Establishing a central zone in scaphoid surgery: a computational approach.

PURPOSE: Scaphoid fractures are commonly fixed with headless cannulated screws positioned centrally in the scaphoid. Judgement of central placement of the screw may be difficult. We generated a central zone using computer analysis of 3D reconstructions of computed tomography (CT) images. As long as the screw axis is completely contained within this central zone, the screw would be considered as centrally placed. METHODS: Thirty cases of 3D CT reconstructions of normal scaphoids in a computerised operation planning and simulation system (Vxwork software) were obtained. The central zone was established after some distance shrinkage of the original scaphoid surface reconstruction model using the function "erode" in the software. The shape of the central zone was evaluated, and the width of the central zone in the proximal pole, waist portion and distal pole was measured. We also established the long axis of the scaphoid to see whether it stays in the central zone. RESULTS: All central zones could be divided into distal, waist and proximal portions according to the corresponding irregular shape of the scaphoid. As the geometry of the central zone was so irregular and its width very narrow, it was possible to completely contain the screw axis either in the proximal portion alone, waist alone or distal central zone alone. CONCLUSIONS: Establishing the central zone of scaphoid 3D CT images provided a baseline for discussion of central placement of a scaphoid screw. The geometry of the scaphoid central zone determined that the screw could hardly be inserted through entire scaphoid central area during surgery.

Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China.

BACKGROUND: Some hydatid cysts of cystic echinococcosis type 1 (CE1) lack well-defined cyst walls or distinctive endocysts, making them difficult to differentiate from simple hepatic cysts. AIM: To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries. METHODS: The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region (China) from January 2018 to September 2023 were retrospectively analyzed. Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis, routine abdominal ultrasound, high-frequency ultrasound, abdominal computed tomography (CT) scan, and laparoscopy. Subsequent to the treatments, these patients underwent reexaminations at the outpatient clinic until October 2023. The evaluations included the diagnostic precision of diverse examinations, the efficacy of surgical approaches, and the incidence of CE recurrence. RESULTS: All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan. Among them, 16 patients were preoperatively diagnosed with atypical CE1, and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound. All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy, of whom 14 patients were intraoperatively confirmed to have CE1, which was consistent with the postoperative pathological diagnosis, one patient was diagnosed with a mesothelial cyst of the liver, and the other was diagnosed with a hepatic cyst combined with local infection. Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts, 4 received aspiration sclerotherapy of hepatic cysts, and 19 received laparoscopic fenestration. These patients were intraoperatively diagnosed with simple hepatic cysts. During the follow-up period, none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices. One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space. CONCLUSION: Abdominal high-frequency ultrasound can detect CE1 hydatid cysts. The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.

[Central placement of screw fixation for scaphoid fracture: a biomechanical study].

OBJECTIVE: To evaluate the effect to the fixation stability of central screw placement during scaphoid fracture surgery. METHODS: We designed oblique osteotomies for 32 identical sawbone scaphoids and fixed each specimen with a cannulated screw. Sawbone scaphoids were divided into 4 groups, according to position of the osteotomy (distal waist portion or proximal waist portion) and the position of the screw (central or eccentric). We performed Computed Tomography scanning to one specimen, and then the central zone of the scaphoid was established from volume data by using the preoperative planning system software (VxWork 4.0). The position of the osteotomy plane, the entrance and exit points of the screw guide pin were designed on the software as well. We placed the specimens under the increasing load of a pneumatically driven plunger to compare the load to failure and the distance at failure between the central and eccentric screw groups. RESULTS: In general, we found the statistical differences of the load to failure and the displacement of fracture between the groups (F=31.485,P=0.001; F=33.328,P=0.018). The average load to failure and fracture displacement was more statistically different in the central group [(80.82 ± 15.63) N, (2.3 ± 0.5) mm] for proximal waist fracture than in the eccentric group [(58.32 ± 17.18) N, (3.1 ± 0.5) mm]. As to the distal waist fracture, the average load to failure and fracture displacement was better in the central group [(76.83 ± 14.54) N, (2.2 ± 0.7) mm] than in the eccentric group [(70.38 ± 13.32) N, (2.5 ± 0.6) mm] without significant difference. CONCLUSION: In this biomechanical model of an unstable oblique scaphoid fracture, we find that higher stability of fixation has been achieved with a screw placed centrally in the scaphoid, compared with a screw peripherally placed.

