Minimally Invasive Plate Osteosynthesis for a Distal Radius Fracture with Forearm Skin Problem.

In this study, we performed osteosynthesis for a distal radius fracture using a minimally invasive approach for a patient with skin disorder of the forearm and obtained favorable results. This case report may provide new findings confirming the usefulness of this surgical approach for distal radius fractures. Blister formation on the right forearm was observed in a 53-year-old female who was diagnosed with a distal fracture of the right radius and underwent splinting in a local hospital, and she was referred to our hospital 2 days after the injury. Minimally invasive locking plate osteosynthesis was performed, and there was no skin lesion at this incision site. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. We reported volar locking plate osteosynthesis using the minimally invasive approach in a patient with skin disorder of the forearm. Such patients are rarely encountered. However, this minimally invasive approach is extremely useful for utilizing the advantages of volar locking plate fixation without being affected by the soft tissue environment.

Lateral collateral ligament reconstruction in atraumatic posterolateral rotatory instability.

BACKGROUND: Chronic elbow pain has several causes. Instability pain is one of the differential diagnosis. Posterolateral rotatory instability (PLRI) of the elbow results from lateral collateral ligament (LCL) insufficiency. This instability has been recognized in association with trauma of the elbow. The standard treatment of LCL insufficiency is ligament reconstruction with a tendon graft. Treatment outcome of LCL reconstruction in atraumatic PLRI cases has been rarely reported. This study reports the results of LCL reconstruction in patients with chronic lateral elbow pain from atraumatic PLRI. MATERIALS AND METHODS: Data were collected from 36 patients referred to our institution for surgery because of chronic lateral elbow pain between November 2011 and June 2015. Six patients with atraumatic PLRI underwent LCL reconstruction with tendon graft. Demographic data, number of steroid injections, postoperative clinical examination, Mayo Elbow Performance Index, 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and complications were recorded with a mean follow-up of 24 months. RESULTS: Reconstruction resulted in significant improvement of pain. The mean postoperative Mayo Elbow Performance Index score was 97.5 (range, 95-100), and the score of the 11-item version of the Disabilities of the Arm, Shoulder, and Hand was 9 (range, 3.3-33). Postoperative instability test results were negative in all patients. Mean postoperative range of motion was 136° in flexion and 1° in extension. No complications were detected at the follow-up assessment. CONCLUSIONS: We consider LCL reconstruction is one of the reference treatments for atraumatic PLRI because it provides effective and reliable results.

Evaluation of thenar muscles by MRI in carpal tunnel syndrome.

In the present study, the thenar muscles were evaluated using magnetic resonance imaging (MRI), in addition, the correlations between thenar muscle changes, clinical findings and electrodiagnostic results from patients with carpal tunnel syndrome were investigated. The subjects were 13 patients (17 wrists) who were clinically diagnosed with carpal tunnel syndrome. In all patients, a medical history was obtained and physical examination was performed, in addition to assessment using the Kapandji scoring system, visual analogue scale (VAS), quick-disabilities of the arm, shoulder and hand (Q-DASH) score, electrodiagnostic results of the median nerve, and MRI of the thenar muscles. Thenar muscle volume was not significantly correlated with clinical data or the electrodiagnostic results. The thenar muscle major axis was significantly correlated with grasp power (P<0.05) and the Kapandji score (P<0.05), while the thenar muscle minor axis was significantly correlated with abductor pollicis brevis distal motor latency (APB DML) (P<0.01). In addition, the thenar muscle minor axis/thenar muscle major axis ratio was significantly correlated with APB DML and Kanatani's stage. Notably, thenar muscle thinness was significantly correlated with the severity of electrodiagnostic changes, while the grasp power and Kapandji score were correlated with thenar muscle thickness. Furthermore, it was demonstrated that thenar muscle thinness was significantly correlated with the severity of electrodiagnostic changes; in addition, there was a significant correlation between the thenar muscle major axis and the grasp power or Kapandji score. Taken together, these results revealed that thenar muscle atrophy did not affect patient-based assessments, including VAS and Q-DASH, but reflected electrodiagnostic results, particularly DML and severity. The results of the present study suggest that thenar muscle atrophy can be used to estimate the severity of carpal tunnel syndrome.

A survey of extensor pollicis longus tendon injury at the time of distal radius fractures.

