Reproducibility and reliability of performance indicators to evaluate the therapeutic effectiveness of biofeedback therapy after elbow surgery: An observational case series.

Electromyographic biofeedback (EMG-BF) therapy provides information on the state of contraction of the targeted muscles and relaxation of their antagonists, which can facilitate early active range of motion (RoM) after elbow surgery. Our aim in this study was to calculate the minimum detectable change (MDC) during EMG-BF therapy, initiated in the early postoperative period after elbow surgery.This study is an observational case series. EMG-BF of muscle contraction and relaxation was provided during active elbow flexion and extension exercises. Patients completed 3 sets of 10 trials each of flexion and extension over 4 weeks. The total range of flexion-extension motion and scores on the Japanese Society for Surgery of the Hand version of the disability of the arm, shoulder, and hand questionnaire and the Japanese version of the Patient-Rated Elbow Evaluation were obtained at baseline and weekly during the 4-week intervention period. A prediction formula was developed from the time-series data obtained during the intervention period, using the least-squares method. The estimated value was calculated by removing the slope from the prediction formula and adding the initial scores to residuals between the measured scores and predicted scores individually. Systematic error, MDC at the 95th percentile cutoff (MDC95), repeatability of the measures, and the change from the baseline to each time-point of intervention were assessed.The MDC95 was obtained for all 3 outcome measures and the range of values was as follows: RoM, 8.3° to 22.5°; Japanese version of the Patient-Rated Elbow Evaluation score, 17.6 to 30.6 points; and disability of the arm, shoulder, and hand questionnaire subscale: disability and symptoms score, 14.2 to 22.9 points.The efficacy of EMG-BF after elbow surgery was reflected in earlier initiation of elbow RoM after surgery and improvement in patient-reported upper limb function scores. The calculated MDC95 cut-offs could be used as reference values to assess the therapeutic effects of EMG-BF in individuals.

Vascularized Iliac Bone Lining in Downgraded Treatment of Campanacci Grade III Giant Cell Tumor of the Distal Radius.

It is commonly accepted that wide en bloc resection followed by reconstruction is essential in progressive lesions (Campanacci grade III) for local control of possible recurrence. However, specific grade III can be downgraded and treated with intralesional curettage to preserve better wrist function, without increasing the recurrency rates. In this report, Grade III giant cell tumor of the distal radius was successfully treated using vascularized osseous graft from the inner lip of the iliac bone in addition to downgrading strategy.

"Silent Ruptures" of the Flexor Digitorum Profundus of the Little Finger due to Pisotriquetral Arthroses.

Asymptomatic pisotriquetral arthroses caused ruptures of the flexor digitorum profundus tendon of the little finger in 2 elderly patients. Ruptures occurred with unnoticeable onset, and bilateral ruptures separately occurred with interval of several years in one patient. The tendon was ruptured in zone IV with perforation of the gliding floor through which the degenerative pisiform was visible. The gliding floor was repaired followed with excision of the pisiform, and the ruptured tendon was then transferred to the profundus tendon of the ring finger. Asymptomatic pisotriquetral arthrosis in old age can be an aspect of the pathological background of flexor tendon ruptures of the little finger that occur unnoticed.

Does Graft on Flap Method Work on Sequela of Fingertip Amputation?

The graft on flap method, a useful option for the restoration of fresh fingertip amputation, was applied to the reconstruction of the short fingertip stumps resulting from the initial amputated stump plasties. As a modification, a nail bed graft from the big toe and a small cubic iliac bone graft were substituted for the lost tissues normally reduced as a composite graft in fresh cases. Upon follow-up ranging from 1 to 8 years, the grafted bone was found to have been resorpted in all cases. For the reconstruction of short fingertip stumps after the initial amputated stump plasties, acceptable results have not yet been achieved using the graft on flap method.

Three cross leg flaps for lower leg reconstruction of Gustilo type III C open fracture.

