MP joint after TM joint arthrodesis are valuable information for optimal postoperative rehabilitation protocol. To achieve good range of motion of thumb abduction and adduction following TM joint arthrodesis, emphasis must be placed in obtaining maximum potential motion of STT joint rather than hypermobility of MP joint.

Analysis of shoulder abduction by dynamic shoulder radiograph following suprascapular nerve repair in brachial plexus injury

BACKGROUND Suprascapular nerve repair is a widely-prioritized procedure for shoulder reconstruction following brachial plexus injury. Although this procedure only reconstructs glenohumeral joint motion, the standard clinical assessment of shoulder function also includes the scapulothoracic joint contribution. The purpose of this preliminary study was to develop an objective method to accurately analyze shoulder abduction following suprascapular nerve repair in brachial plexus injury patients. METHODS We introduced an objective method to accurately analyze independent shoulder abduction performed by supraspinatus muscle with the help of dynamic shoulder radiography. Antero-posterior radiographs of both shoulders in adduction and maximal active abduction were obtained. Five parameters were measured. They included global abduction, abduction in glenohumeral, scapulothoracic and clavicular joints along with lateral flexion of thoracic spine. Data were analyzed to distinguish glenohumeral joint contribution from that of scapulothoracic motion. The detailed biomechanics of glenohumeral motion were also analyzed in relation to scapulothoracic motion to separately define the contribution of each in global shoulder abduction. RESULTS The test-retest, intra-examiner and inter-examiner reliabilities of the measurements were assessed. Intra-class correlation coefficient, Bland-Altman plots and repeatability coefficients showed excellent reliability for each parameter. The range of glenohumeral abduction showed high correlation to subtraction of the range of scapulothoracic from the range of global abduction. However, not all negative ranges of glenohumeral abduction meant non-recovery after nerve repair, because scapulothoracic motion contributed in parallel but not uniformly to global shoulder motion. CONCLUSION The conventional measurement of shoulder global abduction with goniometer is not an appropriate method to analyze the results of suprascapular nerve repair in brachial plexus palsy patients. We recommend examination of glenohumeral and scapulothoracic motions separately with dynamic shoulder radiographic analysis. With scapulothoracic contribution to the global shoulder motion, the glenohumeral motion can be wrongly assessed.