Pseudomalignant myositis ossificans of the proximal phalanx: a report of two cases.

This report presents two cases of pseudomalignant myositis ossificans (PMO) of the fifth proximal phalanx and their management. The charts, X-rays, pathology specimens, and clinical outcome for two patients treated for PMO were retrospectively reviewed. Both patients presented with isolated swelling and pain over the proximal phalanx of the fifth digit and underwent biopsy of the lesions. In both cases the pathology results were conclusive for PMO. Both patients had improvement in pain and swelling postoperatively. There was no recurrence in either patient. PMO can easily be confused with a malignancy. Proper workup, including biopsy, should be performed in order to accurately make the diagnosis. Radical procedures or amputations should not be performed until a diagnosis has been made. Excision is indicated when nerve compression or loss of joint motion secondary to mass effect occurs. Historically, recurrence has not been a problem after excision.

Results of four-corner arthrodesis using dorsal circular plate fixation.

PURPOSE: Four-corner arthrodesis with scaphoid excision has been used to reduce pain and preserve functional range of motion for patients with radioscaphoid arthritis. Early results of 4-corner arthrodesis with scaphoid excision using dorsal circular plate fixation are compared with reported results in the literature. METHODS: We reviewed retrospectively the first 18 four-corner arthrodeses performed with this system by 4 hand surgeons. Two patients had revision surgery for nonunions before the study that were considered failures. Eight patients returned for final radiographs, objective examination, and functional questionnaire. The average follow-up period was 20 months (range, 13-33 mo). These results were compared with reported results in the literature using alternate fixation methods. RESULTS: Radiographic union was achieved in only 3 wrists. Range of motion was 46% that of the opposite normal wrist and grip strength compared with the opposite wrist was 56%. Five patients would have the procedure again and 6 of 8 have returned to their original employment. CONCLUSIONS: Four-corner arthrodesis with scaphoid excision using a circular internal fixation plate produced a high number of nonunions. Grip strength and range of motion results also were inferior to those reported in the literature.