Micha Rinott

Low-Grade Fibromyxoid Sarcoma of the Hand: A Case Report

We report a case of low-grade fibromyxoid sarcoma with giant collagen rosettes in the hand of a 21-year-old female. This is a clinically and radiological benign appearing tumor that has a high rate of recurrence and metastasis.

The use of prophylactic antibiotics in treatment of fingertip amputation: a randomized prospective trial

PURPOSE Fingertip amputation is a common injury. Considerable controversy exists as to whether prophylactic antibiotics are necessary for this injury. Our goal was to compare the rate of infections among subgroups with and without prophylactic antibiotic treatment. The study hypothesis was that infection rates were similar in the 2 groups. METHODS This was a prospective randomized control trial of adult patients presenting with fingertip amputation with bone exposed, requiring surgical treatment. Patients were randomized to 2 groups: group 1 received no antibiotics, and group 2 received 1 g intravenous antibiotics (cefazolin) for 3 days. The 2 groups were matched for age, time to surgery, injury mechanism, and type of surgery. All surgical treatments were performed in the operating room, and all patients were reevaluated in our outpatient clinic after 10 days and again after a month. The primary outcome measure was the rate of infection. RESULTS Fifty-eight patients were initially enrolled in the study; 2 patients withdrew before study completion, 29 subjects were randomized to the no-antibiotic group, and 27 subjects were randomized to the antibiotic group. No statistically significant differences on any baseline values were found between the 2 treatment groups. There was no infection in either group at the end of follow-up. CONCLUSIONS This study suggests that routine prophylactic antibiotics do not reduce the rate of infection after fingertip amputations with bone exposed treated surgically in the operating room.

Osteoid Osteoma of the Hamate: An Unusual Cause of Ulnar-sided Wrist Pain

Ulnar-sided wrist pain is a common complaint that presents a diagnostic challenge. Determining the cause of ulnar-sided wrist pain is difficult, largely due to the complexity of the anatomic and biomechanical properties of the ulnar side of the wrist. Osteoid osteoma is a benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bone. Its incidence is 11% of benign tumors and 3% of all primary bone tumors, with 6% to 13% of all cases occurring in the hand. Osteoid osteoma of the hamate can produce ulnar-sided wrist pain in the dorsal or volar aspect of the wrist, depending on the location of the tumor in the bone. In its classical and most frequent form, the osteoma may settle in the cortex or the spongiosa. A third rare form appears subperiosteally. Occasionally it destroys the articular cartilage by erosion or penetration. Most of the tumors will produce dorsal pain. A tumor located in the hook will produce volar pain. This article describes a case of ulnar-sided wrist pain due to a rare case of osteoid osteoma of the hamate. We recommend marking the nidus with a needle intraoperatively with the aid of radiography.

Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series.

At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the “volar Kapandji technique” completed follow-up of at least 12 (12 to 54) months. The mean age was 43 (23 to 53) years. The mean Disability of the Arm, Shoulder, and Hand score was 21.7 (0 to 41) and the mean Patient-Rated Wrist Evaluation score was 12.9 (0 to 25.8). The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.

The effectiveness of splinting and surgery on sleep disturbance in carpal tunnel syndrome

This controlled prospective study assessed the effectiveness of night splinting compared with non-splinting and surgery for severity of insomnia in patients with carpal tunnel syndrome. Sleep characteristics were observed for several days without a brace, with a brace and after surgery. The sleep measurements included the use of an actigraph worn on the wrist during night, a ‘sleep log’ that conveyed subjective impressions as to how the patient had slept and a short insomnia instrument, the Insomnia Severity Index. The Insomnia Severity Index scores showed that a night splint significantly improved insomnia symptoms compared with no splinting, and surgery significantly improved insomnia symptoms compared with splinting. The sleep log scores showed that the sleep quality and the number of awakenings when a splint was not worn were significantly different from the scores with the splint and the scores after surgery but showed no differences between splint and surgery. The actigraph did not show any significant differences between the treatment methods. Level of evidence: III

Complex Dorsal Metacarpophalangeal Dislocation: Long-Term Follow-Up

PURPOSE To describe the long-term follow-up results of complex dorsal metacarpophalangeal joint dislocation (MPJD). We hypothesize that there would be no long-term functional deficit in most patients, even with the presence of one of the familiar complications. METHODS We describe 5 patients with a median follow-up of 13 (range, 7-36) years and review the literature focusing on follow-up and complications. RESULTS All patients reported full function of the hand. Compared with the contralateral finger, a mild loss of MPJ flexion was noted in 2 patients. Grip strength was reduced in 2 patients. The mean QuickDASH score was 4.5 (range, 0-20.5). Two patients with osteochondral metacarpal head fractures treated with screw fixation demonstrated secondary osteoarthritis changes on x-ray. The literature indicates that complications in patients with complex dorsal MPJD are related to failure of diagnosis, multiple attempts at closed reduction, concomitant osteochondral fracture, traumatic open reduction, or prolonged immobilization, and may result in joint stiffness, early degenerative arthritis, or osteonecrosis of the metacarpal head, pain, premature epiphysis closure, and metacarpal shortening. CONCLUSIONS The findings from this study suggest that complex dorsal MPJD treated on the day of injury with dorsal or volar open reduction techniques can eventually result in a satisfactory outcome, even with one of the complications mentioned. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic V.

Familial Occurrence of Kienbock’s Disease

We present the first reported case of a mother and daughter with unilateral Kienbock’s disease, along with a radiographic and genetic study of the case. The radiographic study demonstrated ulnar minus and flattened radius in both patients. The karyotype of both affected individuals (mother and daughter) was normal 46XX (peripheral lymphocytes). Since the chromosomal analysis was normal, we could not speculate with regard to genetic etiology, or suggest further molecular investigation. If more familial cases become available, it would be possible to investigate this in the future.