A 60 year old male had Gustilo type III C open fracture of the right lower leg. After radical debridement, the large open defect including certain loss of the bone tissue was successfully augmented and covered, by consecutive three cross-leg flaps, which consisted of the free rectus abdominis musculocutaneous flap, the fibula osteocutaneous flap and the conventional sural flap. Although indication for amputation or preservation is decided with multiple factors in each case, a strategic combination of cross-leg flap, free flap, external fixation and vascular delay could increase the potential of preservation of the lower leg with even disastrous Gustilo type III C.

Treatment of Combined Injuries of the Axillary and Suprascapular Nerves with Scapulothoracic Dissociation.

A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.

Atypical subcutaneous granuloma annulare on the digit: a case report.

Subcutaneous granuloma annulare is a benign inflammatory disorder consisting of deep dermal or subcutaneous nodules, and frequently occurring in the extremities and scalp in children. The occurrence of aggregated multiple nodules in a digit is quite atypical. This is a report of an eight-year-old girl who presented with increasingly asymptomatic multiple nodules on her middle finger over a period of six months. Definitive diagnosis of subcutaneous granuloma annulare was achieved with surgical biopsy and no aggressive growth subsequently and showed a tendency toward spontaneous resolution.

Glomangiomatosis concentrated in the ankle with varied appearances: a case report.

Glomangiomatosis is an exceedingly rare condition. This report details a case of multiple glomangiomas concentrated in the ankle of a 59-year-old male. Despite identical histological findings, the lesions displayed varied clinical features at physical examination, at magnetic resonance imaging, and upon further examination after excision. Unlike solitary glomus tumors, glomangiomas can vary widely in clinical appearance.

Articular synovial chondromatosis of the finger.

A 40-year-old woman presented with a six-month history of synovial chondromatosis of the metacarpophalangeal joint of the right ring finger, which was resected through both dorsal and volar incisions. To our knowledge there have been only 17 reported cases of articular synovial chondromatosis of the digital joint so far. We present a case affecting the metacarpophalangeal joint with a review of scattered information found in other 17 reports.

Two-stage tendon sheath reconstruction using sublimis tendon and silicone Penrose drain after severe purulent flexor tenosynovitis: a case report.

Two-stage tendon sheath reconstruction, a method of pulley reconstruction using the sublimis tendon and a pseudosheath formed with a silicone Penrose drain wrapped around the profundus tendon, is a new technique for improving a poor functional prognosis after purulent flexor tenosynovitis.

Percutaneous flexible double pinning (Py-Desmanet's procedure) for pediatric distal radius fractures.

PURPOSE: The purpose of this study is to report the results of percutaneous flexible double pinning for pediatric distal radius fractures. METHODS: Thirteen unstable fractures (three physeal and ten metaphyseal) of the distal radius in which the physeal plate could be still identified were treated with percutaneous flexible double pinning between 2008 and 2011. The average age of these cases was 9.8 years (range, 2-16 years). According as Py-Demanet's original technique, the fracture was fixed with two percutaneous transepiphyseal intramedullary wires. Kirschner wires or c-wires of 1.4-1.6 mm in diameter were used in each case depending on age. Operative and short follow-up outcomes were assessed. RESULTS: The average operative duration was 23 min (range, 5-45 min). Comorbid distal ulnar fractures were further stabilized by intramedullary pinning. Additional external splintage was administered in all cases for 6 weeks postoperatively. Wires were removed after an average of 7.2 weeks (range, 4-10 weeks). Bone union was achieved in all cases. Neither malunion nor early epiphyseal closure of the distal radius was identified at mean follow-up of 12 months (range, 3-51 months). DISCUSSION: Flexible double pinning has been successfully used for distal radius fractures in adults. Since this technique is minimally invasive, quick, and technically easy, it is also a good treatment option for unstable distal radius fractures in children. LEVEL OF CLINICAL EVIDENCE: Therapeutic Level IV.

Regional first web flap used to cover the amputated stump of the thumb.

