Narihito Kodama

Ultrasound-Assisted Closed Reduction of Distal Radius Fractures

PURPOSE To assess the accuracy and ability of ultrasound for monitoring closed reduction for distal radius fractures. METHODS Consecutive patients undergoing ultrasound-guided closed reduction of acute, displaced distal radius fractures between January 2003 and December 2006 at our department were enrolled. The control group was extracted from patients who underwent a closed reduction for similar fractures under fluoroscopy or without any imaging assistance. To confirm the accuracy of the ultrasonography measurements, displacement distance values were compared with those on radiographic imaging before and after reduction. X-ray parameters for pre- and postreduction, reduction time, total cost, and success rate were compared between the ultrasound-guided and the control groups. RESULTS The ultrasound-guided group consisted of 43 patients (mean age, 68 y) and the control group consisted of 57 patients, which included 35 patients (mean age, 74 y) with fluoroscopic reduction and of 22 patients (mean age, 72 y) with reduction unaided by imaging. There were no significant displacement differences between radiographic and ultrasound measurements. In x-ray parameters for pre- and postreduction, there were no significant differences between the 2 groups. Ultrasound-guided reduction took longer than the other 2 methods. The success rate of the ultrasound and the fluoroscopic groups were similar (95% and 94%, respectively). CONCLUSIONS Our data suggest that ultrasound assistance can aid reduction of distal radius fractures as well as fluoroscopy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.

A Simple Method for Choosing Treatment of Distal Radius Fractures

PURPOSE To design an easy-to-use guide for decision making in distal radius fractures in patients older than 50 years and to retrospectively analyze its ability to predict treatment in 164 patients. METHODS The present study consisted of 4 parts. The first part was a review of the literature to identify possible important factors that predict treatment outcome of distal radius fractures in patients 50 years old and older. The second part identified which of these first-tier factors that orthopedic surgeons consider to be important by a questionnaire that was sent to 83 orthopedic surgeons qualified by the Japanese Orthopedic Association with response rate of 61%. The third part further identified which of the subsets of factors best predict outcome in a retrospective study of 41 patients 50 years old or older, yielding a final subset of factors to create a scoring system. The fourth part of the study then evaluated the ability of this scoring system to predict the outcome as evaluated by the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score in a retrospective study of 164 distal radius fractures in patients 50 years old or older. RESULTS The 164 patients were divided into 4 groups by the present scoring system: conservative group, relative conservative group, relative surgical group, and surgical group according to the recommended therapeutic modalities. Clinical outcomes of those that followed the recommendation of the present scoring system resulted in favorable consequences. In contrast, the outcomes of those not following the recommendation were inferior. CONCLUSIONS The present scoring system may be used as an easy-to-use decision-making tool when choosing conservative or surgical treatment for distal radius fractures.

Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome

Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.

A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle

A new method of vascularised tibial grafting has been developed for the treatment of avascular necrosis (AVN) of the talus and secondary osteoarthritis (OA) of the ankle. We used 40 cadavers to identify the vascular anatomy of the distal tibia in order to establish how to elevate a vascularised tibial graft safely. Between 2008 and 2012, eight patients (three male, five female, mean age 50 years; 26 to 68) with isolated AVN of the talus and 12 patients (four male, eight female, mean age 58 years; 23 to 76) with secondary OA underwent vascularised bone grafting from the distal tibia either to revascularise the talus or for arthrodesis. The radiological and clinical outcomes were evaluated at a mean follow-up of 31 months (24 to 62). The peri-malleolar arterial arch was confirmed in the cadaveric study. A vascularised bone graft could be elevated safely using the peri-malleolar pedicle. The clinical outcomes for the group with AVN of the talus assessed with the mean Mazur ankle grading scores, improved significantly from 39 points (21 to 48) pre-operatively to 81 points (73 to 90) at the final follow-up (p = 0.01). In all eight revascularisations, bone healing was obtained without progression to talar collapse, and union was established in 11 of 12 vascularised arthrodeses at a mean follow-up of 34 months (24 to 58). MRI showed revascularisation of the talus in all patients. We conclude that a vascularised tibial graft can be used both for revascularisation of the talus and for the arthrodesis of the ankle in patients with OA secondary to AVN of the talus.

Florid reactive periostitis of the forearm with pronation and supination contracture.

Extraskeletal bone lesions are occasionally encountered in the upper extremities. The differential diagnosis for these lesions includes myositis ossificans and related nonneoplastic, heterotopic ossifications, fibrodysplasia ossificans progressiva, and extraskeletal osteosarcoma [1]. Florid reactive periostitis (FRP), one of the heterotopic ossifications, is a benign bone-forming lesion that is frequently encountered in the hands and feet [2–6]. Typically, the lesion affects adolescents and young adults and presents as a swollen and painful finger or toe. However, FRP involving the forearm is rare, and the etiology is unclear. We report the case of a 53-year-old woman who was followed clinically and radiographically after the diagnosis of FRP with pronation and supination contracture in the forearm. We also discuss the surgical treatment with use of a pedicled fascio-fat flap after marginal resection of the lesion.

