A new technique for metacarpophalangeal joint replantation after four-finger amputation.

Although finger amputations are not life-threatening, they are functionally and psychologically problematic for the patient. Successful replantation of amputated fingers results in better appearance and functional outcome. Therefore, the patient's satisfaction and psychological status improve. Usually, the first step of replantation involves bone and joint fixation. Various fixation methods can be used. Rapid and rigid fixation allows the surgeon to focus on repairing the soft tissues. In this report, we describe four-finger metacarpophalangeal (MCP) joint replantation with a new technique where no fixation device is used for the MCP joints. All four fingers survived and the total active motion of the four fingers ranged from 220 to 250 degree. Grip strength was 40kg and pinch strength was 5kg. Two-point discrimination was ranged from 4 to 8mm. We achieved a successful outcome comparable to previous reports. In conclusion, when amputation occurs at the MCP joint level, the fixation stage can be omitted to allow early repair of soft tissues.

Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions.

BACKGROUND: Rotator cuff lesions are one of the major causes of shoulder pain and dysfunction. Numerous non-surgical treatment modalities have been described for chronic rotator cuff lesions, but the debate continues over the optimal procedure. The aim of this report is to present the results of prolotherapy in the treatment of chronic refractory rotator cuff lesions. HYPOTHESIS: Dextrose prolotherapy will reduce pain and improve shoulder function and patient satisfaction. MATERIAL AND METHODS: We recruited 120 patients with chronic rotator cuff lesions and symptoms that persisted for longer than 6 months. Patients were divided into two groups: one treated with exercise (control group; n=60) and the other treated with prolotherapy injection (prolotherapy group; n=60). In the latter, ultrasound-guided prolotherapy injections were applied under aseptic conditions. In the former, patients received a physiotherapy protocol three sessions weekly for 12 weeks. Both groups were instructed to carry out a home exercise program. Clinical assessment of shoulder function was performed using a visual analog scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), Western Ontario Rotatory Cuff (WORC) Index, patient satisfaction, and shoulder range of motion. Patients were examined at baseline, weeks 3, 6, and 12, and last follow-up (minimum of one year). RESULTS: A total of 101 patients (44 controls and 57 in the prolotherapy group) completed all study protocols and were included in the study. Using a within-group comparison, both groups achieved significant improvements over baseline, as measured by the VAS, SPADI, WORC index, and shoulder range of motion (P<0.001). Using a between-group comparison, a significant difference was found in the VAS scores at baseline, weeks 3, 6, and 12, and last follow-up. In addition, significant differences were found in the SPADIs and WORC indices at weeks 6 and 12 and the last follow-up. Significant differences were found in shoulder abduction and flexion at week 12 and last follow-up, and in internal rotation at last follow-up. However, no significant was found in external rotation at any follow-up period. In the prolotherapy group, 53 patients (92.9%) reported excellent or good outcomes; in the control group, 25 patients (56.8%) reported excellent or good outcomes. CONCLUSION: Prolotherapy is an easily applicable and satisfying auxiliary method in the treatment of chronic rotatory cuff lesions. STUDY TYPE: Randomized prospective comparative trial. LEVEL OF EVIDENCE: Level of evidence 1.

Recurrence Pattern of Pulmonary Langerhans Cell Histiocytosis After Lung Transplantation: A Case Report.

Pulmonary Langerhans cell histiocytosis is an uncommon indication for lung transplantation. The recurrence of the primary pathology after transplantation is rare. Extra-pulmonary involvement of Langerhans cell histiocytosis before transplantation and resuming of smoking after transplantation are risk factors for recurrence. Herein, we present a 48-year-old woman with a recurrence pattern 24 months after bilateral sequential lung transplantation. On thoracic computed tomography, progressive parenchyma infiltrates were present without clinical symptoms. Infiltrations regressed and respiratory status of the patient was improved with steroid therapy. No events had occurred at follow-up of 31 months.