Luis Renato Nakachima

Melorheostosis of the Thumb and Trapezium Bone

Melorheostosis of the hand is rare. We report a 28-year-old woman with persistent pain associated with a slowly growing mass on the dorsum of the right thumb. The radiographs, computed tomography, and magnetic resonance imaging were used to examine characteristic of melorheostosis involving the trapezium bone, first metacarpal, and proximal phalange. The lesions underwent a surgical debulking of the hyperostotic cortex and a cortical fenestration.

Carpal tunnel release using the Paine retinaculotome inserted through a palmar incision.

BackgroundCarpal tunnel syndrome (CTS) is the most commonly diagnosed and treated entrapment neuropathy. There is no consensus regarding the optimal technique for carpal tunnel release. The objective of this study is to demonstrate the surgical treatment of CTS by a small palmar incision and utilization of Paine retinaculotome to divide the transverse carpal ligament.MethodsIn this technical note, we describe the use of a retinaculotome described by Paine in 1955, through a palmar approach.DiscussionOpen, minimally invasive and endoscopic surgical techniques have all been described as treatment options for CTS, and short-term success with these methods is well established. During the last decade, less invasive techniques have been developed in order to reduce the incidence of pillar pain and tender scars. We have used a mini-palmar incision and the Paine retinaculotome for carpal tunnel release since 1994. The goals of surgery are to create a small incision that permits a patient to have early motion and return to activity.ConclusionAfter many years, no permanent nerve or vascular damage has been reported. This method has demonstrated itself to be efficient and safe in the treatment of the carpal tunnel syndrome.

Intra-individual evaluation of results between open and endoscopic release in bilateral carpal tunnel syndrome

Objective The authors performed an intra-individual comparison of surgical results between the open and endoscopic surgical techniques in patients with bilateral carpal tunnel syndrome. Each hand was submitted to surgery using one of these techniques. Methods Fifteen patients (30 hands) were evaluated by the Boston Questionnaire, visual analogue pain scale, palmar grip strength, and for tip, key, and tripod pinch strengths. These measurements were taken before surgery and at two weeks, one month, three months, and six months after the procedure. Scores for each evaluation tool in each evaluation time period were compared. Results In comparison to the group submitted to open surgery, the group submitted to endoscopic surgery had worse scores in the evaluation of the 1st and 6th postoperative months regarding the severity of the symptoms. The authors found no differences in the functional status of the hand. Regarding the intensity of pain evaluated by the visual analogue pain scale, no difference was found between the averages in all time periods evaluated. No differences in palmar grip strength and in fingertip, key (lateral), and tripod pinch strengths were found in all time periods. There were no differences between averages in the preoperative period at two weeks, one month, and three months after surgery. After six months, the group of patients submitted to open surgery presented greater tripod force than the group of patients who underwent endoscopic surgery. Conclusion No differences were observed by using the intra-individual evaluation in the results between open and endoscopic techniques for the treatment of carpal tunnel syndrome.

Hand Surgery and the Crack-Cocaine User. A Case Report

Keywords Crackhands.Fingertipburns.Handsurgery.CrackuserIntroductionCocaine comes in two forms, hydrochloride (white power)and freebase (crack). “Crack” is the street name given tococaine made by the combination of the hydrochloride andalkali (sodium bicarbonate or ammonium) [1]. Some crack-cocaine users develop changes in the appearance of theirhands caused by the heat of the glass cocaine pipe [2]. Thepresence of burns and blackened hyperkeratotic lesions,mostly on the dominant hand or digits, have led to the term“crack hands” [3]. We present a case report of a patient witha chronic boutonniere deformity in the fifth finger andsuperficial burns on the tips of the thumb, second and thirdfingers.Case ReportA 21-year-old man was admitted to the hospital for surgeryto correct chronic botounniere deformity of the fifth fingerof the right hand.During the entrance exam, burns on the tips of the thumbindex and middle fingers (Fig. 1) were observed. Immedi-ately, it was thought that those were thermal burns fromlighting a crack cocaine pipe. The patient was asked if hewas using crack and he denied it. As the lesions were notacute, the surgery was performed without complicationsduring anaesthesia.During the surgical repair, the central band of the exten-sor hood was reattached in to the base of the media phalanxwith a mini-anchor. The PIP joint was fixed in full extensionwith a transarticular Kirschner wire. The patient wasinformedoftheimportanceofmaintainingthePIPinapropersplint for the designated amount of time following repair.During the second week after the operation, a pin tract infec-tionappeared.Itwastreatedwithoralantibioticsandremotionof the Kirschner wire. The splint was sustained for 6 weeks.The patient performed hand therapy irregularly. After 1 year,the finger was painful and with loss of digital motion in aflexion deformity.DiscussionCocaine is a central nervous system stimulant extracted fromErythroxylumcocaleaves.Free-basecocaineispreparedfrom

Evaluation of Interobserver Agreement in the Albertoni’s Classification for Mallet Finger

Objective: To measure the reliability of Albertoni’s classification for mallet finger. Methods: We performed an evaluation using a questionnaire where there were 43 pictures of radiographs of the distal interphalangeal joint with mallet finger. All lesions were classified by Albertoni’s classification, for a total of 19 respondents (12 hand surgeons and 7 interns). It was then evaluated by the interobserver agreement using the kappa coefficient, separated by groups—(1) tendon avulsion, (2) avulsion fracture, (3) fracture of the dorsal lip, and (4) phisis injury—and subgroups (each group divided into 1 and 2). Results: Agreement was excellent for the group A (k, 0.95 [0.93-0.97]) and remained good when separated into A1 and A2; group B was reasonable (k, 0.42 [0.39-0.44]), and poor when separated into B1 and B2; in the group C, agreement was good (k, 0.72 [0.70-0.74]), but when separated into C1 and C2, it became moderate. In group D, agreement was always bad (k, 0.16 [0.14-0.19]). The general agreement was moderate, with k, 0.57 (0.56-0.58). Conclusion: Albertoni’s classification evaluated for interobserver agreement is considered a reproducible classification by the method used in the research.