Vascularised bone graft from the base of the second metacarpal for refractory nonunion of the scaphoid.

A vascularised bone-graft procedure from the base of the second metacarpal was performed in 14 patients with nonunion of the scaphoid. There were 11 men and three women with a mean age of 22 years. In eight patients, who had dorsiflexed intercalated segment instability (DISI), an open wedge was formed at the site of nonunion, and the vascular pedicle was grafted from the volar side. In the six patients without DISI, transplantation was carried out through the same dorsal skin incision. Complete bony union was obtained in all patients after a mean post-operative period of 10.2 weeks, and DISI was corrected in all affected patients. According to Cooney's clinical scoring system, the results were excellent in five, good in six, and fair in three patients. Because of its technical simplicity and the limited dissection needed, the procedure should be considered for the primary surgical treatment of patients with nonunion of the scaphoid.

The effect of cellular proliferative activity on recurrence and local tumour extent of localized giant cell tumour of tendon sheath.

This study investigates whether the proliferative activity of giant cell tumour of tendon sheath is related to its recurrence rate and local aggressiveness. The clinicopathological and immunohistochemical features of 30 localized giant cell tumours of tendon sheath were studied and the influence of the MIB-1 staining index on recurrence, tumour extent around the phalanx and involvement of the bone were evaluated. No significant difference in the MIB-1 staining index was found between the lesions which recurred and those which did not. Also there was no significant association between local aggressiveness and the MIB-1 staining index. These results suggest that the proliferative activity of localized giant cell tumour of tendon sheath is not related to its high recurrence rate and local aggressiveness.

Fine needle aspiration cytology for soft tissue tumours of the hand.

The purpose of this study was to evaluate the usefulness of fine needle aspiration cytology for the preoperative diagnosis of soft tissue tumours of the hand. Fine needle aspiration cytology was performed on 93 soft tissue tumours of the hand which were classified as malignant, benign or unclassified based on cytological findings. We also attempted to make specific diagnosis by cytology. The cytological diagnosis was then compared with the postoperative histopathological diagnosis. The cytological differentiation between benign and malignant tumours showed neither false-positive nor false-negative results. Of the 47 lesions with sufficient material for cytology and that were postoperatively diagnosed histologically, 35 (including one recurrent lesion) were correctly diagnosed by fine needle aspiration cytology. No complications were encountered. Fine needle aspiration cytology has a high degree of diagnostic accuracy and safety for soft tissue tumours of the hand.

A case report of spondyloepiphyseal dysplasia congenita.

Spondyloepiphyseal dysplasia congenita (SED) is a rare form of skeletal systemic disease, characterized by congenital dwarfism with a short trunk and epiphysial dysplasia in the long bones and vertebral bodies. Patients also frequently suffer from atlanto-axial instability due to os odontoideum. Compression of the spinal cord caused by atlanto-axial instability is a common, serious complication in SED patients, and causes severe spinal cord symptoms or occasionally sudden death. We present an SED patient who underwent a posterior fusion of the occiput to the cervical spine for severe spinal cord symptoms due to atlanto-axial instability.

A suspension procedure using the extensor carpi ulnaris tendon for distal radioulnar joint disorders.

Recently the Sauve-Kapandji (S-K) procedure has become popular for the treatment of various distal radioulnar joint (DRUJ) disorders. However, some complications, especially pain over the proximal stump of the ulna due to instability of the ulna have been reported in more recent follow-up studies. To prevent the occurrence of this pain, we devised a modified S-K procedure, which we called the suspension procedure, in which the extensor carpi ulnaris (ECU) tendon was used to suspend the proximal ulnar stump. We report here the surgical technique and compare clinical and radiographic results between the suspension procedure and the S-K procedure alone. We performed the S-K procedure alone on 8 patients (original group) and the suspension procedure on 5 (suspension group). Clinical results were assessed according to the clinical evaluation scoring system described by Inoue. Radiographic evaluations included the radio-ulnar distance, the gap of the ulna, and the distance between the articular surface of the wrist and the proximal ulnar stump. In the original group, 4 patients were rated as excellent, 2 as good and 2 as fair, whereas in the suspension group, 3 were rated as excellent, 2 as good and none as fair. In regard to radiographic evaluations, there were no significant differences in any of the 3 parameters between the 2 group. This suspension procedure had an advantage over the S-K procedure alone, especially in preventing the occurrence of stump pain. As there was no significant difference in radiographic findings between the two procedures regarding the site of osteotomy, the amount of bone resection, and radio-ulnar distance, stump pain may be attributed to dynamic instability rather than to static instability.

