Japanese version of Patient-Rated Elbow Evaluation is a useful outcome measure that potentially reflects hand function in patients with rheumatoid arthritis who underwent total elbow arthroplasty.

OBJECTIVES: We examined the relationship between the Japanese version of Patient-Rated Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA). MATERIALS AND METHODS: This study involved 46 elbows of 40 RA patients. We collected clinical data 1 year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures preoperatively and postoperatively. RESULTS: Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength [B = -0.09; 95% confidence interval (95% CI) -0.17 to -0.01, p = 0.03] and preoperative Hand20 (B = 0.31, 95% CI 0.03-0.58, p = 0.03) were significant factors that might influence the postoperative PREE-J. CONCLUSIONS: The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

Oncological and prognostic analysis of soft tissue sarcoma of the elbow: report using the bone and soft tissue tumor registry in Japan.

OBJECTIVE: Soft tissue sarcomas in the elbow are extremely rare, and they have primarily been described in case series. Definitive concerning the prevalence and prognostic factors of elbow soft tissue sarcomas remain unknown. We examined the outcome of patients with elbow soft tissue sarcomas and identified the relevant prognostic factors. METHODS: In total, 219 patients with elbow soft tissue sarcomas were identified using data from the bone and soft tissue tumor registry in Japan. Differences in demographics, disease characteristics, treatment and survival were compared among the patients. Survival analyses including local recurrence-free survival, distant metastasis-free survival, and overall survival were performed using the Kaplan-Meier method with log-rank tests and the Cox proportional hazards model. RESULTS: Two hundred nineteen patients with elbow soft tissue sarcomas were identified, including 119 males (54.3%) and 100 females (45.7%). In total, 189 patients (86.3%) underwent surgery including re-excision. Of the surgically treated patients, 180 (95.2%) underwent limb salvage surgery, and nine patients (4.8%) underwent amputation. The 5-year overall survival, local recurrence-free survival, and distant metastasis-free survival rates for the entire patient cohort were 76.3, 70.1, and 69.3%, respectively. After adjusting for clinically relevant factors, overall survival was significantly worse among patients with tumors: >10 cm (hazard ratio = 4.34; 95% confidence interval = 1.03-18.2) and metastatic disease (hazard ratio = 6.94; 95% confidence interval = 1.55-31.0). CONCLUSIONS: Tumor size was identified as an independent risk factor for poor prognosis.

Quantitative examination of isolated finger flexion associated with function of the flexor digitorum superficialis.

[Purpose] Isolated finger flexion associated with function of the flexor digitorum superficialis has been qualitatively assessed using standard and modified tests. The purpose of this study was to quantify isolated finger flexion in healthy participants. [Participants and Methods] We assessed 100 volunteers (mean age: 44.6 years) without upper limb dysfunction using the standard and modified flexor digitorum superficialis tests. The sum of the isolated active flexion angles of the metacarpophalangeal and proximal interphalangeal joints of the test finger was also calculated, with the other three fingers held in an extended position with our original jig. [Results] The mean isolated flexion angles were, respectively, 152.4° and 154.8° for the right and left index fingers, 161.1° and 160.4° for the middle fingers, 160.6° and 158.2° for the ring fingers, 129.4° and 134.6° for the independent flexor digitorum superficialis function, 85.8° and 74.7° for the common flexor digitorum superficialis function, and 75.8° and 71.2° for absent flexor digitorum superficialis function in the small finger. The functional variations of the flexor digitorum superficialis of the small fingers showed symmetry in 65.0% of the fingers but asymmetry in 35.0%. [Conclusion] The data obtained in this study provide normal reference values for the examination of independent movement disorders of the fingers.

Proteomics analysis of site- and stage-specific protein expression after peripheral nerve injury.