[Segmental schwannomatosis in upper-extremity: 5 cases report and literature review].

OBJECTIVE: Multiple schwannomas localized in a single body part not crossing the midline constitute a rare variant of neurofibromatosis, segmental schwannomatosis. We report our experience with 5 cases of segmental schwannomatosis of the upper extremity and review the related literature to improve our skills in diagnosis and differentiation. METHODS: Five patients with segmental schwannomatosis received surgical treatment in our department from 2003 to 2012, of whom 4 were female and the other one male. The mean age was 38 years, ranging from 29 to 48 years. In retrospect, we discussed the clinical appearance, histologic characteristics, genetic data and surgical management. RESULTS: A total of 351 patients with schwannomas were treated in the recent decade. There were 326 patients with solitary schwannoma, accounting for 92.88%, 25 with neurofibromatosis type 2 (NF-2), occupying 7.12% and 5 with segmental schwannomatosis representing 1.42% of the total. Schwannomas are limited in one upper extremity and randomly located at ulnar nerve, median nerve and radial nerve and their branches, with no obvious predisposition. Their family history was negative for cutaneous tumors or central nervous system disease. Neurological examinations did not reveal symptoms related to vestibular nerves or optic nerves, which excluded NF-2 preliminarily. The prior symptom of three cases was pain which could be irradiated to the nerve distribution area. No pain but slight numbness was found in two cases. MRI disclosed multiple masses along the course of the nerves. They were isointense to muscle on T1-weighed images and hyperintense to subcutaneous fat on T2-weighed images. All schwannomas were resected and histological sections exhibited a characteristic feature of schwannoma. Follow-up work of 4.5 years was done to 4 cases and no recurrence or impairment of nerves was found. CONCLUSION: Segmental schwannomatosis is characterized by multiple schwannomas localized in one limb (upper extremity in our cases) without vestibular nerve tumors, most frequently seen in females at the age of 30-60 years. Segmental schwannomatosis is rarely seen in the previous literature. We found around 20 cases in English articles and no cases in domestic articles. In consideration of the clinical appearances of these 5 cases and the genetic research in the related literature, we recommend that segmental schwannomatosis is a distinct form of neurofibromatosis which needs to be more studied. We should also pay more attention to differentiating this disease from other forms of neurofibromatosis.

[Clinical study of full-thickness skin graft for reconstruction of completely defect nail unit].

OBJECTIVE: To explore a reconstruction method for complete nail bed defect caused by various kinds of reasons and to retrospectively analyze the effect of application of free full-thickness skin graft for the whole nail unit repair. METHODS: Between Apr. 2010 and Mar. 2012, the method of free full-thickness skin graft was done for reconstruction of the completely nail unit defect in seven cases. There were 2 male and 5 female patients; the mean age of these patients at the time of surgery was 51.9 years (range: 7 to 70 years). The preoperative diagnoses included two cases of malignant melanoma, one of chronic infection, one of squamous cell carcinoma, two of subungual pigmentation and one of junctional nevus. There were 2 thumb lesions, 3 middle and 2 index finger lesions. Nail unit defect was in the range of 1.5 cm×2 cm to 2.5 cm × 3.5 cm and full thickness skin graft was harvested from the same medial side of upper arm (3 cases), forearm cubital fossa (1 case) and contralateral side of groin region (3 cases). RESULTS: All the patients were followed with an average follow-up time being 10 months. All the free skin graft taken was achieved with 100% in all the 7 cases, even in those patients whose partial cortical bone had been curetted. The skin graft was often bluish initially, and superficial blisters were always noticed within 1.5 months postoperatively and the survival skin graft was smooth eventually, and skin graft was adhered to the underlying bone tightly. There was no epidermal inclusion cyst and no residual nail formation. The skin donor sites were without complications. Aesthetic appearance was assessed by the surgeons and found no unacceptable for their patients. And all the patients were satisfied with the cosmetic appearance and active range of motion of their involved fingers, who did not express a desire to undergo any further of nail reconstruction. CONCLUSION: Free full-thickness skin grafting for reconstruction of the complete nail unit defect is a simple, safe and effective procedure which provides a satisfactory aesthetic appearance and does not make any significant skin donor site morbidity especially for middle-aged and elder patients.

