Clinical Results of Closed Reduction and Percutaneous Pinning for Gartland Type II Flexion-Type Supracondylar Humeral Fractures in Children: Report of Three Cases.

Supracondylar humerus fractures are the most common upper limb injury in children, but the incidence of flexion-type fractures is relatively low. Herein, we report the clinical results for three children with Gartland type II flexion-type supracondylar humeral fractures treated by closed reduction and percutaneous pinning. From April 2004 to March 2020, 102 children with supracondylar humeral fractures underwent surgery at our hospital and related institutions. Four had a flexion-type supracondylar humeral fracture (3.9%). Three patients (1 boy and 2 girls) with Gartland type II flexion-type supracondylar humeral fractures were followed for more than 12 months. The patients were treated by closed reduction and percutaneous pinning. Age was 7-13 years at the time of injury, and the duration of postoperative follow-up was 12-16 months. In one case, ulnar nerve paresis was observed as a preoperative complication. After performing closed reduction, percutaneous Kirschner wire cross-fixation was performed. Subsequently, long upper limb cast fixation was carried out for 4 weeks postoperatively. One patient developed preoperative nerve paralysis but recovered in approximately 3 months, without postoperative complications such as infection, nerve paralysis, or cubitus varus or valgus deformity. Flynn's criteria results were excellent for two patients and good for one patient. To maintain anatomical reduction of the fracture fragment, closed reduction using a traction table and percutaneous steel wire fixation are useful for treating flexion-type supracondylar humerus fractures in children with Gartland type II fractures.

Minimal Invasive Corrective Osteotomy with the Ilizarov Mini-Fixator for Malunited Fractures of Proximal Phalanges in Adolescence: Report of Three Cases and a Review of the Literature.

Posttraumatic malunion with combination of angular, rotational, and shortening deformity of the proximal phalanx may cause scissoring of a finger and impairment of hand function. Cosmetic disfigurement and severe dysfunction of fingers require surgical correction, most often via open corrective osteotomies and rigid fixation with a plate or screws. However, such an approach requires a longer incision, inevitably results in a scar, and has a higher potential for extensor tendon adhesion. Also, abruption of the periosteum and plating of the phalange requires longer bone healing time. Thus, we devised a technique of minimally invasive correction of phalangeal malunion using an external mini-fixator. We presented representative three cases of malunited fractures of phalanges treated with the Ilizarov mini-fixator in adolescence and review reports of similar cases. The usage of Ilizarov mini-fixator provided excellent outcomes for posttraumatic malunion of three fingers.

Comparison of Single-Plate and Double-Plate Osteosynthesis with Locking Plate Fixation for Distal Humeral Fracture in Older Adults.

BACKGROUND: Management of transcondylar fracture of the humerus in older adults remains a challenging issue in trauma surgery. Both single- and double-plate fixation are used, and the best procedure is yet to be determined. This retrospective study evaluated and compared the clinical and radiological outcomes of single- and double-plate fixation for transcondylar humeral fracture. METHODS: This study included older adults (age >65 years) with transcondylar fractures of the humerus (AO/OTA 13A2-3; transverse, transmetaphyseal fracture) treated at our hospital between 2002 and 2019. The patients were divided into two groups based on the fixation procedures they underwent, namely, single (group S) or double (group D) locking plate osteosynthesis. Postoperative outcomes were investigated. RESULTS: Group S and group D comprised 11 (11 women) and 17 (2 men; 15 women) patients, respectively. In group S, the elbow was immobilized in a long-arm cast or splints for 2 weeks to prevent early displacement of fracture. Residual numbness of the ulnar digits was observed in two patients in group S and in nine patients in group D. No significant difference was noted between the two groups in the ratio of loss of reduction, loosening of the medial screw, ulnar nerve disturbance, or clinical outcomes. The ratio of elbow contracture significantly differed between 2 groups. The elbow flexion angle was significantly lower in group S. CONCLUSIONS: Open reduction and internal fixation with a double plate appears to be the optimal choice for early postoperative mobilization and maintenance of flexion and arc of the elbow joint.

