Development and validation of a nomogram to predict surgical site infection after soft-tissue sarcoma resection.

Aims: Surgical site infection (SSI) after soft-tissue sarcoma (STS) resection is a serious complication. The purpose of this retrospective study was to investigate the risk factors for SSI after STS resection, and to develop a nomogram that allows patient-specific risk assessment. Methods: A total of 547 patients with STS who underwent tumour resection between 2005 and 2021 were divided into a development cohort and a validation cohort. In the development cohort of 402 patients, the least absolute shrinkage and selection operator (LASSO) regression model was used to screen possible risk factors of SSI. To select risk factors and construct the prediction nomogram, multivariate logistic regression was used. The predictive power of the nomogram was evaluated by receiver operating curve (ROC) analysis in the validation cohort of 145 patients. Results: LASSO regression analysis selected possible risk factors for SSI, including age, diabetes, operating time, skin graft or flap, resected tumour size, smoking, and radiation therapy. Multivariate analysis revealed that age, diabetes, smoking during the previous year, operating time, and radiation therapy were independent risk factors for SSI. A nomogram was developed based on the results of multivariate logistic regression analysis. In the development cohort, the incidence of SSI was 4.5% in the low-risk group (risk score < 6.89) and 26.6% in the high-risk group (risk score ≥ 6.89; p < 0.001). In the validation cohort, the incidence of SSI was 2.0% in the low-risk group and 15.9% in the high-risk group (p = 0.004). Conclusion: Our nomogram will enable surgeons to assess the risk of SSI in patients with STS. In patients with high risk of SSI, frequent monitoring and aggressive interventions should be considered to prevent this.

Medium-term Outcomes of Excision Using Surgical Microscope of Tenosynovial Giant Cell Tumors of the Hand.

BACKGROUND/AIM: The recurrence rate following the excision of tenosynovial giant cell tumors (TSGCT) of the hand is very high. Intraoperative application of a surgical microscope has been reported. However, to date, there are no reports of medium-term outcomes related to this technique. This study aimed to evaluate the medium-term outcomes of tumor excision using surgical microscope for TSGCT of the hand. PATIENTS AND METHODS: A total of 27 patients, who underwent an initial surgery for histologically-confirmed TSGCT of the hand, between 2008 and 2020, were included and evaluated. The mean follow-up time postoperatively was 6.8 years. Tumor recurrence and preoperative tumor characteristics were assessed. RESULTS: All tumors were adherent to tendons, tendon sheaths, neurovascular structures or periarticular ligaments and capsules. Bony lesions were observed in 11 tumors. The surgical microscope was used in 13 tumors. Recurrences were observed in three tumors (overall recurrence rate: 11%). Tumor characteristics were similar in both groups, but the recurrence rate in the group treated using the surgical microscope was 0%, whereas the recurrence rate in the group treated without the surgical microscope was 21%. Re-operations using the surgical microscope for recurrent tumors were performed, without recurrence postoperatively. CONCLUSION: Among patients with TSGCT of the hand treated with tumor excision using the surgical microscope, the postoperative recurrence rate was 0%. Based on the results of this study, the surgical microscope might be used for excision of TSGCTs of the hand.

Ultrasound Investigation of the Radial Nerve's Superficial Branch: Reducing the Risk of K-Wire Insertion Damage in Distal Radius Fractures.

BACKGROUND: Kirschner wire (K-wire) insertion during surgery for distal radius fractures carries a risk of damaging the radial nerve's superficial branch. In this prospective study, we investigated the relationship between the radial nerve's superficial branch and the radius using ultrasound to minimize risk. METHODS: We collected data from 101 healthy volunteers (202 limbs; 51 men; mean age: 40.6 years). We ultrasonographically assessed the courses of the radial nerve's dorsal and superficial palmar branches at 0, 1, 2, and 3 cm proximal to the radial styloid process tip. The positional relationship between the radial nerve's superficial branch and the radius was determined by splitting the radius's ultrasound map into 4 sections (R1-R4) from the palmar side. The section containing the dorsal and palmar branch midpoints was determined for each height. RESULTS: In many limbs, the dorsal branch tended to wrap from the proximal palmar to the distal dorsal side at 1 to 2 cm proximal to the radial styloid process tip. In approximately 90% of limbs, the palmar branch ran along the radius's palmar side rather than the radial surface. CONCLUSIONS: A small incision enabling direct view may be the best approach for avoiding nerve damage when the superficial branch is less than or equal to 2 cm proximal to the tip of the radial styloid process. Inserting the K-wire from the dorsal side of the radius may be safer for more proximal locations. We recommend a preoperative ultrasound examination to determine the course of the superficial branches of the radial nerve in each patient.