[Diagnosis and surgical treatment of giant cell tumor in hand bone].

OBJECTIVE: To review the experience with clinical and imaging characteristics of giant cell tumor (GCT) of the hand as well as the surgical outcomes. METHODS: Between 2000 and 2010,16 cases of GCT of the hand were admitted to our department. There were 10 male and 6 female patients with a mean age of 41.3 years (age range: 24 to 65 years) with Campanacci's grade I ( n = 0), Grade II (n=12), and Grade III (n=4). Eight cases occurred in metacarpal bone and 8 cases in phalanx. All patients had the symptoms of pain,swelling and restricted range of motion in the affected joint.The average time from the onset of the symptom to the first visit of the patients was 12 months( range: 5 to 15 months).Radiographic changes showed osteolytic lesions occupying at least half of the diaphyseal region in most of the cases. Four grade III patients underwent tumor resection and bone graft or serial amputation, while 12 Grade II patients extensive curettage and bone graft. RESULTS: Twelve patients'clinical and radiographic diagnosis at admission was endochondroma, while postoperative histopathology reported all the lesions as GCT. Twelve patients were followed up for a mean of 58.8 months (range: 24 to 140 months). Immediate relief of pain was observed postoperatively in all patients. No complications, such as infection or joint stiffness, were observed in any patient. The average healing time of bone graft was 3.3 months (range: 3 to 5 months).Ten gradeII patients were followed up for at least 2 years and 3 of them had local recurrence 8 to 16 months after first resection. En bloc resection was then performed, and no second reccurence was reported. Two gradeII patients were followed up for at least 2 years and none of them had local recurrence. No malignancy, multiple center lesion or lung metastasis was reported. Active range of motion in the patients without joint arthrodesis was maintained during the follow-up period. CONCLUSION: GCTs of the hand are relatively rare, and tend to be misdiagnosed as endochondroma. The results of the present study suggest that extensive curettage provides favorable local control and satisfactory functional outcomes.

An Analysis of the Pathogenic Genes and Mutation Sites of Macrodactyly.

OBJECTIVE: This study aimed to explore the pathogenic genes and mutation sites of macrodactyly. METHODS: Whole-exome sequencing was performed on the pathological tissue and peripheral blood of 12 patients with macrodactyly who were operated in our hospital between June 2018 and May 2020. In order to conduct comprehensive bioinformatics analysis and screen the pathogenic genes of macrodactyly, the patients were divided into four groups: macrodactyly of finger group, macrodactyly of foot group, macrodactyly and syndactyly of finger group, and macrodactyly and syndactyly of foot group. The results of the whole-exome sequencing were verified using Sanger sequencing in order to clarify the pathogenic genes and mutation sites of macrodactyly, and immunohistochemical analysis of the protein signaling pathways encoded by the pathogenic genes was performed to observe the protein expression and further verify the mutant genes. RESULTS: In the comprehensive bioinformatics analysis and Sanger verification of the whole-exome sequencing, the PIK3CA gene mutation was screened as the pathogenic gene of macrodactyly. The mutation sites were identified as the p.E542K (c.G1624A) and p.E545K (c.G1633A) sites of exon10 and the p.H1047R (c.A3140G) and p.G1049R (c.G3145C) sites of exon21. Among these, the p.G1049R (c.G3145C) locus was found in macrodactyly for the first time. The mutation of the PIK3CA gene was also found to lead to increased expression of serine-threonine kinase (AKT) in adipocytes in the PI3K-AKT-mTOR signaling pathway. CONCLUSION: Mutation of the PIK3CA gene leads to the enhancement of the PI3K-AKT-mTOR signaling pathway, which is the cause of macrodactyly. There is also some diversity in PIK3CA gene mutation sites.

[Establishment of a "central zone" in the scaphoid bone by computer analysis of three-dimensional reconstructions of computed tomography imaging and selection of central location of the scaphoid screw].