Purulent Flexor Tendon Rupture of the Hand due to Mycobacterium abscessus Infection: A Case Report and Review of the Literature.

Mycobacterium abscessus infection of the upper extremities is uncommon. However, M abscessus can cause severe chronic tenosynovitis, and delayed diagnosis may result in poor outcomes. We describe an unusual clinical case of purulent flexor tendon synovitis followed by subcutaneous tendon rupture due to M abscessus infection in a patient with diabetes mellitus. A 76-year-old man presented to our hospital with painful, erythematous swelling over his left fourth finger. On physical examination, the left fourth finger was swollen and reddish, with persistent exudate from the surgical scar. The left elbow was also swollen and reddish with persistent discharge, which was consistent with olecranon bursitis. The patient was unable to flex his left fourth finger, and the passive range of motion of the finger was also restricted. The physical examination findings and patient history suggested purulent flexor tendinitis. His infection healed after radical debridement of necrotic tissue and administration of antibiotics effective against M abscessus. Third-stage flexor reconstruction restored the function of the fourth finger. The combination of surgical debridement and chemotherapy was the most effective treatment for mycobacterial tenosynovitis. This case shows that M abscessus can cause chronic severe purulent tenosynovitis and flexor tendon rupture after tendon surgery. Although early diagnosis and combination treatment with debridement and chemotherapy might improve outcomes by limiting the severity and duration of damage to the flexor synovial system, late-presenting patients require combined radical debridement of necrotic tissue and aggressive chemotherapy followed by staged flexor tendon reconstruction.

Surgical Outcomes of Coronal Shear Fracture of the Distal Humerus in Elderly Adults.

BACKGROUND: This study evaluated clinical outcomes of elderly adults with coronal shear fractures (CSFs) of the distal humerus treated by open reduction and internal fixation (ORIF). METHODS: Between April 2002 and March 2019, data from eight elderly patients (76.3 ± 5.1 years) with CSFs of the distal humerus were analyzed retrospectively. Postoperative complications, range of motion of the elbow joint, and functional elbow scoring (Mayo Elbow Performance Score; MEPS) were assessed. RESULTS: The mean follow-up duration was 23.6 ± 13.9 months. CSFs were treated by a buried implantable headless screw or Kirshner wires or bioresorbable screw with/without lateral locking plates. There were no superficial or deep infections or elbow joint instability. Seven patients obtained fracture healing, but one patient exhibited nonunion. Osteochondritis dissecans was present in one patient. Three patients had a step-off deformity (>2 mm) of the articular surface. Two patients exhibited collapse of the fractured articular surface. A patient with severe comminution of both the capitellum and trochlea exhibited collapse of the entire articular surface, with osteonecrosis of the capitellum and trochlea. Mean range of motion of the elbow was 116.3±12.7° of flexion and -28.8±14.1° of extension. The mean MEPS was 78.8±10.2 points, representing patients scored as excellent (n=1), good (n=3), and fair (n=4). CONCLUSIONS: ORIF yielded satisfactory outcomes for elderly adults with noncomminuted CSFs of the distal humerus. However, treatment of comminuted articular fracture fragment and complex posterior fracture remains challenging.

Novel Surgical Procedure for Half Palmaris Longus Transfer during Opponensplasty of the Thumb for Patients with Carpal Tunnel Syndrome: A Technical Note.

Thumb opposition is an essential movement for daily use of the hand, including precise pinching/grasping and fine and complicated hand movement. Although studies have reported use of several donor tendons for opponensplasty, opponensplasty using the palmaris longus (i.e., Camitz opponensplasty) has been used in patients with loss of opposition function due to longstanding carpal tunnel syndrome. The procedure involves a simple, useful tendon transfer and does not cause functional deficits. To obtain enough length to transfer the tendon to the metacarpophalangeal joint of the thumb, the PL tendon should be obtained with the palmar aponeurosis. However, the palmar aponeurosis is not always available for opponensplasty, as it is occasionally thin and insufficient for elongation of the palmaris longus. An extended skin incision over the palm can cause painful scar formation and postoperative residual pain. This procedure restores the palmar abduction function of the thumb but not opposition function. In the present article, we describe a modification of Camitz opponensplasty that uses a half-split palmaris longus, which is long enough to anchor to the insertion of the adductor pollicis at the metacarpophalangeal joint of the thumb.