Questionnaire survey about the effects of new lifestyles during the pandemic of COVID-19 on upper limb diseases.

BACKGROUND: The novel coronavirus (COVID-19) that emerged in 2019 and spread globally in 2020 has resulted in the imposition of lockdowns or a state of emergency in many cities worldwide. In Japan, a "new lifestyle" is being advocated. We hypothesize that the new lifestyle has changed people's use of their upper limbs during the COVID-19 pandemic. Therefore, through this questionnaire study, we aimed to determine the factors associated with exacerbation of symptoms during the pandemic and to investigate the current status of patients who require hand surgery. METHODS: This study was a prospective multi-center questionnaire survey. This study was conducted in Japan from December 2020 to July 2021 at university and general hospitals in nine prefectures. A questionnaire was administered to patients who visited a hospital with symptoms of nerve entrapment syndrome, osteoarthritis, or tenosynovitis. RESULTS: A total of 502 patients with a mean age of 63.8 years responded. The 240 patients who experienced exacerbation (exacerbated and markedly exacerbated) were compared with other patients (unchanged, improved, and markedly improved). An increase in the time spent on personal computers and smartphones was associated with exacerbation of hand symptoms. Patients who wanted to undergo surgery but were postponed due to COVID-19 accounted for 23.5% of the outpatients. The mean scores for pain, jitteriness, and anxious depression in these patients were significantly higher than those of patients who did not want surgery. CONCLUSIONS: Our results suggest that an increase in the time spent on personal computers and smartphones is associated with exacerbation of hand symptoms during the COVID-19 pandemic. Patients who wanted to undergo surgery but were postponed by COVID-19 experienced greater pain, jitteriness, and anxious depression.

Clinical Outcomes of Soft Tissue Sarcoma around the Elbow Joint: A Retrospective Single Institution Study.

Background: We report a retrospective case series analysis of clinical outcomes of patients with soft tissue sarcoma around the elbow. Methods: Twenty-two patients underwent surgical tumor excision between January 1999 and May 2017, with a mean follow-up of 85.2 months. Results: Six tumors were localized in the upper arm, nine in the elbow, and seven in the forearm. Sixteen tumors were deep-seated, and six were superficially located. Fifteen patients underwent wide excision, including one amputation, and 18 achieved (81.8%) negative margins histologically. Two local recurrences and four distant metastases developed. The mean Musculoskeletal Tumor Society score was 92.0% (range, 33.3-100). The 5-year local recurrence-free survival rate, metastasis-free survival rate, and overall survival rate were 90.0%, 77.0%, and 79.7%, respectively. Conclusions: Local control and limb function can have favorable outcomes when the tumor excised has a histologically negative margin without sacrificing the major structure.

Comparing exposed and buried Kirschner wires in fixation for pediatric supracondylar humerus fractures: A propensity score-matched study.

PURPOSE: To thoroughly compare the outcomes between exposed and buried Kirschner wires (K-wires) in fixation for pediatric supracondylar humerus fractures. METHODS: We examined patients who underwent surgery at our institution between January 2007 and June 2021. We investigated their age, sex, fracture pattern, number of K-wires used, whether they were exposed or buried, operative time, postoperative complications, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and perioperative radiographic parameters. After propensity score matching, intergroup comparisons were performed to assess the differences in postoperative complication rate, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and loss of reduction. RESULTS: Propensity score matching resulted in 43 pairs in both groups. Although more patients complained of skin irritation in the buried K-wire group, there was more backing out of the K-wire in the exposed K-wire group (p < 0.01). There were no significant differences in other complications. There were more outpatient visits in the buried K-wire group (p < 0.01). The duration from surgery to K-wire removal and the total length of hospitalization were significantly longer in the buried K-wire group (p < 0.01). There was no significant difference in the loss of Baumann's angle (p = 0.61), tilting angle (p = 0.48), or the development of rotation (p > 0.99) between groups. CONCLUSION: More outpatient visits and longer lengths of hospitalization in the buried K-wire group may lead to increased costs and burden on parents.

