Trapezium Tunnel Syndrome.

The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome.

Sliding Plate System: A Novel Method and Device for Shortening Osteotomy.

We report a novel sliding plate system (SPS) and its application for radial shortening osteotomy. We conceptualised, designed and introduced the SPS, which helps with precise shortening osteotomy in both radius and ulna. We implanted the SPS in a patient with Kienböck disease following a radius shortening osteotomy. The SPS was safe and efficient, and the surgical technique eliminated extra steps. The SPS affords precise shortening, optimum compression and anatomic alignment after radius shortening osteotomy. Level of Evidence: Level V (Therapeutic).

Appearance Outcomes of Repositioned Native Nail Plate as a Free Graft and Artificial Nail Plate in the Reconstruction of the Fingertip Injuries.

Purpose: The aim of this study was to evaluate the cosmetic outcomes of native nail plate (NP) replacement as a free graft and using an artificial NP in reconstruction of the fingertip injuries. Methods: Two prospective cohorts of patients with fingertip injuries and avulsed NPs were evaluated. In group 1 (54 patients with 61 fingertip injuries), the native NP was available and suitable for placement under the proximal nail fold. In group 2 (31 patients with 32 fingertip injuries), the native NP was either lost or highly damaged and it was not suitable for use. In this group, an artificial NP was used. The final cosmetic outcomes of regrown NPs were evaluated at a minimum of 4 months after surgery using the Oxford Finger Nail Appearance Score. Results: "Trapped in a door" was the most common cause of injury in pediatric patients, whereas work-related injuries were the most common cause of injury in adults. The difference between the mean appearance scores of the two groups favored group 1 (native NP). There was a negative correlation between the patient age and appearance scores, irrespective of the treatment group. The presence of a distal phalanx fracture adversely affected the appearance scores. Conclusions: Replacing the native NP for splinting in fingertip injuries is advantageous. Fingertip injuries in pediatric patients and fingertip injuries without distal phalanx fractures achieved better cosmesis scores. Type of study/level of evidence: Therapeutic III.

A Degloved Hand Was Resurfaced with Sandwich Flaps.

The right hand of a 35-year-old man trapped in a roller machine and sustained an entire degloving injury of the right hand involving fingers, thumb and a part of palmar and dorsal surfaces of the hand. The denuded hand and fingers were covered with two anteriorly based random paired flaps, forming a hand sandwich, from the opposing surfaces of medial left arm and adjacent left lateral chest wall. The denuded thumb was covered with a separate pocket of paired random vis-à-vis flaps. Finally, the right hand was turned to a functional mitten hand with a 15x13 cm flap on the dorsal surface, 10x10 cm flap on the palm surface. The thumb's covered surface with flaps was 7x 6 cm.

Concomitant Avascular Necrosis of the Lunate and Proximal Pole of the Scaphoid in a Thalassemia Minor Patient.

Avascular necrosis (AVN) of multiple carpal bones is a very rare condition. This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid that had led to severe joint space narrowing and degenerative arthritis in the radiocarpal and distal radioulnar joints (DRUJs). She was known to have thalassemia minor hemoglobinopathy. Wrist arthrodesis and distal ulna hemiresection-interposition arthroplasty (Bowers technique) for a DRUJ were offered and performed. The patient was satisfied with the clinical outcomes.

The 100 Top-Cited Articles about Kienböck's Disease: A Bibliometric Analysis.