Minimally Invasive Corrective Osteotomy with the Ilizarov Mini-Fixator for Malunited Fractures of the Phalanges: Technical Note.

Posttraumatic malunion of the phalanx with rotational deformity may cause crossing of the finger and impair hand function. Cosmetic disfigurement and severe dysfunction of the fingers require surgical correction, most often via open corrective osteotomies and rigid fixation with plates. However, such an approach requires a longer incision, inevitably results in a scar, and has a higher potential for extensor tendon adhesions, which result in extension lags. In addition, abruption of the periosteum and plating of the phalanges require longer bone healing. This report describes the straightforward, minimally invasive correction of phalangeal malunions with a mini-external fixator. In this procedure, a digital block of the affected finger can be performed. The fully flexed position of all fingers provides accurate correction of phalangeal malunions. Although treatment of phalangeal malunions remains challenging, the present procedure is an alternative solution for phalangeal malunions.

Association of Magnetic Resonance Imaging Features with Angioleiomyoma Histologic Subtype.

BACKGROUND: Angioleiomyomas typically present as small, painful, soft-tissue tumors less than 2 cm in diameter. The features of angioleiomyomas on magnetic resonance (MR) imaging are not well understood, and the association of MR findings with histologic subtype is unclear. In the present study, the MR features of angioleiomyomas of average size were compared in relation to histologic subtype. METHODS: This retrospective review of medical records analyzed MR imaging data and histologic specimens from 18 consecutive patients with angioleiomyomas that were resected at our hospital during the period from January 2006 through December 2013. RESULTS: On T1-weighted images, lesions exhibited homogeneous areas that were isointense with skeletal muscle. However, T2-weighted images of solid and venous angioleiomyomas showed heterogeneous areas that were isointense or slightly hyperintense, while cavernous angioleiomyomas exhibited hyperintensity. Most lesions had a hypointense rim, and two thirds had adjacent vessels. CONCLUSIONS: Our results suggest that MR findings for angioleiomyoma vary in relation to histologic subtype. T2-weighted images of solid and venous angioleiomyomas yielded specific MR findings that allowed for differentiation from other soft-tissue tumors, such as soft-tissue sarcomas. Most of these tumors exhibited isointense to slightly hyperintense regions, as compared with skeletal muscle, while findings for cavernous angioleiomyomas were nonspecific. Thus, clinical findings and MR imaging were almost sufficient for preoperative diagnosis of solid and venous angioleiomyomas.

Intratendinous Ganglion of the Extensor Pollicis Longus: Case Report and Literature Review.

Ganglion cysts are common benign lesions in the hand and wrist. However, intratendinous ganglion cysts are uncommon. We present a case of intratendinous ganglion cyst in the extensor pollicis longus (EPL) tendon of the right hand of a 73-year-old woman. The subcutaneous mass moved in concert with the EPL tendon in her right thumb. Magnetic resonance imaging showed a space-occupying lesion in the EPL tendon. Biochemical and hemato-immunological examinations ruled out diabetes, rheumatoid arthritis, and other connective tissue diseases. She reported motion pain during thumb extension, for which she desired surgery. An intratendinous cyst was identified intraoperatively within the tendon substance of the EPL, in which a part of the cyst was herniated into a slit in the tendon substance, just distal to the extensor retinaculum, without notable proliferative synovial tissue. The EPL tendon was opened longitudinally, and a cystic lesion was enucleated. Pathological examination showed that the cyst wall consisted of fibrous tissue with degeneration and no epithelial lining. Postoperative recovery was uneventful. Six months after surgery, the patient had no residual pain and no cyst recurrence. The rarity of intratendinous ganglion cysts makes diagnosis and treatment challenging. Because intratendinous ganglion cysts and associated synovitis frequently weaken the structure of affected tendons, prompt diagnosis and surgical excision are necessary.