BACKGROUND: The peripheral nervous system has greater regenerative potential than the CNS. This fact suggests the existence of molecules that act as key factors in nerve regeneration during molecular changes in the peripheral nervous system. METHODS: The right sciatic nerve of female Sprague-Dawley rats was exposed and transected at the mid-thigh level. Animals were sacrificed at 5, 10 or 35 days after nerve transection. Proximal and distal nerve segments (1-cm in length) were dissected. We then sought to observe overall molecular changes after peripheral nerve injury using a proteomic approach. For an overview of the identified proteins, each protein was classified according to its biological and molecular functions. We identified a number of proteins showing site- and stage-specific patterns of expression. RESULTS: Both proximal and distal molecular changes at 5, 10 and 35 days after nerve transection were investigated, and a total of 2353 proteins were identified. Among the various expression patterns observed, aFGF and GAP-43 were found to increase in the proximal stump at 10 days after transection, and PN-1, RPL9 and prosaposin increased in the distal stump at 5 days after transection. Among these proteins, aFGF, GAP-43, PN-1 and prosaposin were found to be associated with nerve regeneration. CONCLUSION: We demonstrated that aFGF, GAP-43, PN-1 and prosaposin expression increased at specific stages and in specific sites, such as the proximal or distal stump, after nerve transection by comprehensive measurement using proteomics analysis. We believe that these specific expression patterns might play important roles during regeneration after nerve injury.

Intraneural Nodular Fasciitis in a Child: A Case Report and Review of the Literature.

We present the case of an 11-year-old boy with intraneural nodular fasciitis of the median nerve at the distal part of the carpal tunnel. Complete excision of the involved median nerve and cable grafting using 4 fascicular segments of the sural nerve was performed for persistent pain and numbness after initial resection of the tumor in piecemeal fashion. Pain and numbness were completely resolved and there was no evidence of recurrence 24 months after the final surgery.

Specific targeting of a naturally presented osteosarcoma antigen, papillomavirus binding factor peptide, using an artificial monoclonal antibody.

Osteosarcoma is a rare but highly malignant tumor occurring most frequently in adolescents. The prognosis of non-responders to chemotherapy is still poor, and new treatment modalities are needed. To develop peptide-based immunotherapy, we previously identified autologous cytotoxic T lymphocyte-defined osteosarcoma antigen papillomavirus binding factor (PBF) in the context of HLA-B55 and the cytotoxic T lymphocyte epitope (PBF A2.2) presented by HLA-A2. PBF and HLA class I are expressed in ∼90 and 70% of various sarcomas, respectively. However, the expression status of peptide PBF A2.2 presented by HLA-A2 on osteosarcoma cells has remained unknown because it is difficult to generate a specific probe that reacts with the HLA·peptide complex. For detection and qualification of the HLA-A*02:01·PBF A2.2 peptide complex on osteosarcoma cells, we tried to isolate a single chain variable fragment (scFv) antibody directed to the HLA-*A0201·PBF A2.2 complex using a naïve scFv phage display library. As a result, scFv clone D12 with high affinity (KD = 1.53 × 10(-9) M) was isolated. D12 could react with PBF A2.2 peptide-pulsed T2 cells and HLA-A2+PBF+ osteosarcoma cell lines and simultaneously demonstrated that the HLA·peptide complex was expressed on osteosarcoma cells. In conclusion, scFv clone D12 might be useful to select candidate patients for PBF A2.2 peptide-based immunotherapy and develop antibody-based immunotherapy.

Prognostic impact of CD109 expression in myxofibrosarcoma.

