Treatment for the recurrent case of locking of the metacarpophalangeal joint of the thumb: A case report.

BACKGROUND: Locking of the metacarpophalangeal (MP) joint of the thumb is a rare condition caused by hyperextension injury. Cases are treated by closed reduction, but open reduction is occasionally required. CASE PRESENTATION: Herein, we report a recurrent case of locking of the MP joint. Closed reduction was successful for treatment of the first injury but unsuccessful for the second injury, and open reduction was performed. At the operation for the second injury, we observed a transverse groove on joint cartilage of the metacarpal head. CONCLUSION: In recurrent cases, we should assume the possibility of failure of closed reduction and prepare for open reduction.

Comparison of ceftriaxone and cefazolin as prophylactic antibiotics for surgical site infection in orthopedic upper extremity surgery: The nationwide shortage of cefazolin in March 2019.

BACKGROUND: Due to the nationwide supply shortage of cefazolin in March 2019 in Japan, ceftriaxone was used as an alternative prophylaxis antibiotic agent. This retrospective study was designed to investigate the impact of cefazolin and ceftriaxone as a prophylactic antibiotic agent for surgical site infection (SSI) in orthopedic upper extremity surgery. METHODS: We used cefazolin for antibiotic prophylaxis to prevent SSI before March 2019. Because of cefazolin shortage, ceftriaxone was used as an alternative agent in our hospital. From April 2014 to May 2021, 2493 upper extremity surgeries were reviewed. The exclusion criteria in this study were as follows: patients aged under 16 years, those with an open wound, those with infectious diseases, those who underwent trigger finger surgery, and those who underwent percutaneous pinning surgery. The incidence of deep SSI was evaluated according to the Centers for Disease Control and Prevention guidelines. RESULTS: Among the 2493 eligible cases, 1674 were included in this study. In the cefazolin group, 1140 cases were included, whereas, in the ceftriaxone group, 534 cases were included. No significant differences in the demographic data of the patients were observed between the two groups. The incidence of deep SSI was 0.08% (1/1140 cases) in the cefazolin group and 1.1% (6/534 cases) in the ceftriaxone group, with a significant difference between the two groups (odds ratio, 12.9; p = 0.005). CONCLUSIONS: This study indicated that the use of ceftriaxone instead of cefazolin after upper extremity surgery increases the risk of deep SSI.

An anatomic study on the attachment of the joint capsule to the tibia in the lateral side of the knee.

PURPOSE: The purpose of the current study was to examine the width, area, and histological characteristics of the capsular attachment to the tibia in the lateral side of the knee. METHODS: A total of 27 knees were used in this study. The joint capsule of the knee was peeled away from the tibia and the width of the capsular attachment to the tibia was measured by two independent observers using a caliper. Interclass correlation coefficients for each value were calculated to evaluate the validity of the measurement. The capsular attachment to the tibia of the seven knees was histologically analyzed using Masson's trichrome staining. RESULTS: At the posterior border of Gerdy's tubercle, the capsular attachment was wide; the average width was 8.6 mm (SD 3.0). Toward the posterolateral aspect of the knee, the capsular attachment gradually tapered. Finally, the capsular attachment was linear at the apex of the head of the fibula. Histological analysis at the posterior border of Gerdy's tubercle revealed developed uncalcified fibrocartilage on the capsular attachment. In contrast, at the apex of the head of the fibula, the joint capsule was adhered to the capsule of the proximal tibiofibular joint. Fibrous connective tissue was directly attached to the calcified fibrocartilage. CONCLUSIONS: The attachment width of the knee joint capsule at the lateral side varied according to location. We consider that this finding on the capsular attachment will facilitate an understanding of the pathology or mechanism of diseases on the lateral side of the knee joint.