The regional first web flap is a distally-based flap that is raised from the radiodorsal aspect of the metacarpophalangeal joint of the index finger towards the dorsal first web, and used to cover a thumb amputation. The advantage of this flap over the conventional cross-finger flap is that is gives a thicker and hairless flap with no skin graft to the donor site. Mobilisation of the joints, including the metacarpophalangeal joint of the index finger, can also be maintained during the immobilisation period between two stages.

Vascularized genicular osseous-periosteal flap for pseudarthrosis of the proximal phalanx of the little finger: a case report.

This study describes pseudoarthrosis of the proximal phalanx of the little finger and its successful treatment using a free vascularized genicular osseous-periosteal flap. Since this thin and pliable flap can be harvested as a small vascularized unit, it is ideal for the treatment of phalangeal pseudoarthrosis.

Atypical ulnar tunnel syndrome accompanied by sensory disturbance of the dorsal sensory branch of the ulnar nerve.

An atypical accessory abductor digiti minimi, which is morphologically a bicipital muscle, was the cause of the ulnar tunnel syndrome. A ganglion grew from the volar carpal joint at the same time and caused sensory disturbance of the dorsal sensory branch of the ulnar nerve.

A rare nodular fasciitis involving the finger: a case report.

This is a report of a 43-year-old man with nodular fasciitis of the little finger. Nodular fasciitis with its feature of rapid growth and aggressive histological appearance is often mistaken for a malignant neoplasm and rarely involves fingers.

Atypical triggering at the wrist due to intratendinous infiltration of tophaceous gout.

This is a report of a 41-year-old male with triggering of the long finger flexor digitorum superficialis tendon at the wrist secondary to tophaceous gout. The tophus was severely infiltrating the tendon, and a tenotomy of the FDS tendon was performed. Preoperatively, the lesion could not be distinguished from a neoplasm.

Relationship between sensory recovery and advancement distance of oblique triangular flap for fingertip reconstruction.

PURPOSE: Oblique triangular flaps often need extensive advancement for fingertip coverage. The purpose of this report is to retrospectively investigate the relationship between sensory recovery and advancement distance of oblique triangular flaps. METHODS: Fourteen consecutive fingertip amputations in 11 patients were treated with oblique triangular flaps between 2005 and 2006. These cases had been regularly followed up (range, 14-21 months) until sensory recovery of the fingertip covered with the flap reached a plateau, and then final sensory condition was evaluated with the Semmes-Weinstein monofilament test and a moving 2-point discrimination test, in addition to evaluation of existence of dysesthesia. RESULTS: Dysesthesia existed in 7 fingers, and there was an associated a significant difference between a flap advancement distance of more than 12 mm and a flap advancement distance of less than 12 mm. In an objective evaluation of whether the 2.83 monofilament (0.086 g) could be recognized in the Semmes-Weinstein test, there was also an associated significant difference between a flap advancement distance of more than 12 mm and a flap advancement distance of less than 12 mm. CONCLUSIONS: Good sensory recovery occurred in cases with less than 12 mm flap advancement. In cases where the flap was advanced more than 12 mm, sensory disturbance of the fingertip occurred and did not subside. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Usefulness of vascular bundle interposition of the descending branch of the lateral circumflex femoral vessels for free flap reconstruction of the calvarial defect.

Usefulness of the descending branch of the lateral circumflex femoral vessels as a vascular bundle interposition graft was introduced. Large calvarial defect with no recipient vessel for direct anastomosis was successfully covered with free flap nourished by the cervical vessels through the vascular bundle interposition graft of the descending branch of the lateral circumflex femoral artery and its venae comitantes. The vascular bundle interposition has remarkable advantages over the venous graft regarding its patency and durability, especially in the head and neck region in which grafted vessels is difficult to be set on the straight. The descending branch of the lateral circumflex femoral vessels can be harvested up to 20 cm, and its diameter is suitable for interposition between conventional free flaps and recipient vessels in the head and neck region.