Shan-Wei Yang

Surgical management of uncomplicated midshaft clavicle fractures: a comparison between titanium elastic nails and small reconstruction plates

BACKGROUND This study compared titanium elastic nail (TEN) fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures. METHODS The records of 57 patients with midshaft clavicular fractures that were operated on within 2 weeks after injury at Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, were retrospectively analyzed. Each patient received either TENs (n = 25) or fixation with a 3.5-mm reconstruction plate (n = 32) depending on the preference of the operating surgeon. Operative parameters, postoperative pain and function scores, complications, and fracture union time were determined. RESULTS There was no difference in the fracture pattern distribution between the 2 groups, and all operations were performed without complications. Operation time, wound size, blood loss, length of hospitalization, and subjective time to pain relief were less for the TEN group than for the 3.5-mm reconstruction plate fixation group (P < .001 for all). Patients in the TEN group showed a greater range of shoulder motion and higher Constant scores than those in the plate fixation group up to 18 weeks after surgery (P < .001 for all). Fewer patients in the TEN group, 4 (16%), requested removal of the implant, as compared with 12 (37.5%) in the plate group. CONCLUSION Fixation of uncomplicated midshaft clavicle fractures with TENs provides adequate fixation and faster relief of pain and return to normal function of the affected shoulder than fixation with 3.5-mm reconstruction plates.

Giant Cell Tumor of the EDL Tendon Sheath: An Unusual Cause of Hallux Valgus

Hallux valgus is a lateral deviation of the proximal phalanx of the first metatarsophalangeal joint. It is a common disorder in adults. The etiologic factors include modern shoes, rheumatoid arthritis, pes planus, metatarsus primus varus, and trauma. Tumors causing hallux valgus deformities are unusual. We report a 50-year-old female with a hallux valgus deformity caused by a giant cell tumor of the second EDL tendon sheath. Surgical excision of the tumor and corrective osteotomy produced a permanent cure. This unusual cause of a hallux valgus deformity should increase awareness of tumors as a possible cause of foot deformities.

Evaluation of the ability of xanthan gum/gellan gum/hyaluronan hydrogel membranes to prevent the adhesion of postrepaired tendons

After tendon-repair surgery, adhesion between the surgical tendon and the synovial sheath is often presented resulting in poor functional repair of the tendon. This may be prevented using a commercially available mechanical barrier implant, Seprafilm, which is composed of hyaluronan (HA) and carboxymethyl cellulose hydrogels. In a rat model, prepared membranes of various compositions of gellan gum (GG), xanthan gum (XG) and HA as well as Seprafilm were wrapped around repaired tendons and the adhesion of the tendons was examined grossly and histologically after 3 weeks of healing. Certain formulations of the XG/GG/HA hydrogel membranes reduced tendon adhesion with equal efficacy but without reducing the tendon strength compared to Seprafilm. The designed membranes swelled rapidly and blanketed onto the tendon tissue more readily and closely than Seprafilm. Also they degraded slowly, which allowed the membranes to function as barriers for extended periods.

Clinical results of using minimally invasive long plate osteosynthesis versus conventional approach for extensive comminuted metadiaphyseal fractures of the radius

IntroductionThe minimally invasive plate osteosynthesis (MIPO) technique has been introduced recently. The extensive comminuted fractures of the distal radial metaphysis with diaphyseal involvement are probably good indications for MIPO technique because of less extensive dissection and soft-tissue stripping. The purpose of this retrospective study was to compare the clinical results of MIPO technique to those of conventional open reduction in extensive metadiaphyseal fractures of distal radius.Materials and methodsOf 34 patients treated for comminuted metadiaphyseal fractures of the distal radius between June 2006 and May 2012, all the patients had extra-articular fractures. Twenty-one patients underwent MIPO technique and 13 underwent conventional open reduction with long periarticular locking plates system (Zimmer). Six patients in the MIPO group and three in the conventional group who had concomitant distal ulnar fractures or distal radioulnar joint (DRUJ) injury underwent plate osteosynthesis or Kirschner-wire fixation before radial fixation. Perioperative parameters and union time were recorded. Radiologic assessment, Mayo Wrist Score, and satisfaction scale were evaluated at the final follow-up.ResultsAll fractures united without secondary procedures. Radiologic assessment, Mayo wrist score, and time to union showed no significant difference between the two groups, but the MIPO group had significantly smaller incision wound, higher satisfaction scale, and shorter operative time than did the conventional group.ConclusionsMIPO is capable of achieving functional results as good as those of conventional open reduction, with a higher satisfaction scale, smaller incision, and shorter operative time. When MIPO intervention is planned, concurrent distal ulnar fracture or DRUJ injury should be repaired first, thus facilitating subsequent indirect reduction. For treating intra-articular fractures, anatomical reduction of the articular surface is more important, and the MIPO technique described here is not recommended.