Anterolateral Versus Posterolateral Approach for Lateral Condylar Fractures of the Humerus in Children.

Two surgical approaches, an anterolateral and a posterolateral approach, have been advocated for lateral condylar fractures (LCFs) of the humerus in children. The purpose of this study was to evaluate the radiographic and clinical outcomes of the 2 surgical approaches. METHODS: We retrospectively analyzed the data of consecutive patients <15 years of age with an LCF treated via open reduction and internal fixation through 1 of 2 surgical approaches during the period of April 2000 to March 2019. Patients were classified into the anterolateral (AL) and posterolateral (PL) groups, according to the surgical approach used. Postoperative complications and radiographic and clinical findings (including range of motion and findings on the basis of the Flynn criteria) were investigated. To investigate humeral deformity, the Baumann angle and the carrying angle were measured on anteroposterior radiographs. RESULTS: Sixty-one of 82 patients met the inclusion criteria. The AL group included 17 patients (13 male, 4 female), and the PL group included 44 patients (28 male, 16 female). In the PL group, 7 patients had cubitus varus deformity, 3 had malunion due to unacceptable reduction of fracture fragments, and 6 had elbow joint contracture. In the AL group, the overall clinical results were excellent for 15 patients and good for 2. In the PL group, the clinical results were excellent for 12 patients, good for 14, fair for 6, and poor for 12. CONCLUSIONS: An anterolateral approach would be the optimal approach for an LCF in pediatric patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Acute calcific periarthritis of the proximal phalangeal joint on the fifth finger: A case report and literature review.

RATIONALE: Acute calcium deposits, including acute calcific periarthritis or acute calcific peritendinitis, are benign calcifying soft tissue lesions that have a self-resolving course. These calcifying lesions usually develop in the shoulder, while acute calcific periarthritis in the digits is uncommon. When acute calcific periarthritis involves the digits, the lesion occasionally mimics other benign calcifying or ossifying lesions and can easily be misdiagnosed, resulting in unnecessary diagnostic studies and treatment. We present a rare case of acute calcific periarthritis around the proximal phalangeal joint of the left fifth finger that took a long time to spontaneously resolve, and review previous reports of similar cases. PATIENT CONCERNS: A 69-year-old woman complained of longstanding pain and swelling of the fifth finger of the left hand. She had visited several clinics and hospitals and had been treated with analgesics and splinting for more than 2 months, but the pain in the finger had gradually worsened. DIAGNOSES: Blood chemistry analysis showed no signs of inflammation or other abnormalities. Radiographs revealed a well-defined subcutaneous calcifying lesion without bony destruction, suggesting a benign calcification process. Computed tomography and magnetic resonance imaging led to a diagnosis of acute calcific periarthritis of the proximal interphalangeal joint of the fifth finger. INTERVENTIONS: An excisional biopsy was recommended to achieve a definitive diagnosis, but this was declined by the patient. Thus, no invasive treatments were administered, and she was treated with analgesics and encouraged to massage the affected finger. OUTCOMES: The pain gradually improved, and follow-up radiographs showed complete disappearance of the calcifying mass 6 months after the initial visit to our hospital, without recurrence during a follow-up period of more than 2 years. LESSONS: Acute calcific periarthritis is diagnosed based on history, clinical examination, and imaging findings, which provide evidence for the diagnosis of calcium deposition in the digits even if the lesions have been present for a long time. Watchful observation is an appropriate treatment strategy for acute calcific periarthritis of the digits.

Premature closure of the distal radial physis without evident history of trauma: A case report.