Comparison of responsiveness of the Japanese Society for Surgery of the Hand version of the carpal tunnel syndrome instrument to surgical treatment with DASH, SF-36, and physical findings.

BACKGROUND: The Japanese Society for Surgery of -the Hand version of the Carpal Tunnel Syndrome Instrument (CTSI-JSSH), which consists of two parts--one for symptom severity (CTSI-SS) and the other for functional status (CTSI-FS)--is a self-administered questionnaire specifically designed for carpal tunnel syndrome. The responsiveness of the CTSI-JSSH was compared with that of the JSSH version of the Disability of Arm, Shoulder, and Hand questionnaire (DASH), the official Japanese version of the 36-Item Short Form Health Survey (SF-36, version 1.2), and physical examinations to elucidate the role of the CTSI-JSSH for evaluating patients with carpal tunnel syndrome. METHODS: Preoperatively, a series of 60 patients with carpal tunnel syndrome completed the CTSI-JSSH, DASH, and SF-36. Results of physical examinations, including grip strength, pulp pinch, and static two-point discrimination of the thumb, index, and long fingers, were recorded. Three months after carpal tunnel release surgery the patients were asked to fill out the same questionnaires, and the physical examinations were repeated. The responsiveness of all the instruments was examined by calculating the standardized response mean (SRM) and effect size (ES). Correlation coefficients were calculated between questionnaire change scores and patient satisfaction scores as well as between the CTSI change scores and those of the DASH and SF-36. RESULTS: The largest responsiveness was observed in the CTSI-SS (SRM/ES: -1.00/-1.08) followed by the CTSI-FS (-0.76/-0.63), and bodily pain subscale of SF-36 (SF-36-BP, 0.45/0.55), and the DASH (-0.46/-0.47). Only the change scores of the CTSI-SS had significant correlation with patient satisfaction (r = 0.34, P < 0.01). An absolute value of Spearman's correlation coefficient of >0.5 was observed between the change scores of the CTSI-SS and the DASH, the CTSI-SS and the SF-36-BP, the CTSI-FS and the DASH, and the DASH and the SF-36-BP. CONCLUSION: The CTSI-JSSH was proven to be more sensitive to clinical changes after carpal tunnel release than the other outcome measures and should be used to evaluate patients with carpal tunnel syndrome who speak Japanese as their native language.

[Clinical evaluation of cervical myelopathy by means of short latency somatosensory evoked potentials].

Short latency somatosensory evoked potentials (sSEP) were recorded in 47 patients with cervical myelopathy, and the results obtained were compared with clinical symptoms and changes in the waveform of evoked spinal cord action potentials. sSEPs were classified into three types according to the changes in the waveform: type 1; normal waveform (18 cases), type 2; longer latency or reduced amplitude of sSEP (20 cases), type 3; no observable sSEP (9 cases). Decompression surgery on the spine was performed in 29 cases (including 9 type 1 cases, 13 type 2 cases and 7 type 3 cases). Changes in sSEP waveform was correlated to clinical symptoms (JOA score) and disability periods. In some cases, type 2 sSEP approached normal waveform after the operation, and there was an improvement in clinical symptoms. Evoked spinal cord action potentials were recorded during the operation in 15 cases (4 type 1 cases, 6 type 2 cases and 5 type 3 cases), and the location of the disc lesioned was inferred in all cases except in one case of type 1. In 3 type 1 cases, only one disc was lesioned. In all type 2 and type 3 cases, more than two discs were lesioned. It was therefore considered that when only one disc was lesioned, sSEP did not necessarily exhibit abnormalities.