Do Liquid Nitrogen-treated Tumor-bearing Nerve Grafts Have the Capacity to Regenerate, and Do They Pose a Risk of Local Recurrence? A Study in Rats.

BACKGROUND: Under most circumstances, the resection of soft tissue sarcomas of the extremities can be limb-sparing, function-preserving oncologic resections with adequate margins. However, en bloc resection may require resection of the major peripheral nerves, causing poor function in the extremities. Although liquid nitrogen treatment has been used to sterilize malignant bone tumors, its use in the preparation of nerve grafts has, to our knowledge, not been reported. Hence, this study aimed to investigate the tumor recurrence and function after peripheral nerve reconstruction using liquid nitrogen-treated tumor-bearing nerves in a rat model. QUESTIONS/PURPOSES: (1) Do liquid nitrogen-treated frozen autografts have regeneration capabilities? (2) Do liquid nitrogen-treated tumor-bearing nerves cause any local recurrences in vivo in a rat model? METHODS: Experiment 1: Twelve-week-old female Wistar rats, each weighing 250 g to 300 g, were used. A 10-mm-long section of the right sciatic nerve was excised; the prepared nerve grafts were bridge-grafted through end-to-end suturing. The rats were grouped as follows: an autograft group, which underwent placement of a resected sciatic nerve after it was sutured in the reverse orientation, and a frozen autograft group, which underwent bridging of the nerve gap using a frozen autograft. The autograft was frozen in liquid nitrogen, thawed at room temperature, and then thawed in distilled water before application. The third group was a resection group in which the nerve gap was not reconstructed. Twenty-four rats were included in each group, and six rats per group were evaluated at 4, 12, 24, and 48 weeks postoperatively. To assess nerve regeneration after reconstruction using the frozen nerve graft in the nontumor rat model, we evaluated the sciatic functional index, tibialis anterior muscle wet weight ratio, electrophysiologic parameters (amplitude and latency), muscle fiber size (determined with Masson trichrome staining), lower limb muscle volume, and immunohistochemical findings (though neurofilament staining and S100 protein produced solely and uniformly by Schwann cells associated with axons). Lower limb muscle volume was calculated via CT before surgery (0 weeks) and at 4, 8, 12, 16, 20, 24, 32, 40, and 48 weeks after surgery. Experiment 2: Ten-week-old female nude rats (F344/NJcl-rnu/rnu rats), each weighing 100 g to 150 g, were injected with HT1080 (human fibrosarcoma) cells near the bilateral sciatic nerves. Two weeks after injection, the tumor grew to a 10-mm-diameter mass involving the sciatic nerves. Subsequently, the tumor was resected with the sciatic nerves, and tumor-bearing sciatic nerves were obtained. After liquid nitrogen treatment, the frozen tumor-bearing nerve graft was trimmed to a 5-mm-long tissue and implanted into another F344/NJcl-rnu/rnu rat, in which a 5-mm-long section of the sciatic nerve was resected to create a nerve gap. Experiment 2 was performed with 12 rats; six rats were evaluated at 24 and 48 weeks postoperatively. To assess nerve regeneration and tumor recurrence after nerve reconstruction using frozen tumor-bearing nerve grafts obtained from the nude rat with human fibrosarcoma involving the sciatic nerve, the sciatic nerve's function and histologic findings were evaluated in the same way as in Experiment 1. RESULTS: Experiment 1: The lower limb muscle volume decreased once at 4 weeks in the autograft and frozen autograft groups and gradually increased thereafter. The tibialis anterior muscle wet weight ratio, sciatic functional index, muscle fiber size, and electrophysiologic evaluation showed higher nerve regeneration potential in the autograft and frozen autograft groups than in the resection group. The median S100-positive areas (interquartile range [IQR]) in the autograft group were larger than those in the frozen autograft group at 12 weeks (0.83 [IQR 0.78 to 0.88] versus 0.57 [IQR 0.53 to 0.61], difference of medians 0.26; p = 0.04) and at 48 weeks (0.86 [IQR 0.83 to 0.99] versus 0.74 [IQR 0.69 to 0.81], difference of median 0.12; p = 0.03). Experiment 2: Lower limb muscle volume decreased at 4 weeks and gradually increased thereafter. The median muscle fiber size increased from 0.89 (IQR 0.75 to 0.90) at 24 weeks to 1.20 (IQR 1.08 to 1.34) at 48 weeks (difference of median 0.31; p< 0.01). The median amplitude increased from 0.60 (IQR 0.56 to 0.67) at 24 weeks to 0.81 (IQR 0.76 to 0.90) at 48 weeks (difference of median 0.21; p < 0.01). Despite tumor involvement and freezing treatment, tumor-bearing frozen grafts demonstrated nerve regeneration activity, with no local recurrence observed at 48 weeks postoperatively in nude rats. CONCLUSION: Tumor-bearing frozen nerve grafts demonstrated nerve regeneration activity, and there was no tumor recurrence in rats in vivo. CLINICAL RELEVANCE: A frozen nerve autograft has a similar regenerative potential to that of a nerve autograft. Although the findings in a rat model do not guarantee efficacy in humans, if they are substantiated by large-animal models, clinical trials will be needed to evaluate the efficacy of tumor-bearing frozen nerve grafts in humans.