BACKGROUND: CD109, a TGF-ß co-receptor, is reported to be preferentially expressed during the early stages of tumorigenesis in several carcinoma types. Myxofibrosarcoma is one of the most common soft-tissue sarcomas found in elderly patients. This study aimed to elucidate the impact of CD109 expression in myxofibrosarcoma on prognosis and recurrence. METHODS: Immunohistochemical staining for CD109 was performed on archival specimens from 37 patients. The Fisher exact test was used to evaluate association between CD109 expression and other clinicopathological features. Survival analysis was performed using Kaplan-Meier curves, and the prognostic significance was evaluated using the log-rank test. Multivariate analysis of factors was performed using Cox regression analysis. RESULTS: CD109 overexpression was significantly associated with surgical stage and distant metastasis (P = 0.00499, and 0.011, respectively). The frequency of CD109 overexpression was approximately 10% and CD109 overexpression was significantly associated with decreased overall survival (P = 0.004). Five-year overall survival rates 77% and 0% for CD109-negative and CD109-positive patients, respectively. In multivariate analysis, CD109 overexpression was the only independent risk factor for poor outcome (P = 0.02; hazard ratio, 10.64; 95% confidence interval, 1.47-76.91). CONCLUSIONS: Immunohistochemical CD109 expression in myxofibrosarcoma was associated with poor prognosis.

Effect of simultaneous stretching of the wrist and finger extensors for lateral epicondylitis: a gross anatomical study of the tendinous origins of the extensor carpi radialis brevis and extensor digitorum communis.

BACKGROUND: Pulling the wrist into flexion with the elbow in extension and forearm in pronation has been used as the stretching technique of wrist extensors for lateral epicondylitis. Simultaneous stretching of the fingers in addition to the wrist flexion has also been applied. However, the mechanism of this simultaneous stretching has not been clarified. This study is designed to clarify the mechanism underlying this simultaneous stretching technique based on the anatomical features of the origins of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). METHODS: Thirty-nine arms from formalin-embalmed Japanese human specimens were dissected. The features of the origins of the ECRB and EDC were macroscopically observed, and the locations of each origin on the lateral epicondyle were measured. RESULTS: The ECRB had a long and wide, purely tendinous origin which originated from the anterior slope of the lateral epicondyle. The tendinous origin of the index finger of the EDC (EDC-IF) arose from the posterior aspect of the ECRB tendinous origin, with a coexisting muscular portion observed at the level of the proximal forearm. The middle finger of the EDC (EDC-MF) had a short tendinous origin with an associated muscular portion and originated proximo-laterally to the origin of the ECRB on the lateral epicondyle. In addition, the muscular origin of the EDC-MF arose on the superficial and posterior aspect of the ECRB tendinous origin. In contrast, the ring and little fingers of the EDC originated from the tendinous septum of the extensor digiti minimi and extensor carpi ulnaris, and had no connection with the ECRB tendinous origin. CONCLUSIONS: On the basis of our anatomical findings, simultaneous stretching of the wrist extensors by wrist, index and middle fingers flexion could provide stretching force to both the tendinous origins of the ECRB and EDC through the EDC-IF and EDC-MF.

Pressure and tendon strain in the sixth extensor compartment of the wrist during simulated provocative maneuvers for diagnosing extensor carpi ulnaris tendinitis.

BACKGROUND: Various provocative maneuvers for diagnosing extensor carpi ulnaris (ECU) tendinitis have been reported; however, it remains unclear which maneuver is the most sensitive to detect ECU tendinitis. To clarify this, we investigated and compared the extratendinous pressure and ECU tendon strain in the sixth extensor compartment of the wrist during various provocative maneuvers for diagnosing ECU tendinitis. METHODS: Nine upper extremities from nine fresh-frozen cadavers were examined. We investigated extratendinous pressure in the ECU fibro-osseous tunnel of the distal ulna and ECU tendon strain during eight forearm positions-neutral rotation, pronation, supination, pronation with wrist flexion, supination with wrist flexion, supination with wrist extension, both hand and forearm supination, and supination with ECU full loading-to simulate provocative maneuvers reported to detect ECU tendinitis. RESULTS: Pressure was significantly higher during both hand and forearm supination (carpal supination test) and during supination with wrist extension (prayer's hand supination test) than during neutral rotation. The pressure during the carpal supination test was 3 times higher than that during the prayer's hand supination test and 27 times higher than that during the neutral position. Strain was significantly higher during the carpal supination test and during supination with ECU full loading (the ECU synergy test) than during other maneuvers. CONCLUSIONS: Both pressure and tendon strain increased most notably during the carpal supination test compared to the other maneuvers, which suggests that the carpal supination test is the most sensitive for the detection of ECU tendinitis.