RATIONALE: The distal radius is the region of the body with the highest incidence of physeal injury. However, it is uncommon for the distal radius to undergo growth arrest without a history of trauma. We present a case of premature closure of the distal radial physis without evident history of trauma in a girl. PATIENT CONCERNS: A 14-year-old girl presented with chronic progressive deformity and painful functional limitation of her right forearm. The right wrist pain had begun when the patient was 5 years old. There was no evident history of trauma. The deformity and persistent right wrist pain had prevented her from performing sports activities and activities of daily living. DIAGNOSES: Radiography and computed tomography showed a volarly angulated distal radius and dorsally protruding distal ulna with a length discrepancy between the distal radius and ulna due to premature physeal closure of the right distal radius. INTERVENTIONS: To eliminate the deformity and achieve painless functional recovery of the wrist, an opening wedge osteotomy of the distal radius with an iliac bone graft was performed, followed by a shortening osteotomy of the distal ulna. OUTCOMES: Radiography at final follow-up 1 year and 9 months postoperatively showed good alignment of the distal radioulnar joint without length discrepancy between the two forearm bones. The range of motion of the left wrist had reached 100% of the contralateral wrist without any pain, and the right grasp strength was 18 kg, which was 82% compared with the dominant left wrist. LESSONS: Premature closure of the distal radial physis impairs the growth potential of the physis and leads to wrist dysfunction due to deformities. In the present case, a satisfactory outcome was achieved via corrective osteotomy of the distal radius with an iliac bone graft combined with ulnar shortening osteotomy.

Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint after distal radius fracture: A case report.

RATIONALE: Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture. PATIENT CONCERNS: A 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist. DIAGNOSIS: Radiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea. INTERVENTIONS: The patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ. OUTCOMES: At 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist. LESSONS: Malunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.

The Presence and the Location of an Ulnar Styloid Fracture Associated With Distal Radius Fracture Predict the Presence of Triangular Fibrocartilage Complex 1B Injury.

PURPOSE: To investigate the correlation between ulnar styloid fracture (USF) associated with distal radius fracture (DRF) and triangular fibrocartilage complex (TFCC) injuries and to elucidate whether the presence or location of an USF in a patient with DRF predicts the presence of traumatic TFCC injuries. METHODS: From 2005 to 2018, an arthroscopic evaluation was performed to detect TFCC injuries associated with DRF. The presence and location of USFs were evaluated using computed tomography. TFCC injuries were classified in accordance with Palmer's classification. All wrists were divided into group A (DRF without USF) and group B (DRF with USF). The incidence of TFCC injuries in the 2 groups was compared. group B was then divided into 2 subgroups in accordance with the USF location: the tip or middle fracture subgroup and the base fracture subgroup. Data were analyzed with significance set at P < .05. RESULTS: One hundred thirty-eight patients were enrolled in this study. Group A included 42 wrists in 42 patients, whereas group B included 96 wrists in 96 patients. There were significant differences between the 2 groups regarding the incidence of traumatic TFCC injuries (P = .036) and TFCC 1B injury (P = .002), although there were no differences between the 2 groups regarding age, sex, injured side, direction of displacement, and type of DRF. Within group B, the tip and middle fracture subgroup included 37 wrists in 37 patients, whereas the base fracture group included 59 wrists in 59 patients; a significant difference was observed between the two subgroups regarding the incidences of TFCC 1B injuries (P = .044). CONCLUSIONS: The presence of USF associated with DRF predicted the presence of frequently occurring traumatic TFCC injury and TFCC 1B injury. Moreover, the location of USFs was a predictive factor for TFCC 1B injury in adults with DRF. On the other hand, traumatic TFCC injury had occurred in adults with DRF, regardless of the presence of USF. LEVEL OF EVIDENCE: Level IV, Case series.

Recurrent Dislocation of the Extensor Carpi Ulnaris Tendon with Ulnar-Sided Triangular Fibrocartilage Complex Injury in an Ice Hockey Player: A Case Report.