BACKGROUND: The purpose of this study is to investigate the presence or absence, incidence, and degree of extensor pollicis longus (EPL) tendon injury by visual confirmation of the EPL at the time of osteosynthesis for distal radius fractures. METHODS: The subjects were 25 patients (5 males and 20 females; mean age: 56 years) with distal radius fracture that had a dorsal roof fragment. During osteosynthesis using a volar locking plate, the third compartment was exposed in order to determine the EPL injury. The survey items in this study were: incidences of the forms of EPL injury (1: absent, 2: tendon floor fibrillation, and 3: laceration), and the presence or absence of periosteal rupture on the EPL tendon floor. In addition, on the final follow-up, the presence or absence of EPL rupture, the range of wrist motion, grip strength, Visual Analog Scale (VAS) score, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the Mayo wrist score were investigated. RESULTS: During the operation, EPL injury was classified as: 1) absent (12%), 2) tendon floor fibrillation (52%), or 3) laceration (36%). In the EPL tendon floor, periosteal rupture was observed in all patients. The mean postoperative follow-up period was 8 months (6-12 months) and no EPL rupture was observed in any patient. The wrist range of motion was 71° for flexion, 75° for extension, 84° for pronation, and 85° for supination, and the grip (% compared with the unaffected side) was 79%. The VAS, Q-DASH and Mayo scores were 1, 10 and 93 respectively. CONCLUSION: This study showed a high incidence of EPL tendon injury at the time of distal radius fractures (88%). To improve the ambient environment of the damaged tendon may be useful in terms of the prevention of tendon injury.

Two Portal Percutaneous Endoscopic Decompression for Lumbar Spinal Stenosis: Preliminary Study.

STUDY DESIGN: Retrospective. PURPOSE: To report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations. OVERVIEW OF LITERATURE: There are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis. METHODS: Medical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percutaneous endoscopic decompression for lumbar spinal stenosis were reviewed. The operations were performed by unilateral laminotomy for bilateral decompression. RESULTS: All patients displayed clinical improvement when were evaluated with visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and Macnab criteria. The improvement of VAS and ODI was 8.3±0.7 to 2.3±2.6 and 65.2±13.7 to 24.0±15.5, respectively (both p<0.05). Complications were the same as for open decompression. The most common complication was transient nerve root paresthesia. CONCLUSIONS: Surgical decompression with two portal percutaneous endoscopic decompression has initial benefits, but long-term studies should pay more attention to the risks of postoperative instability and restenosis as well as the need for re-operation. Further investigations with long-term results are thus required.

The Efficacy of Chitosan Dressing in Reducing Blood Loss for Harvest Site in Split Thickness Skin Graft: A Randomized Control Trial.

Background: Split thickness skin grafting (STSG) is common procedure for covering soft tissue defects and causes bleeding due to large raw surface area. Chitosan is a biodegradable, non-toxic, complex carbohydrate derivative extracted from chitin found in the shells of crustaceous animals. Chitosan is a new local hemostatic dressing certified for external use. But there was no study which was conducted in the randomized control trial to prove the efficacy of chitosan in reducing blood loss for harvest site in split thickness skin graft. Objective: To compare the efficacy of chitosan dressing and standard dressings in reducing blood loss at STSG harvest site and observe its complications. Material and Method: A randomized control trial study to compare the efficacy of chitosan dressing and standard dressings in reducing blood loss at STSG harvest site was performed between June 2014 to August 2015 at HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University in Nakhon Nayok province. Demographic data, area of harvest site, blood loss, VAS score at the time of wound dressing and complications were recorded. Results: Twenty patients with skin defect were randomly assigned into 2 groups (Chitosan group n = 10 and Standard dressing group n = 10). No difference of demographic data between the 2 groups. The average area of donor site in the chitosan group was 36.5 cm2 and standard dressing group was 40.2 cm2 (p-value = 0.42). Blood loss from the chitosan group was 15.4 gm compared with 26.3 gm from the standard group (p-value = 0.81). Even though chitosan dressing can decrease the amount bleeding by 40% compared to the standard dressing but there was no significant difference between the two groups. No serious complication was detected at the time of follow-up. Conclusion: Chitosan gauze dressing did not decrease blood loss from harvest sites of STSG compared with the standard dressing group and there was no serious complication associated with chitosan was detected.