OBJECTIVE: To establish an area by generating a surface model located a certain distance inside the scaphoid bone by computer analysis of three-dimensional reconstructions of computed tomography images, and define the central zone of the scaphoid. METHODS: Twenty cases of three-dimensional computed tomography reconstructions of normal scaphoids in a computerized operation planning and simulation system (Vxwork software) were obtained. The scaphoid surface model was shrunk by using the function "erode" in the software until the waist portion became the one third size of the original waist portion of the scaphoid, and then another 1.5 mm shrinkage was made to get the central zone. Geometry and size of the central zone were evaluated and measured. RESULTS: Geometry of all central zones was similar, as irregular as the scaphoid. The central zone could be divided into distal pole, waist portion and proximal pole. The narrowest part in the central zone was the waist portion, whose diameter ranged from 0.8-1.2 mm. Based on irregularity and size of the central zone, a screw axis could only be possibly contained completely either in the proximal, waist or distal central zone area, as it was very difficult to place the screw centrally in the whole scaphoid. CONCLUSION: The establishment of the central zone of the scaphoid three-dimensional computed tomography images could provide a baseline for discussion of central placement for scaphoid screw.

[An epidemiological investigation of acute occupational hand injuries].

OBJECTIVE: To study composition, distribution and causes of acute occupational hand injuries in Beijing Jishuitan Hospital. METHODS: From April 1st 2005 to September 30th 2005, all patients with acute hand injuries were investigated by questionnaire focusing on all related epidemiological elements. RESULTS: Two thousand six hundred fifty eight cases with acute hand injuries were about 17.3 % of patients with acute orthopedic injuries. Their mean age was (30.4 +/- 10.8) years old. The radio of males to females in cases with acute hand injuries was 57:1. The cutting and crushing injuries were the main causes of acute hand injuries. Most of cases with acute hand injuries were engaged in work related to machines. The acute hand injuries were mainly involved in index and middle figures of both hands, 94.9 % of acute hand injuries were opening, and 87.6% of acute hand injuries were involved in the deep tissues. CONCLUSION: Acute hand injuries are the common occupational severe injuries for young male workers. The acute hand injuries occur in patients engaged in work related to machines. The prevention of acute hand injuries should be emphasized.

Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report.

BACKGROUND: Hepatic cystic echinococcosis (CE) is an infectious zoonotic parasitic disease, and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment. Hepatocellular carcinoma (HCC) is the fourth most common malignant tumor. Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized. We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about. CASE SUMMARY: A 70-year-old man presented with upper abdominal pain. On admission, laboratory data showed that, except for hepatitis B surface antigen positivity, other indicators were normal, including alpha-fetoprotein. Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe, without reinforcement after enhanced scanning and sized about 16.9 cm × 12.2 cm, which was considered a type II hydatid cyst. Multiple small solid lesions were also found adjacent to it, and thus it was highly suspected as a malignant tumor. After a multidisciplinary team discussion, the diagnosis of co-occurrence of hepatic CE and HCC was made. According to Romic classification, the case belongs to type IIb, and radical left hemi-hepatectomy was performed. Postoperative pathological examination revealed CE co-existence with well-differentiated HCC, consistent with the preoperative diagnosis. CONCLUSION: With the combination of hepatitis B and obvious extrusion by large hydatid, the HCC risk of a patient might be higher.

[Biomechanical research of antegrade intramedullary fixation for the metacarpal fractures].

OBJECTIVE: To study the biomechanical characteristics of antegrade intramedullary fixation for metacarpal fractures. METHODS: From March to May 2008, both the 4th and 5th metacarpals from 25 formalin embalmed cadaver hands had three-point bending test after transverse osteotomy followed by randomly fixation with one of the following three methods: plate and screw, antegrade intramedullary K-wire, crossed K-wire. While, both the 2nd and 3rd metacarpals had torsional loading test after the same management as the 4th and 5th metacarpal had undergone. RESULTS: In the three-point bending test, both the maximum bending moment (M(max)) and bending rigidity (EI) of the antegrade intramedullary K-wire were comparable with those of the plate and screw, and were significantly larger than those of the crossed K-wire. In the torsional loading test, the antegrade intramedullary K-wire had a statistically smaller maximum torque (T(max)) than the plate and screw, and had a comparable T(max) with the crossed K-wire; while, the torsional rigidity (GJ) of the intramedullary K-wire was statistically weaker than that of both the plate and screw and the crossed wire. CONCLUSIONS: One single antegrade intramedullary K-wire can provide a satisfactory M(max) and EI for metacarpal fixation and shows relatively weak in the torsional loading test. The injured finger should be well protected to avoid torsional deformity in clinical practice.