Total dorsal capsulectomy for the treatment of mucous cysts.

PURPOSE: To describe the technique of total dorsal capsulectomy alone for mucous cysts of the distal interphalangeal (DIP) joint and evaluate its outcomes and complications. METHODS: Nineteen patients (18 women and 1 man) with 19 mucous cysts were treated by a total dorsal capsulectomy without cyst excision or osteophyte removal. The average age at surgery was 63 years. The thumb was involved in 4 patients, index finger in 1, middle finger in 7, ring finger in 4, and little finger in 3. Twelve patients had nail deformities associated with the mucous cyst. The average period of postoperative follow-up was 26 months. The dorsal half of the DIP joint capsule was resected with a punch and curette. The cyst and osteophytes were left intact. RESULTS: The average preoperative range of motion for the DIP joint was from 10° of extension to 45° of flexion. Radiographs showed osteophytes at the DIP joint in all affected digits. After surgery, all cysts disappeared at an average of 3 weeks. There was no recurrence at the time of final follow-up. All nail deformities had resolved at an average of 5 months after surgery. The average motion for the DIP joint at the time of final follow-up was from 8° of extension to 56° of flexion. There were no acquired nail deformities or other complications. CONCLUSIONS: A total dorsal capsulectomy alone was a simple treatment for mucous cysts and did not lead to any recurrence. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Time to functional recovery after arthroscopic surgery for tennis elbow.

BACKGROUND: This study evaluated recovery from chronic lateral epicondylitis after arthroscopic treatment. METHODS: Twenty-three consecutive patients (5 men, 18 women) with chronic lateral epicondylitis underwent arthroscopic surgery. Patients were a mean age of 49 years. Prospective outcome data were collected before the operation and at 1, 2, 3, 6, 12 and 24 months after surgery. Outcomes were assessed using a visual analog scale (VAS: 0-100), grip strength percentage (compared with the unaffected side), the Japanese Orthopaedic Association elbow score, and the Disability of the Arm, Shoulder and Hand questionnaire. RESULTS: A mean VAS score at rest of 26 preoperatively improved to 8 (P = .0026), 6, and 3 at 1, 2, and 3 months after surgery, respectively. A mean VAS score during activity improved from 68 preoperatively to 35 (P < .001), 23, and 19 at 1, 2, and 3 months after surgery, respectively. Both VAS scores gradually decreased up to 24 months after surgery. The mean grip strength improved from 66.1% preoperatively to 88.7% at 2 months after surgery (P < .001). The mean Japanese Orthopaedic Association elbow score improved from 38 points preoperatively to 61 points at 1 month after surgery (P < .001). The mean Disability of the Arm, Shoulder and Hand score improved from 32 points preoperatively to 15 points at 3 months after surgery (P < .001). CONCLUSION: Arthroscopic surgery for lateral epicondylitis provides significant improvement in pain and functional recovery up to 3 months after surgery. However, it takes more than 6 months for the VAS score during activity to fall below 10 points.

Efficacy of axillary nerve block in elbow arthroscopic surgery: a randomized trial.