CONGENITAL UNILATERAL UPPER LIMB MUSCULAR HYPERTROPHY ASSOCIATED WITH CONTRACTURE OF AN EXTRINSIC EXTENSOR TENDON

We report a case of congenital unilateral upper limb muscular hypertrophy which presented with loss of extensor tendon excursion of a single digit in late adolescence. The reason for the problem arising is not clear and is not clearly explained by the underlying congenital pathology.

Physeal Bar Resection Under Guidance With a Navigation System and Endoscopy for Correction of Distal Radial Deformities After Partial Growth Plate Arrest

Partial growth plate arrest caused by trauma may lead to severe deformity and dysfunction. The Langenskiöld method is a surgical technique that involves resection of the physeal bar causing partial growth plate arrest. However, it is a technically demanding procedure. We used the Langenskiöld method under guidance with a navigation system and endoscopy and obtained good results in 2 cases. We consider that use of these tools can be a helpful adjunct to the carrying out this procedure.

Arthrodesis of the ankle using an anterior sliding tibial graft for osteoarthritis secondary to osteonecrosis of the talus: A comparison of vascularised non-vascularised grafts

AIMS This retrospective cohort study compared the results of vascularised and non-vascularised anterior sliding tibial grafts for the treatment of osteoarthritis (OA)of the ankle secondary to osteonecrosis of the talus. PATIENTS AND METHODS We reviewed the clinical and radiological outcomes of 27 patients who underwent arthrodesis with either vascularised or non-vascularised (conventional) grafts, comparing the outcomes (clinical scores, proportion with successful union and time to union) between the two groups. The clinical outcome was assessed using the Mazur and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. The mean follow-up was 35 months (24 to 68). RESULTS The mean outcome scores increased significantly in both groups. In the vascularised graft group, the mean Mazur score improved from 36.9 to 74.6 and the mean AOFAS scale improved from 49.6 to 80.1. In the conventional arthrodesis group, the mean Mazur score improved from 35.5 to 65 and the mean AOFAS scale from 49.2 to 67.6. Complete fusion was achieved in 13 patients (76%) in the vascularised group, but only four (40%) in the conventional group. The clinical outcomes and proportion achieving union were significantly better in the vascularised group compared with the conventional arthrodesis group, although time to union was similar in the two groups. TAKE HOME MESSAGE Vascularised sliding tibial grafts may be used to achieve arthrodesis in patients with OA of the ankle secondary to osteonecrosis of the talus.

New option for surgical treatment of the trapeziometacarpal osteoarthritis: a case report

Abstract We present the case of a 71-year-old, left-handed woman with left thumb carpometacarpal (CMC) joint arthritis. The patient had no pain and could use the hand actively in daily life with a new option of surgical treatment, a vascularized pedicled third CMC joint transfer to the thumb CMC joint.

Tumor-Induced Osteomalacia Caused by a Bone Tumor in the Ulna

Hypophosphatemic osteomalacia induced by overproduction of fibroblast growth factor 23 (FGF23) by a tumor is a relatively rare paraneoplastic syndrome that recently has been recognized. During the course of the disease, termed “tumor-induced osteomalacia” (TIO), the level of phosphorus in the blood becomes reduced as a result of accelerated diuresis due to excessive FGF23 production by the tumor, resulting in bone calcification dysfunction in the entire body, which leads to osteomalacia1-4. TIO most commonly develops in middle-aged adults, with no differences between men and women. Clinically, it is characterized by general bone pain, muscular weakness, and pathological fractures. A TIO-like syndrome can also be seen in association with other diseases such as prostate cancer, small-cell carcinoma (oat cell cancer), hematologic malignancies, neurofibromatosis, epidermal nevus syndrome, and polyostotic fibrous dysplasia of bone5-15. We describe a tumor resection and ulnar bone reconstruction in a patient with an ulnar tumor that caused TIO. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-nine-year-old left-handed man presented to our department with pain in the left forearm. There was no appreciable family or previous medical history. He worked as a delivery person. Plain radiographic findings revealed a cystic lesion of the bone and a pathological fracture in the diaphysis of the left ulna. Moreover, a Looser zone, which is a lucent band adjacent to the periosteum representing an unhealed insufficiency-type stress fracture commonly associated with osteomalacia, was seen in the diaphysis of the left radius (Fig. 1). Systemic bone disease was suspected. The patient initially had noticed bone pain throughout the entire body about two years prior, but did not seek treatment. Fig. 1 Anteroposterior (top) and lateral (bottom) radiographs show a cystic lesion and pathological fracture in the …