Clinical Outcomes of Limb-sparing Tumor Surgery With Vascular Reconstruction for Bone and Soft-tissue Tumors.

BACKGROUND/AIM: This study aimed to retrospectively investigate clinical outcomes after tumor resection surgery and discuss reconstruction methods and postoperative complications. PATIENTS AND METHODS: We analyzed the clinical outcomes, such as graft survival and prognosis, of nine patients with bone and soft-tissue tumors of the extremities with major vascular invasion who underwent limb-sparing surgery with vascular reconstruction between January 2006 and December 2020. RESULTS: The primary tumor was malignant in eight cases and intermediate in one case, with a mean postoperative follow-up duration of 52.1 months. A total of 10 vascular reconstructions (arterial in eight patients and both arterial and venous in one) were performed with autologous vein grafts in four cases and synthetic grafts in five cases. Graft occlusion was observed in two cases reconstructed with the great saphenous vein measuring >200 mm in length, and the 5-year arterial patency rate was 8/9. Only one case showed local recurrence, and at 5 years, local control was achieved in eight out of nine patients. Limb-sparing was achieved in all cases and the 5-year overall and disease-free survival rates were 77.8%. Postoperative complications occurred in six patients and wound-related complications were improved by re-surgery, while the others were controlled by conservative treatment. CONCLUSION: Limb-sparing tumor resection surgery with vascular reconstruction has favorable clinical and oncological outcomes. Most postoperative complications related to this surgery can be controlled by conservative treatment, except for wound-related complications. In reconstructions with autologous vein grafts of a length exceeding 200 mm, the graft occlusion rate may increase, and synthetic grafts may be recommended.

Radiological Outcomes of the Simplified Sauvé-Kapandji Procedure for Osteoarthritis of the Distal Radioulnar Joint.

Background: We have been using a simplified Sauvé-Kapandji (SK) procedure using a headless compression screw for the treatment of osteoarthritis (OA) of the distal radio-ulnar joint (DRUJ). Unlike a standard SK procedure, the simplified SK procedure does not require exposure of the DRUJ to prepare the opposing surfaces of the sigmoid fossa and the ulnar head or any procedures to stabilise the proximal stump of the ulna. The aim of this study is to report the radiological outcomes of the simplified SK procedure. Methods: We retrospectively reviewed data of all patients who underwent a simplified SK procedure for osteoarthritis of the DRUJ at our hospital between October 2008 and September 2020 with a follow-up of at least 25 weeks. Baseline demographic and clinical characteristics were investigated. We also measured radiographic parameters and performed statistical analyses to evaluate the shelf-forming region, ulnar stump and deviation of the carpal region. Results: Our study included 10 patients with a mean follow-up of 52.3 weeks. There was no instance of complications such as nonunion of DRUJ arthrodesis, callus formation at ulnar pseudoarthrosis and painful instability at the proximal stump of the ulna. According to the Wilcoxon signed rank test, no radiographic parameters significantly changed during the follow-up period. There was a significant negative correlation between radioulnar width and the variation of ulnar translation index. Conclusions: All radiographic parameters were well maintained, at least during the short follow-up period. There was no instance of nonunion of DRUJ arthrodesis. The simplified SK with simple headless compression screw insertion may be a reliable method for treating OA of the DRUJ. Level of Evidence: Level IV (Therapeutic).