BACKGROUND: The purpose of this study was to evaluate postoperative pain levels after arthroscopic elbow surgery under general anesthesia and to determine whether an axillary nerve block provides additional pain management benefits compared with a portal site injection of local anesthetic. METHODS: Thirty-six patients undergoing arthroscopic elbow surgery under general anesthesia were randomized to either a study group receiving axillary nerve block (Ax group) or a control group receiving portal site injections of local anesthetic (Lo group). During the first 48 hours after surgery, pain visual analog scale (VAS) scores (0-100), total amount of oral analgesics required, and patient satisfaction were assessed. RESULTS: Among all 36 patients, mean pain VAS scores at rest were 37, 18, and 9 for the first 12-hour period and at 24 and 48 hours after surgery, respectively. The mean pain VAS scores during physiotherapy were 47 and 33 at 24 and 48 hours postoperatively, respectively. No intergroup differences were observed between the Ax and Lo groups at any time point after surgery (P value range, .41 to .87). The mean number of loxoprofen tablets required during the 48-hour study period was 5.1 in the Ax group and 4.5 in the Lo group (P = .90). The Ax and Lo groups had mean overall patient satisfaction scores of 91 and 91, respectively (P = .98). CONCLUSIONS: Postoperative pain levels after arthroscopic elbow surgery could be well managed with oral analgesics and local anesthetic. An axillary nerve block was not found to provide any postoperative pain control benefits.

Significant increase of plasma tetranectin in ovx mice as defined by proteomics analysis.

BACKGROUND: Proteomics is recognized as a useful tool in the dynamic screening of plasma protein expression. This study aimed to identify increased expressions of novel plasma proteins in ovariectomized mice (ovx) using selective reaction monitoring (SRM) validation in combination with electrospray ionized-quadrupole time-of-flight mass spectrometry (ESI-Q-TOF-MS) screening. MATERIALS AND METHODS: Twenty-week-old female C57BL/6 mice were ovariectomized or subjected to surgical exposure of the ovaries alone (sham). Blood plasma protein at 4 weeks after these operations was pooled for the ovx and sham group each and separated on SDS-PAGE, and then digested by peptides, which were first differentially displayed by ESI-Q-TOF-MS analysis. Mass spectra of peptides upregulated more than twofold in ovx compared to sham mice were selected for protein identification by ESI-Q-TOF-MS. The selected peptides were further validated in independent samples by SRM using electrospray ionized-triple quadrupole-linear ion trap mass spectrometry (ESI-QqLIT-MS). Optimum transitions for SRM were manually chosen for their high specificity in identifying peptides derived from the candidate proteins. RESULTS: Differential analysis of peptides revealed 1,108 upregulated peptides in ovx compared with sham control mice. Among the upregulated peptides, 231 nonredundant proteins were identified. Validation analysis for the potential use of these proteins as markers of bone turnover was performed using ESI-QqLIT-MS. The four proteins from the plasma samples, namely mannose-binding lectin-C, major urinary protein 2, type I collagen alpha 2 chain, and tetranectin, were evaluated in a blinded manner. A statistically significant elevation of all four proteins in the plasma of ovx mice was confirmed by SRM. Of the four upregulated plasma proteins, tetranectin increased by almost 50 times in the ovx mice compared with the sham mice. CONCLUSIONS: On the basis of proteomics analysis, this study demonstrated that four plasma proteins were significantly elevated in the ovx mice; of these, tetranectin was markedly upregulated by almost 50 times compared with the sham mice.

Innervated thenar pedicle flap with the palmar cutaneous branch of the median nerve for treating a thumb pulp defect: a case report.

A 51-year-old male plumber with a thumb pulp defect was treated with a reversed innervated thenar pedicle flap. The flap was based on the radial digital artery originating from the princeps pollicis artery with the palmar cutaneous branch of the median nerve. The flap survived and achieved good innervation with a moving 2-point discrimination of 6 mm at 12 months after surgery. This flap is indicated for patients who hesitate to have tissue taken from the foot. We believe that this flap is a feasible option for reconstructing thumb pulp defects.

Differential axillary nerve block for hand or forearm soft-tissue surgery.

