Yoshifumi Nagatani

Peripheral Nerve Intraneural Ganglion Cyst: Mr Findings in Three Cases

We present MR findings of three cases of surgically proved intraneural ganglion cysts involving the common peroneal nerve (two patients) and ulnar nerve (one patient). The lesions were located along the course of the involved nerve and situated close to a joint. MRI demonstrated the cystic nature and extent of the lesions with clear definition of the anatomic relationship of the lesions to the surrounding structures.

Vascularized toe-to-finger joint transplantation. 11 patients followed for 4 years.

Since 1983, we have transplanted 11 free vascularized joints in 8 men and 3 women, mean age 32 years. The causes of joint involvement were trauma in 9 cases and infection in 2. One MP and 10 PIP joints of the second toe were transplanted to 3 MP and 8 PIP joints of the fingers. After a mean postoperative follow-up period of 4 years, the mean postoperative range of motion was 31 degrees compared with 16 degrees preoperatively. Radiographs showed destruction of 4 PIP joints, probably caused by vascular failure in 2 joints and infection in 2. In spite of no evidence of arthrosis, some of the joints had gradually undergone a loss of extension. Although there are some problems that should be overcome, we advocate a free vascularized toe-joint transplantation for severe finger-joint destruction without extensive surrounding soft-tissue damage.

Natural History of Chronic Scaphoid Fractures

The dorsiflexed intercalated segment instability (DISI) pattern can usually be detected in chronic scaphoid fractures. We reviewed the roentgenographic findings of 75 chronic scaphoid fractures (21 delayed unions and 54 non-unions) in order to assess the incidence and severity of the DISI pattern and degenerative changes of the wrist. In the cases of delayed union, 3 out of 4 (75%) distal third fractures and 1 out of 16 (6%) middle third fractures had a DISI pattern; it was absent in the 1 proximal third fractures. In the cases of non-union, 9 out of 10 (90%) distal third fractures and 10 out of 35 (29%) middle third fractures had a DISI pattern. Thus, the DISI pattern was found most frequently in distal-third fractures and more frequently in chronic cases. In the patients whose duration of non-union was less than 10 years, the incidence of degenerative changes of the wrist was 15%. However, when the duration of non-union was more than 20 years, all the patients had arthrosis.

Treatment of Acute Stable Scaphoid Fracture Using the Herbert Screw with a Small Skin Incision

Acute stable scaphoid fracture (Herbert type A2) is generally managed conservatively with a plaster cast. However, long-term immobilization causes inconveniences of daily living and, more importantly, prohibits an early return to work even for the person who is not a heavy laborer and could resume working had the wrist not been fixed in a cast. Since the Herbert bone screw gives rigid internal fixation of bone fragments and allows early mobilization of the wrist, acute stable scaphoid fracture is treated using this screw, without requiring a cast, in order to solve the problems mentioned above. The screw is inserted into the scaphoid through a small skin incision just over the scaphotrapezial joint using a free-hand procedure monitored under an image intensifier. Thirteen wrists of 13 patients were operated upon from May, 1988 until November 1990. The average age of the patients was 29.4 years. The average time for returning to work after surgery was 3.2 weeks (range 1 day to 6 weeks). The average hand-grasping power was 94.6% and the average range of motion of the wrist was 98.1% compared with the non-affected side. According to Herbert’s assessment system, the results of all the cases were graded as excellent.