Ulnar-sided wrist pain is common among athletes who subject their wrists to forceful rotational movements. Injury to the numerous complex structures in the ulnar wrist, including the extensor carpi ulnaris (ECU) tendon and triangular fibrocartilage complex (TFCC), can result in ulnar-sided wrist pain. Although differentiating between ECU tendinitis and TFCC injury is necessary, ECU tendon disorders and TFCC injury occasionally occur concurrently. Subluxation or dislocation of the ECU tendon is rare but may cause symptoms in athletes subjecting their wrists to forceful rotational movements. We present a case of recurrent dislocation of the ECU tendon and ulnar-sided TFCC injury in a 21-year-old male university-league ice hockey player. He initially underwent ECU stabilization; however, his ulnar wrist pain persisted, which adversely affected his athletic performance. He underwent additional surgery to repair the TFCC, which led to definitive resolution of his symptoms and resulted in his return to competitive performance 3 months postoperatively. Treatment of symptomatic dislocation of the ECU remains controversial. In our patient, recurrent dislocation of the ECU tendon with concurrent ulnar-sided TFCC injury resulted in ulnar-sided wrist pain. Combined reconstruction of the tendon's subsheath, using the extensor retinaculum, and repair of the TFCC injury was required for full recovery of his athletic performance.

Quick Arthroscopic Repair of Ulnar-Sided Triangular Fibrocartilage Complex Tears: Technical Note.

Triangular fibrocartilage complex (TFCC) tears can cause ulnar-sided wrist pain. Arthroscopy is important in treatment and diagnosis, and arthroscopic repair of TFCC tears is indicated after failure of nonsurgical treatments such as cast immobilization, splinting, and administration of nonsteroidal anti-inflammatory drugs for more than 3 months. Several arthroscopic procedures have been described, including inside-out, outside-in, and all-arthroscopic techniques. However, these arthroscopic procedures are time-consuming and technically demanding. This article presents a straightforward technique of arthroscopic inside-out repair that uses double-loop sutures for ulnar-sided TFCC tears.

Clinical outcomes of nonsurgical treatment for Preiser disease.

To elucidate whether nonsurgical treatment for Preiser disease is effective.Eight patients with Preiser disease (median age 59 [47-69] years) underwent nonsurgical treatment (median symptom-onset-to-treatment interval 8 [9-180] months). At presentation, 7 patients complained of constant pain and 1 of motion-related pain. Pain restricted wrist range of motion (median modified Mayo wrist score [MMWS] 17.5 [range 10-30]). Radiography revealed stages 1 to 3 disease (Herbert-Lanzetta classification). Median scapholunate angle was 62° (54°-75°), with 3 wrists suffering dorsal intercalated segment instability (DISI). Magnetic resonance imaging showed (Kalainov criteria) 4 stage 1 wrists (complete necrosis) and 4 stage 2 (incomplete necrosis). Two had concomitant Kienböck disease. All patients underwent nonsurgical treatment (ie, oral pain killer, immobilization, rest) and were monitored via radiographic and clinical evaluations. Scapholunate angles and the scaphoid area reduction ratio were calculated using radiography. Response criteria were the patients' subjective and objective status. Endpoint was the time from start of non-surgical to surgical treatment.Immobilization lasting 0 to 24 months (median 1.8 months) did not relieve their symptoms. Follow-up radiography showed that the disease stage had progressed in 5 of 8 wrists, with 5 wrists having DISI. The median area reduction ratio of the scaphoid was 11% (4%-52%) on anteroposterior views and 4% (-23% to 17%) on lateral views. Compared with the contralateral wrist, the median wrist flexion-extension arc was 61% (50%-79%) and the median grip strength 39%. Median MMWS score was 17.5 (10-25) - poor in 6 of 8 patients. Surgery was thus necessary in all patients.Nonsurgical treatment for Preiser disease did not improve subjective or objective outcomes and did not prevent deterioration of radiographic findings.Type of study/level of evidence: Therapeutic, Level V.

Kirschner Wire Fixation with and without Tension Band Wiring for Treatment of Fracture of the Lateral Humeral Condyle in Children.