PURPOSE: This study determined the effective concentration of ropivacaine required to produce the type of differential block known as sensory block with mobilization, for adequate analgesia after forearm or hand soft tissue surgery by axillary brachial plexus block. METHODS: Forty-four patients were enrolled, and ultrasound-guided axillary nerve block with nerve stimulation was achieved using 16 mL of ropivacaine in total. Postoperative analgesia and sensory/motor function, side effects, the use of rescue analgesics, and the patient satisfaction score were evaluated 24 h after surgery. The effective concentration of nerve block was calculated by probit analysis. RESULTS: Eighteen patients achieved differential block and were sufficiently satisfied with the block, which was significantly better than the patient satisfaction obtained with incomplete differential block. The maximum effective concentration of 6 mL of ropivacaine needed for differential block was calculated as 0.1285 %, which meant that 71 % of the patients experienced both sensory block and maintenance of motor function. CONCLUSION: This analysis showed that 16 ml of 0.1285 % ropivacaine is suitable for achieving differential block in ultrasound-guided axillary nerve block for hand and forearm surgery.

Delayed fracture healing in tetranectin-deficient mice.

Tetranectin is a plasminogen-binding protein that enhances plasminogen activation, which has been suggested to play a role in tissue remodeling. Recently, we showed that tetranectin has a role in the wound-healing process. In this study, we investigated whether tetranectin plays a role in fracture healing. The fracture-healing process was studied using a femoral osteotomy model in tetranectin-null mice, previously generated by the authors. Radiographic imaging, micro-computed tomography (µCT), and histological analysis were used to evaluate osteotomy healing. In wild-type mice, a callus was apparent from 7 days, and most samples showed marked callus formation and rebridging of the cortices at the osteotomy site at 21 days. In contrast, in the tetranectin-null mice there was no callus formation at 7 days and much less callus formation and no bridging of cortices were observed at 21 days. At 35 days, all osteotomy sites showed clear rebridging, and secondary bone formation was achieved in wild-type mice by 42 days. In contrast, no clear rebridging or secondary bone formation was observed at 42 days in the tetranectin-null mice. Analysis using µCT at 21 days after osteotomy revealed that the callus area in tetranectin-null mice was smaller than that in wild-type mice. Histological analysis also showed that soft tissue and callus formation were smaller in the tetranectin-null mice at the early stage of the healing process after drill-hole injury. These results suggested that tetranectin could have a role in the positive regulation at the early stage of the fracture-healing process, which was reflected in the delayed fracture healing in tetranectin-deficient mice.

Atypical thumb polydactyly with duplicated metacarpal bone: a report of 2 cases.

We report 2 cases of patients with thumb polydactyly that were difficult to classify into either Wassel type VI with a remarkable hypoplastic metacarpal or Wassel type VII (triphalangeal thumb). The radial digit was functional but hypoplastic, and the ulnar digit presented a dominant appearance but no active motion. The operative findings revealed that the radial and ulnar MP joints were completely independent and the metacarpal bones were separated, simulating Wassel type VI thumb polydactyly. In both cases, the ulnar digit was transported to the top of the radial metacarpal, accompanied by tendon transfer from the radial to the ulnar digit and rotation flap for web plasty. One year after surgery, the postoperative results showed good appearance and function of the preserved ulnar thumb in both cases.

The Thompson procedure for chronic mallet finger deformity.

PURPOSE: To evaluate the outcomes of the Thompson procedure for chronic mallet finger deformity and review the utility of this procedure. METHODS: Seven cases of chronic mallet finger with a swan neck deformity were treated by the Thompson procedure. Ranges of motion for the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints were measured, and complications were investigated at the final examination. Patients were evaluated using the criteria reported by Abouna and Brown. RESULTS: Four patients were men, and 3 were women. The average age at the time of surgery was 44 years (range, 25 to 71 y). The middle finger was affected in 4 cases, and the index, ring, and small finger were involved in 1 case each. The average extensor lag on the DIP joint was 42° (range, 35° to 50°). All cases were treated with the Thompson procedure. The swan neck deformity was corrected in all cases. The average motion at the final examination was -4° (range, -30° to 0°) in extension and 91° (range, 85° to 110°) in flexion for the PIP joint and -5° (range, -10° to 0 °) in extension and 63° (range, 45° to 85°) in flexion for the DIP joint. A buttonhole deformity and a dimple at the proximal tied end of the graft were seen in 1 case. Assessment by the criteria of Abouna and Brown revealed that 6 of 7 patients were categorized as cured and one as improved. No patient was categorized as unchanged. CONCLUSIONS: The procedure provides a predictable method for correcting loss of DIP joint extension with or without PIP joint hyperextension. We believe that the Thompson procedure is an effective technique for the salvage, following failed treatment, of a closed mallet injury with an associated swan neck deformity.