Introduction The aim of this study was to analyze the 100 top-cited articles about Kienböck's disease and their features. Materials and Methods A search through the Elsevier, Scopus database journal articles about Kienböck's disease yielded 1,025 results. The 100 top-cited articles were identified and filtered again to exclude self-citations. The 100 top-cited articles without self-citations were analyzed for the number of citation, citation density, publishing journal, language, authorship, and geographic origin. The abstracts of the articles were obtained to review and determine the types of articles and levels of evidence. Results The mean of the 100 top-cited articles' absolute number of citations was 63.3 ± 34 (range: 23-199). Citation densities ranged from 1 to 8. A total of 97 (97%) articles were written in English. The leading countries were the United States with 50 (50%) articles followed by Japan with 16 (16%) articles. Forty (40%) articles have been published in the Journal of Hand Surgery American volume. Among the 100 top-cited articles, nine articles were devoted to basic science and 91 articles have dealt with clinical science. There were three articles with level II, 24 articles with level III, 46 articles with level IV, and 18 articles with level V of evidences. Conclusion The current study presents an insight to the classic articles about Kienböck's disease. The 100 top-cited articles have established a foundation that the science on Kienböck's disease has been elaborated. The current study is likely helpful for educational purposes and further research about Kienböck's disease. Level of Evidence Economic and decision analysis/Level IV.

Management of Symptomatic Lipoma of the Hand: A Case Series and Review of Literature.

Soft tissue lipoma is one of the most common benign tumors rarely forming in hand. In this study, 11 cases of symptomatic hand lipoma were investigated. The chief complaint was a palpable mass in all 11 patients, out of whom 6 (55%) cases presented with neurological symptoms, including paresthesia and numbness in the median, ulnar, and superficial radial nerve pathways. One patient had an intramuscularly painful forearm with a large mass presentation. In the finger, the clinical manifestations were radial anesthesia of the finger. The mass sizes were above 5 cm3 and less than 5 cm3 in seven and four patients, respectively. The mean follow-up period was 25 months. No patient demonstrated a recurrence during the follow-up period. Although lipoma is a benign tumor and often presents itself as a palpable mass in the hand, it can cause neurological symptoms and decreased function. Regardless of the size of the tumor, mass removal can prevent symptoms.

Interfascicular Gliding Dysfunction Relation with Focal Neuropathy in Diabetic Patients with Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS), a common neuropathy of the upper limb, is highly prevalent in diabetic patients. Recent findings indicate that changes in median nerve elasticity and its gliding characteristics may contribute to the development of CTS. Normally, each nerve should be able to adapt to the positional changes by passive movement relative to the surrounding tissues. This ability is provided by a gliding apparatus around the nerve trunk in the surrounding soft tissue. The fascicles of nerve trunks can also glide against each other (interfascicular gliding). Sonoelastography indicates that nerve elasticity is decreased in patients with CTS compared to healthy patients. Moreover, decreased nerve elasticity in diabetes mellitus type II is associated with increased neuropathy, especially in peripheral nerves. Biomechanical factors, oxidative stress, and microvascular defects are also observed in diabetic neuropathy and account for different complications. A reduction in the elasticity of peripheral nerves may be related to decreased interfascicular gliding because of the biomechanical changes that occur in neuropathy. Surgical treatments, including nerve release and reduction of carpal tunnel pressure, improve peripheral gliding but do not resolve disease symptoms completely. According to the evidence, interfascicular gliding dysfunction is the most important factor in the pathogenesis of CTS in diabetic patients. Available evidence suggests that biomechanical variations affect interfascicular gliding more than peripheral gliding in diabetic patients. Decreased nerve elasticity is strongly correlated with decreased interfascicular gliding. It is further hypothesized that the concurrent use of antioxidants and pharmacological treatment (neuroprotection) such as alpha lipoic acid with carpal tunnel release in diabetic patients may alleviate the interfascicular gliding dysfunction and improve median neve elasticity. Decreased nerve elasticity and interfascicular gliding dysfunction play significant roles in the pathogenesis of CTS in diabetic patients.

Bilateral Clinodactyly of the Index and Middle Fingers Because of Proximal Delta Phalanx.

Congenital clinodactyly is a rare pediatric hand deformity presented in familial, syndromic, or sporadic forms. Its association with bilateral Delta phalanx is very rare. A ten-year old boy presented with symmetric bilateral clinodactyly and brachydactyly of his index and middle fingers. This case report is a unique occurrence of congenital clinodactyly which a few of such case has been previously reported.

Application of shear wave elastography and median nerve cross-section area in the diagnosis and staging of carpal tunnel syndrome: a case-control study.