Profunda femoris artery perforator flap for lateral knee joint reconstruction: A report of two cases.

The profunda femoris artery perforator flap (PAP) based on a proximal skin perforator is often used for breast reconstruction. We report two cases of lateral knee joint reconstruction using a PAP flap based on a distal skin perforator. Case 1 is a 16-year-old male adolescent who underwent inappropriate resection of a synovial sarcoma on the lateral aspect of the right knee joint, which necessitated additional wide resection that led to a soft tissue defect measuring 11 × 5 cm. We elevated a propeller PAP flap (23 × 7 cm) for defect reconstruction, and the flap survived completely. Case 2 is an 81-year-old woman who underwent wide resection of an undifferentiated pleomorphic sarcoma on the lateral aspect of the right knee joint showed a persistent soft tissue defect measuring 9 × 6 cm. We elevated a propeller PAP flap (25 × 7 cm) as described in Case 1, and the flap survived completely. Skin perforators of the profunda femoris artery are present both in the proximal and distal thigh; therefore, a PAP flap can also be elevated in the distal thigh. However, a few reports have discussed PAP flap elevation in the distal thigh for knee joint reconstruction. The PAP flap with a distal skin perforator can be elevated with a relatively large volume of skin paddle and may be a useful option for lateral knee joint reconstruction.

In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger.

Although the index finger is generally used for sensory nerve conduction study in cases of carpal tunnel syndrome, there are reports that the middle finger should be used. The purpose of this study was to compare the results of sensory nerve conduction studies of the index finger and middle finger in patients with carpal tunnel syndrome. Among the 120 hands of 93 patients who were diagnosed with carpal tunnel syndrome and underwent carpal tunnel release surgery at our hospital, 54 hands of 48 patients who showed waveforms in sensory nerve conduction studies both index and middle fingers were included. 6 hands of 6 patients who showed no waveform in the index or middle finger, and 60 hands of 39 patients who showed no waveform in both index and middle finger were excluded. The subjects were 14 males and 34 females, and their ages were 66.2 years. The preoperative sensory nerve action potential (µV) and sensory nerve conduction velocity (m/s) of the index and middle fingers were tested using Wilcoxon's signed rank test. Spearman's rank correlation coefficient was also calculated for the results of the index and middle fingers. Sensory nerve action potentials were 2.0 in the index finger and 1.8 in the middle finger, with significantly lower in the middle finger. Sensory nerve conduction velocity was 30.1 in the index finger and 27.2 in the middle finger, with significantly lower in the middle finger. The correlation coefficients of sensory nerve action potentials and conduction velocities between the index finger and middle finger were 0.82 and 0.96, respectively, both of which showed a significant correlation. The results of the sensory nerve conduction studies of the middle finger were significantly worse than those of the index finger in cases of carpal tunnel syndrome. In addition, there was a strong correlation between the results of the index finger and the middle finger. The results of this study suggest that the nerve bundle to the middle finger may be more strongly affected than the nerve bundle to the index finger in cases of carpal tunnel syndrome.

Deep inferior epigastric artery as a collateral pathway to the lower extremities: A case report.