Surgical Treatment of Multifocal Giant Cell Tumor of Carpal Bones With Preservation of Wrist Function : Case Report

We report a rare case of multifocal giant cell tumor of bone involving the trapezium, trapezoid, capitate, and scaphoid with soft tissue extension. Following intralesional resection, an autogenous corticocancellous iliac crest bone graft was used to fill the resultant defect and preserve carpal height and radiocarpal motion. Successful union with no recurrence was noted at 1-year follow-up.

The Biological Effects of Sex Hormones on Rabbit Articular Chondrocytes from Different Genders

The aim of this study was to investigate the biological effects of sex hormones (17β-estradiol and testosterone) on rabbit articular chondrocytes from different genders. We cultured primary rabbit articular chondrocytes from both genders with varying concentration of sex hormones. We evaluate cell proliferation and biochemical functions by MTT and GAG assay. The chondrocyte function and phenotypes were analyzed by mRNA level using RT-PCR. Immunocytochemical staining was also used to evaluate the generation of collagen-II. This study demonstrated that 17β-estradiol had greater positive regulation on the biological function and gene expressions of articular chondrocytes than testosterone, with the optimal concentrations of 10−6 and 10−7 M, particularly for female chondrocytes.

Use of the Schanz screw as a joystick and the Poller screw in intramedullary nailing for subtrochanteric or proximal femoral fracture

We read with great interest the article titled ‘‘Use of blocking screws in intramedullary fixation of subtrochanteric fractures’’ by Amin et al. [1]. We congratulate the authors on their success in using intramedullary nailing in conjunction with the placement of blocking screws to treat six patients with subtrochanteric fractures. All their patients demonstrated satisfactory results, with alignment and bony union maintained at the final radiographic followup. These types of fractures present with characteristic musculature-induced difficulties to control reduction. The abductors and short external rotators insert over the greater trochanter, and the lesser trochanter is the insertion site for the iliacus and psoas hip flexors. These muscles cause the proximal fragment to develop a flexed, abducted and externally rotated position after a fracture [2]. This deformity cannot be resolved with traction on the fracture table with traction, and it is difficult to find a precise point of entry and achieve excellent reduction. Sadighi et al. [3] reported that percutaneously placed Schanz screws used as joysticks could facilitate closed reduction. Kim et al. [4] described a procedure in which they reamed the proximal fragment progressively up to 13 mm, selected a nail that was 2–3 mm smaller than the estimated diameter of the isthmic portion, and inserted the nail into the proximal fragment and manipulated it in an extended, adducted, and internally rotated direction to achieve good reduction and cross the fracture site. Otherwise, the proximal fragment would have a larger canal diameter compared with the distal fragment, and inadequate alignment with translation would be noted if the proximal reamed canal deviated toward the medial or lateral cortex. Krettek et al. [5] described the clinical application of Poller screws to prevent axial deformities during intramedullary nailing for proximal and distal tibial fractures during intramedullary nailing. Amin et al. [1] termed these screws ‘‘blocking screws’’ and applied them to the proximal femoral fragment, separately targeting the medial one-third and posterior one-third. We developed a simple synthesized technique using the Schanz screw as a joystick and the Poller screw for treatment of subtrochanteric or proximal femoral fractures. With the injured limb under traction on the fracture table, one Schanz screw is inserted over the proximal fragment under fluoroscopic guidance and pushed to cause proximal fragment adduction. It is convenient to find a precise entry point for the nail. A ball-tip guide wire is inserted into the proximal canal after using an awl to create the entry point. The Shanz screw is unscrewed until the lateral third of the canal is occupied as Poller screw. The Schanz screw is maintained in position to keep the make medial cortex contact (extended, adducted, and internally rotated), and the guide wire is progressed across the fracture site. This is C.-Y. Chen K.-C. Lin (&) S.-W. Yang Y.-W. Tarng C.-J. Hsu J.-H. Renn Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, Taiwan e-mail: orthokcl@gmail.com