PURPOSE: Imaging is gaining a more prominent role in the diagnosis of carpal tunnel syndrome (CTS), especially ultrasonography. Shear wave elastography (SWE) is a novel qualitative method to study mechanical changes in tissue. In this study, we aim to assess the role of SWE in diagnosing and staining of the disease. MATERIAL AND METHODS: A total of 124 wrists were included in the study. Seventy wrists had CTS, and 54 were included as the control group. All of the wrists with CTS had staging done with nerve conduction study. All patients underwent ultrasonography by an expert radiologist and had the SWE and cross-section of the median nerve determined. These values were compared among the 2 groups and different stages of CTS. The receiver operating characteristic curve was utilized to assess the diagnostic role of each of the variables. RESULTS: Cross-section area (CSA) and SWE were significantly different between the 2 groups (p = 0.0001). CSA was also significantly different among various stages of CTS. SWE was not significantly different among moderate and severe stages of CTS. Both of the variables had a good ability to distinguish mild CTS from healthy wrists (p = 0.0001). CONCLUSION: SWE can be used in diagnosing CTS and in the staging of the disease.

Transscaphoid Dorsal Lunate Dislocation: A Case Presentation and Review of the Literature.

This case report describes a 74-year-old man with the rare injury of transscaphoid dorsal lunate dislocation (LD). He sustained a crushing injury with a huge amount of energy to his right wrist while working with a pressing machine. There were deep abrasions and areas of skin necrosis on the dorsum of the wrist. The patient was treated with closed reduction and a Herbert screw fixation for the scaphoid fracture. Six months postoperatively, avascular necrosis (AVN) of the lunate and scaphoid was apparent on the wrist radiographs. We offered a proximal row carpectomy to the patient, but he declined surgery because he was able to perform his activity of daily living. Dorsal LD as well as its variants has a high prevalence of AVN of the lunate. Delayed diagnosis, delayed treatment, and open reduction increase the risk of AVN development of the lunate. The level of evidence is therapeutic IV.

Kienböck Disease in a 66-Year-Old Man after Distal Ulna Fracture.

Kienböck disease after fracture-dislocations around the wrist is a rare occurrence. This case report presents a case of a 66-year-old man who developed Kienböck disease 18 months after his distal ulnar fracture. The patient developed negative ulnar variance after union of the distal ulnar fracture. Nonsurgical treatment was not effective in relieving his pain. Radial shortening osteotomy was performed based on the negative ulnar variance that developed. One year postoperatively, visual analog scale improved to 0, grip strength improved to 25 kg, and flexion-extension arc improved to 150 degrees. The patient achieved satisfactory clinical outcomes. This is a therapeutic level IV study.

Albin Lambotte: Pioneer of Osteosynthesis (Bone Fixation).

Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, and not individual views and prejudices except when they had a major impact on the subject's life. The authors of Stamp Vignettes do not intend to imply any endorsement of such views when discussing a Stamp Vignette on Medical Science.

Pregnancy-related Hand and Wrist Problems.

Hand and wrist disorders are common during pregnancy. Most of these problems develop during the third trimester when hormonal changes, fluid retention, and weight gain are maximum. This review study aimed to discuss pregnancy-related hand and wrist problems, and provide an overview of their pathology, clinical presentations, clinical examinations, and treatment options. Pregnancy-related carpal tunnel syndrome and De Quervain disease are among the most encountered disorders; however, neuralgic amyotrophy, pyogenic granuloma in hand, ligamentous laxity of the joints, arthralgia, and exacerbation of hand and wrist arthritis are among other reported disorders during pregnancy. Pregnancy-related hand and wrist problems may remain undertreated and reduce pregnant females' quality of life. Non-surgical treatments are usually effective for pregnancy-related hand and wrist problems. In general, pregnancy-related hand and wrist problems have a good prognosis and usually resolve after childbirth.

Emile Letournel: Pioneer of Acetabular Surgery.

Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, and not individual views and prejudices except when they had a major impact on the subject's life. The authors of Stamp Vignettes do not intend to imply any endorsement of such views when discussing a Stamp Vignette on Medical Science.