We describe a patient in whom the deep inferior epigastric artery served as a collateral pathway to the lower extremities, and free latissimus dorsi myocutaneous flap transfer was successfully used for reconstruction instead of the originally planned free rectus abdominis myocutaneous flap. A 74-year-old woman underwent subtotal tongue resection, followed by free flap tongue reconstruction for tongue cancer. Reconstruction using a free rectus abdominis myocutaneous flap was considered; however, preoperative contrast-enhanced computed tomography revealed complete occlusion of the bilateral external iliac arteries. Doppler ultrasonography revealed retrograde blood flow via the deep inferior epigastric artery, and the internal thoracic artery-deep inferior epigastric artery pathway served as a collateral pathway that supplied the lower extremities. The patient underwent reconstructive surgery using a free latissimus dorsi myocutaneous flap, and the flap completely survived. The internal thoracic artery-deep inferior epigastric artery pathway serves as a critical collateral pathway to the lower extremities in patients with aortoiliac occlusive disease. Blockage of the deep inferior epigastric artery in patients in whom this vessel shows retrograde blood flow may result in lower extremity ischemia. Therefore, preoperative Doppler ultrasonography is warranted to confirm the direction of the blood flow, in addition to evaluation of the deep inferior epigastric artery and its perforators before planning rectus abdominis myocutaneous flap or deep inferior epigastric artery perforator flap surgery.

Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors.

INTRODUCTION: Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed. METHODS: Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1 year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed. RESULTS: Mean patient age was 57.3 years (15-85 years) and the mean observation period was 72.5 months (14-181 months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5 cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS (p < 0.01). CONCLUSION: Most of the tumors underwent unplanned excisions were small (<5 cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.

Reverse digital artery flap for Pacinian hypertrophy of the fingertip: A rare case report.

Pacinian corpuscle hyperplasia is a pathological increase in the size (Pacinian hypertrophy) and/or density of mature Pacinian corpuscles. Although its aetiology and pathogenesis remain unclear, surgery is the main treatment. Here, we report a rare case of Pacinian hypertrophy at the fingertip treated with surgical excision and reconstruction using a reverse digital artery flap. A 47-year-old man presented with injuries to his right little finger, which was wedged in a door while unloading a truck. His fingertip was amputated and stump plasty was performed. However, severe pain persisted at the fingertip for 5 months after the surgery. Therefore, the painful part of his fingertip was resected, and reconstruction was performed using a reverse digital artery flap 6 months after the injury. Haematoxylin and eosin staining of the resected specimen revealed scar tissue with foreign body reaction and mild Pacinian hypertrophy. One year has passed since the injury, and the pain has completely disappeared. The patient regained complete range of motion in his little finger and was able to resume work without any limitations. Surgical excision with sufficient margin and reconstruction with a reverse digital artery flap is a reliable method to relieve pain due to Pacinian hypertrophy at the fingertip.

Distal Radius Fracture with Bone Fragment Protruded into the Radiocarpal Joint: Two Case Reports.

Distal radius fractures often involve comminuted fragments of the dorsal cortex of the radius, but bone fragments rarely protrude into the radiocarpal joint. We report two cases of distal radius fracture with bone fragment protrusion into the radiocarpal joint. To the best of our knowledge, there are no English reports of distal radius fracture with bone fragment protrusion into the radiocarpal joint. Despite the rarity of these cases, clinicians should still be mindful of such injuries and not overlook the possibility of presence of bone fragments within the joint. Missed intra-articular fragments may cause pain, limited range of motion, and subsequent osteoarthritis.

A Radiological Scoring System for Differentiation between Enchondroma and Chondrosarcoma.

BACKGROUND: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. In this study, correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. METHODS: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Furthermore, a new radiological scoring system was developed by combining radiological findings. RESULTS: Periosteal reaction on X-ray (p = 0.025), endosteal scalloping (p = 0.010) and cortical defect (p = 0.002) on CT, extraskeletal mass (p < 0.001), multilobular lesion (p < 0.001), abnormal signal in adjacent tissue (p = 0.004) on MRI, and increased uptake in bone scan (p = 0.002) and thallium scan (p = 0.027) was significantly correlated with final diagnoses. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). CONCLUSION: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas.

Spontaneous extensor tendon rupture due to scaphoid osteophyte: A case report and literature review.