Intramuscular Ganglion Cyst of the Quadriceps Muscle: Report of a Case

A 33-year-old male had complained of a painless mass above his right knee joint for more than three years. Physical examination revealed a firm, mobile, non-tender mass superior-lateral to his right knee joint. Magnetic resonance imaging showed a cystic lesion within the vastus lateralis muscle without communication to the knee joint. After excision of the mass, pathological report of the specimen showed a ganglion cyst without lining cells. Based on its anatomic location and histology, the final diagnosis was intramuscular ganglion cyst of the quadriceps muscle.

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

BackgroundThe wide-awake local anesthesia no tourniquet (WALANT) technique is applied during various hand surgeries. We investigated the perioperative variables and clinical outcomes of open reduction and internal fixation (ORIF) for distal radius fractures under WALANT.MethodsFrom January 2015 to January 2017, 60 patients with distal radius fractures were treated, and 24 patients (40% of all) were treated with either a volar or a dorsal plate via WALANT procedure. Of these 24 patients, 21 radius fractures were fixed with a volar plate, and the other 3 were fixed with a dorsal plate. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated.ResultsOne of the 24 patients could not tolerate the WALANT procedure and was reported as a failed attempt at WALANT. In the cohort, 23 patients successfully received distal radius ORIF under WALANT procedure. The average age is 60.9 (range, 20–88) years. The average operation time was 64.3 (range, 45–85) minutes, the average blood loss was 18.9 (range, 5–30) ml, and the average of duration of hospitalization is 1.8 (range, 1–6) days. The average postoperative day one VAS was 1.6 (range, 1–3). The average time of union was 20.7 (range, 15–32) weeks. The mean follow-up period was 15.1 (range, 12–24) months. Functional 1-year postoperative outcomes revealed an average Quick DASH score of 7.60 (range, 4.5–13.6) and an average wrist flexion and extension of 69.6° (range, 55–80°) and 57.4° (range, 45–70°). There was no wound infection, neurovascular injury, or other major complication noted.ConclusionsWALANT for distal radius fracture ORIF is a method to control blood loss by the effects of local anesthesia mixed with hemostatic agents. Without a tourniquet, the procedure prevents discomfort caused by tourniquet pain. Without sedation, patients could perform the active range of motion of the injured wrist to check if there is impingement of implants. It eliminates the need of numerous preoperative examinations, postoperative anesthesia recovery room care, and side effects of the sedation. However, patients who are not amenable to the awake procedure are contraindications.

Cross-finger subdermal pocketplasty as a salvage procedure for thumb tip replantation without vascular anastomosis: a case report

Objectives Fingertip amputation is often encountered in emergency departments, especially in hospitals located near industrial areas. Replantation of the fingertip can be considered when the normal architecture is preserved in cases of sharp amputation. The goal of replantation is to preserve cosmesis and function, especially for the thumb because of its involvement in grasping and the key pinch. Even when microsurgical vascular anastomosis is applied, the absence of venous anastomosis along with the high rate of failure of arterial anastomosis in zone 1A fingertip amputation may lead to replantation failure. Methods We herein present a case report of thumb tip amputation salvaged via a modified cross-finger technique. The recipient site was on the ipsilateral radial side of the intermediate phalanx of the middle finger. Results The thumb tip was successfully replanted with no vascular anastomosis, and this new technique prevented stiffness in the metacarpophalangeal and interphalangeal joints of the thumb and middle finger. Conclusions This procedure can be performed in local clinics and emergency departments without the need for arterial and venous anastomoses.