Risk Factors of Carpal Tunnel Syndrome in Taiwan: A Population-Based Cohort Study.

BACKGROUND: Carpal tunnel syndrome (CTS), 1 of the most common peripheral neuropathies of the upper extremity, has been studied for decades regarding its epidemiology and associated medical conditions. We conducted a large-scale, age- and gender-matched study from an Asian population database to investigate the relationship between the incidence and the demographic characteristics. METHODS: A retrospective cohort study using data of National Health Insurance Research Database was conducted. One million enrollees in Taiwan was used to identify 9442 patients with CTS and 37,768 randomly selected controls, in a control-case ratio of 4:1. Diagnoses of CTS were ascertained from January 1, 2003, to December 31, 2012. Sociodemographic and medical characteristics were evaluated to assess the correlation with CTS. RESULTS: Annual incidence of CTS was approximately 0.4% during the 10-year-period in Taiwan, with higher incidence rate in female sex and middle age of group (50-59 years). Among the medical conditions, previous wrist injuries, obesity, gout, and rheumatoid arthritis were associated with CTS most significantly. CONCLUSIONS: Carpal tunnel syndrome has presented a relatively constant incidence in Taiwan. Female gender with middle age seemed to have the highest incident rate during a 10-year period from 2003 to 2012. Among the risk factors of CTS, previous wrist injuries, obesity, gout, and rheumatoid arthritis were demonstrated to be the most significantly correlated comorbidities.

Gait Improvement and Ulcer Prevention With Second-to-Great Toe Transposition at the Donor Site: A Case Report.

A young male patient, who sustained a severe burn injury 6 years ago, received amputation of left hand at the level of metacarpal shaft of the thumb and base of proximal phalanxes of the rest of the fingers. Staged operations, including combined second- and third-toe transfer from the right foot to middle and ring fingers of the left hand, and harvest of great toe from the left foot for reconstruction of left thumb, were successively executed. Unfortunately, callus and ulcer were found at the plantar area of first metatarsophalangeal joint of left donor foot in the following 2 years, which caused troublesome disturbance during ambulation. We hereby present how second toe transposition can decrease the donor foot pain and prevent the recurrence of plantar ulcer after 21 months of follow-up.

Application of Computer-Assisted Navigation System in Acute Zygomatic Fractures.

OBJECTIVE: To compare the surgical results of early treatment of zygomatic fractures with and without the use of the computer-assisted navigation system. METHODS: All patients with unilateral traumatic zygomatic fractures treated within 30 days after the injury at a single center between June 2012 and May 2017 were studied retrospectively. Primary outcome was defined by the displacement at 5 junctional sutures of zygomatic bone, the change at each point before and after the reconstruction, and the patient's subjective scoring of their appearance. Secondary outcome included the length of the operation and hospital stay, the number of incisional approaches, the fixation points, the maximal mouth opening, and the sequelae upon follow-up. RESULTS: Twenty-eight patients were enrolled in this study. Fourteen of them received surgery with the help of a computer-assisted navigation system (navigation group), and 14 patients were treated without its assistance (control group). Before the surgery, the mean displacement of each junctional suture and the mean total displacement between both groups were comparable. Postoperative computed tomography showed that the mean total displacement was significantly less for the navigation group than the control group (0.53 vs 2.93 mm, P = 0.001), and the displacement of zygomaticosphenoid suture was smaller (0 vs 0.9 mm, P = 0.009). Patients in the navigation group underwent surgery via the single buccal-gingival approach without the need for longer operation time. There were no significant differences in the length of hospital stay, maximal mouth opening, or cheek numbness. All patients recovered without major complications and were comparatively satisfied with their final appearance. CONCLUSIONS: The navigation system has been demonstrated to be a useful tool for improving the symmetry in delayed or secondary reconstruction of zygomatic fractures. This study showed its effectiveness and safety in cases of early treatment as well, achieving a more accurate correction in a less invasive manner.