Nonunion of the ulnar styloid associated with distal radius malunion.

PURPOSE: Malunion is a complication of distal radius fractures and may be associated with a nonunion of the ulnar styloid. We tested the null hypothesis that there is no difference in outcome between patients without ulnar styloid fracture and those with the ulnar styloid nonunion after corrective radial osteotomy for distal radius malunion. METHODS: A total of 19 patients with dorsally angulated distal radius malunion who had simultaneous radial closing-wedge and ulnar shortening osteotomies were included. There were 16 women and 3 men with a mean age of 63 years. All patients were followed up for a minimum of 1 year. During surgery, the accompanying ulnar styloid nonunion was not internally fixed in any patient. Eight patients had no ulnar styloid fracture, and 11 had a nonunion of the ulnar styloid. Each group of patients was evaluated on the basis of objective radiographic measurements and functional outcomes as determined on the basis of clinical examination, including wrist motion, grip strength, pain-rating score, Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand score. RESULTS: There were no differences in the demographic and preoperative radiographic measurements between the nonfracture and nonunion groups. Postoperative radiographic measurements and functional outcomes improved significantly compared with the preoperative status in both groups. There were no significant differences in postoperative radiographic measurements, motion, strength, pain scores, Mayo scores, or Disabilities of the Arm, Shoulder, and Hand scores between the 2 groups. Four of the 11 ulnar styloid nonunions were healed within 1 to 12 months after corrective radial osteotomy. CONCLUSIONS: An accompanying ulnar styloid nonunion in patients with distal radius malunion has no apparent adverse effect on outcome or function after corrective radial osteotomy. An accompanying nonunion of the ulnar styloid can heal following corrective radial osteotomy.

Reconstruction of chronic thumb metacarpophalangeal joint radial collateral ligament injuries with a half-slip of the abductor pollicis brevis tendon.

PURPOSE: To evaluate a reconstructive method for chronic radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint using a combination of RCL advancement and the transfer of a half-slip of the abductor pollicis brevis tendon. METHODS: Eight patients (4 male and 4 female; mean age, 25 y) with chronic RCL injury of the thumb MCP joint were enrolled. All patients were referred to our institution because of continuing pain and instability on the radial side of the MCP joint when grasping or pinching objects. The mechanism of the injury was adduction stress to the thumb during sporting activities in 5 patients, a heavy object falling on the thumb in 1, and a fall in 2. The mean duration from RCL injury to surgery was 20 weeks. The average postoperative follow-up was 51 months. We evaluated postoperative outcomes including pain, range of motion of the thumb MCP joint, grip strength, key pinch strength, Disabilities of the Arm, Shoulder, and Hand score, and ability to return to preinjury work or sporting activities. RESULTS: No patients demonstrated continuing symptoms, and the MCP joint was stable after surgery. Postoperative grip and pinch strength (37 and 6.3 kg, respectively) were increased compared with preoperative values (34 and 3.9 kg, respectively). All patients returned fully to their preinjury work or sporting activities within 6 months after surgery. Although postoperative flexion was decreased by an average of 6°, no patients noted functional deficiency. CONCLUSIONS: We recommend the reconstructive method of RCL advancement and transfer of a half-slip of the abductor pollicis brevis tendon to alleviate pain and improve grip and pinch strength in chronic RCL injuries of the thumb MCP joint.