BACKGROUND: Kirschner wires (K-wires) are commonly used to treat displaced lateral humeral condyle fracture in children. However, K-wire fixation alone is insufficient for early elbow range of motion (ROM) exercises. Fixation combined with tension band wiring (TBW) converts distraction forces into compression forces, which provides more rigid fixation than K-wire fixation alone. Here, we retrospectively evaluated clinical outcomes of patients with displaced lateral humeral condyle fracture treated with TBW or K-wires only. METHODS: We identified children with lateral condyle fractures who had undergone surgery during the period from April 2000 through March 2014. Nineteen patients were classified into 2 groups according to treatment: 10 were allocated to the TBW group (TBW and K-wires) and 9 to the K-wires group. The mean interval from injury to surgery was 5.1 days in both groups. Fractures were classified by using the Jacob's and Milch's classifications. In addition, we collected and analyzed data on postoperative complications, radiological and clinical evaluations, ROM, and Flynn's criteria. RESULTS: Mean duration of follow-up was 14.4 months in the TBW group and 5.9 months in the K-wires group. Mean bone union time was 38.6 days and 49.8 days, respectively. Mean duration of cast/splint use was significantly longer for K-wires patients (49.8 days) than for TBW patients (35.8 days). Range of flexion at the final follow-up was significantly lower in the K-wires group. CONCLUSIONS: TBW fixation appears to be the optimal treatment for displaced lateral humeral condyle fracture in children, as it facilitates early active range of motion exercises.

Volar Locking Plate Fixation for Intra-Articular Distal Radius Fractures with Volar Lunate Facet Fragments Distal to the Watershed Line.

BACKGROUND: Standard volar plating of distal radius fractures may not adequately fix the volar lunate facet (VLF) fragment, which can result in volar carpal subluxation. We hypothesized that the size of VLF fragments distal to the watershed line might affect reduction loss after distally placed volar locking plate fixation for intra-articular distal radius fracture and examined if the presence of small displaced VLF fragments was a risk factor for reduction loss. METHODS: Twenty-seven hands of 27 patients with intra-articular distal radius fractures with VLF fragments distal to the watershed line were treated by using Acu-Loc 2 volar distal radius locking plate fixation. RESULTS: At final follow-up, the mean Mayo Performance Score was 90.9, and the mean Quick Disabilities of Arm, Shoulder, and Hand score was 13.6. On radiography, 5 patients had a reduction loss of >2 mm in ulnar variance from immediately postoperatively to final follow-up (group 1), while 27 had no reduction loss (group 2). The mean longitudinal, transverse, and anteroposterior lengths and joint surface area of the VLF fragment were significantly smaller in group 1 than in group 2. Three-dimensional computed tomography revealed that the fracture patterns of the radiocarpal and distal radioulnar joints in group 1 were mainly volar-displaced VLF fragments. CONCLUSIONS: By stabilizing fragments, distally placed volar locking plate fixation effectively treated intra-articular distal radius fractures with VLF fragments distal to the watershed line. However, the presence of small displaced VLF fragments may increase the risk of reduction loss in ulnar variance.

Combined Use of Magnetic Resonance Imaging and Fine-Needle Aspiration Cytology for Diagnosis of Soft-Tissue Tumors.

BACKGROUND: Magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) are useful in the diagnosis of soft-tissue tumors and can be performed on outpatients. These modalities are complementary: MRI examines a large area, while FNAC assesses a highly specific region; MRI displays only signal intensities, while FNAC visualizes actual tumor cells. We investigated the combined use of these methods for differentiating malignant and benign tumors. METHODS: 148 patients (153 lesions: 137 benign, 16 malignant) underwent preoperative MRI and FNAC. A diagnosis was judged to be correct if one or both diagnoses were correct, incorrect if at least one diagnosis was incorrect, and indeterminate if both diagnoses were indeterminate or if MRI was indeterminate and the FNAC sample was insufficient. RESULTS: The diagnostic yields for MRI only, FNAC only, and their combination were 81.7%, 84.3%, and 92.2%, respectively, indicating that the diagnostic performance of MRI and FNAC was significantly improved when the methods were combined. CONCLUSIONS: As compared with either modality used alone, combined preoperative use of MRI and FNAC improved diagnosis of soft-tissue tumors.