Spontaneous attritional extensor tendon ruptures of the index finger due to carpal bone lesions are uncommon. Here, we report the case of a patient with a spontaneous rupture of the extensor indicis proprius (EIP) and index extensor digitorum communis (EDC2) tendons due to a previously symptomatic dorsal scaphoid osteophyte. A healthy 60-year-old man with right-hand dominance experienced mild pain over the dorsum of his left hand for no particular cause. He was a maker of tatami mats. Nine months later, he noted a sudden snap on the dorsum of his right hand while he was making tatami mats and he became unable to extend his index finger. Plain radiography revealed an osteophyte on the dorsal side of the scaphoid. Computed tomography revealed a bone fragment on the dorsal side between the scaphoid and lunate, which seemed to be derived from the scaphoid osteophyte. He underwent surgery 24 days after the incident. First, the fragment was excised; then tendon transfer was performed. EIP and EDC2 tendons were bundled using a side-to-side suture and connected to the middle extensor digitorum communis tendon using interlacing sutures. Histopathological findings of the resected bone were compatible with osteoarthritic change. Tatami mat making requires repeated radioulnar deviation, which could be a risk factor for scaphoid osteophytes. To our knowledge, the present case is the first to report extensor tendon rupture due to a scaphoid osteophyte in a healthy person. Although there is no consensus on the appropriate management of symptomatic scaphoid osteophytes, early intervention at the first sign of tenosynovitis might be necessary to prevent extensor tendon ruptures.

Screw fixation without bone grafting for scaphoid fracture nonunion.

INTRODUCTION: We previously reported the classification of the scaphoid fracture nonunions as linear, cystic, and sclerotic or displaced types based on radiographic findings. We have been treating the linear and cystic type fractures via screw fixation without bone grafting and the sclerotic or displaced type fractures via screw fixation with bone grafting. In this retrospective study, we report the treatment outcomes of the linear and cystic types of scaphoid fracture nonunions. METHODS: Nineteen patients with linear and cystic type scaphoid fracture nonunions were included. Two patients had linear type and 17 had cystic type fractures. All the patients were male, their mean age was 29.2 years. All patients were treated with screw fixation alone by a single surgeon. RESULTS: Bone union was achieved in 17 cases. The mean time to bone union was 3.7 months. Bone union was not achieved in one case of linear type and one case of cystic type fracture. The former was thought to be due to misdiagnosis of displaced type as linear type fracture; however, no obvious reason could be found for the latter. DISCUSSION: Screw fixation alone could help achieve bone union in linear type scaphoid fracture nonunions. However, if the type of the fracture is difficult to diagnose based on plain radiography, evaluation using computed tomography should be performed. The cystic type fractures may need to be subclassified according to the location or size of the cyst as well as the viability of the proximal bone fragment.

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Flexion and Abduction.

Background: Despite the movement of the thumb carpometacarpal joint has been studied, many unclarified points remain regarding the movement of this joint. The purpose of this study was to evaluate the in vivo kinematics of the thumb carpometacarpal joint during flexion and abduction using computed tomography images. Methods: The subjects were 9 healthy males. Computed tomography images were obtained in 4 equally-divided positions from maximum extension to maximum flexion, and maximum adduction to maximum abduction of the thumb. A three-dimensional model was constructed from these images, and the models of each position were superimposed with reference to the trapezium. The amount of angular change around the bone axes of first metacarpal bone and rotation axes were evaluated. Results: We found that the first metacarpal bone showed relatively simple behavior during abduction. However, during flexion, it exhibited a particular movement in which the amount of angular change of the metacarpal bone with respect to the trapezium rapidly increased with deep flexion. Conclusions: These results suggest that the thumb carpometacarpal joint exhibits a special movement during flexion, especially deep flexion.

Sensory Disturbance of the Lower Extremity after Sural Artery Flap Elevation.

PURPOSE: Elevation of the sural artery flap with the sural nerve is associated with donor-site morbidities, such as postoperative sensory disturbance of the lower extremity. We evaluated the sensory disturbance of the lower extremity after elevation of the sural artery flap. METHODS: This study included 7 patients who underwent surgery using the sural artery flap. The sensory disturbances immediately after surgery and at present were evaluated on a 10-point scale. The influences of surgery on activities of daily living and patient satisfaction were also evaluated. RESULTS: The sensory disturbance was 4.48 immediately after surgery and 2.24 presently, and the difference between the timepoints was not statistically significant. The influence of surgery on activities of daily living was 2.30, and the patient satisfaction was 7.90. CONCLUSION: It may be necessary to consider the sural artery flap, which does not include the sural nerve, to avoid unnecessary complications. When it is unavoidable to use the sural artery flap, including the sural nerve, it is important to thoroughly inform patients beforehand about the postsurgery sensory disturbance in the lower extremities.