[A method of measuring the displacement of the distal radioulnar joint on the three-dimensional CT imaging].

OBJECTIVES: To establish a clinical method for measuring the displacement of the distal radioulnar joint (DRUJ) precisely irrespective of ulnar variance, and to derive normal population translation references with palmar and dorsal stress. METHODS: Thirty-seven normal distal forearms were scanned with computed tomography using an apparatus designed by Pirela-Cruz. Each extremity was scanned in two positions: maximal ulnar palmar and dorsal stress. The digital imaging and communications in medicine (DICOM) CT images were then imported into Mimics 10.0 for three-dimensional reconstruction. On the DRUJs 3D images, choose the most prominent point of the palmar and dorsal margins of the sigmoid notch and the excavate ulna fovea as the reference points A, B and C. A perpendicular line was then drawn from the point C to a line connecting points A and B with the intersection D. Calculate the ratio of AD/AB and DB/AB. Two observers measured all the DRUJs independently and one repeated the measurements one month later to determine the interobserver and intraobserver reliability. RESULTS: The mean ratio values of palmar (AD/AB) and dorsal (DB/AB) translation were 0.39 ± 0.07 and 0.37 ± 0.07, and the normal references (x(-) ± 2 s) were from 0.25 to 0.50 and from 0.23 to 0.50, respectively. No significant differences were observed in terms of positions, genders and dominant hands. The intraclass correlation coefficient (ICC) values for interobserver and intraobserver reliability (DB/AB, AD/AB) were 0.84, 0.80, 0.93 and 0.92, respectively. CONCLUSIONS: This new method could accurately measure the displacement of DRUJs with acceptable reliability, even with ulna positive or negative variance. Instability of DRUJ may be indicated when AD/AB is less than 0.25 or BD/AB is less than 0.23.

[Effects of different doses and concentrations of ropivacaine in axillary brachial plexus block].

OBJECTIVE: To evaluate clinic pharmacodynamics of ropivacaine hydrochloride, a new long-acting amide type local anaesthetic, in Chinese patients undergoing neurolysis and tendolysis of forearm through axillary brachial plexus block. METHODS: Two hundred ASAI-II persons, aged 18-65,weighing 60-75 kg, undergoing neurolysis and tendolysis of forearm under axillary brachial plexus block were randomly assigned to 4 equal groups to received ropivacaine of the doses of 1.00 mg/kg (Group I), 1.25 mg/kg (Group II), 1.50 mg/kg (Group III), and 2.00 mg/kg (Group IV). Each group was subdivided into 5 equal subgroups according to the concentrations (0.15%, 0.20%, 0.25%, 0.30%, and 0.35%). The effects were analyzed. Results There was no significant difference in starting time, consummating time, and persisting time of sensory and motor nerve block between Group I and Group II (all P > 0.05). The starting time and consummating time of Group III and Group IV were all significantly shorter than those of Group I (all P < 0.05), and the persisting times of Groups III and IV were all significantly longer than those of Group I (P < 0.05). 90 minutes after brachial plexus block the degrees of muscle strength Groups I and II were M1 and M2 respectively, hence, the sensory and motor nerves block was in dissociation. When motor never block was above M3 and M4 the interval of brachial plexus block was 55 min and 27 min in Group III and Group IV respectively. CONCLUSION: Sensory and motor never can be blocked perfectly when the dose of ropivacaine is between 1.5 mg/kg and 2.0 mg/kg and the concentration is between 0.30%-0.35%. When the doses of ropivacaine is 1.25 mg/kg and the concentration is 0.20%-0.25% the starting and consummating time are longer and persisting time is shorter. When the doses of ropivacaine is 1.00 mg/kg and the concentration is 0.15%-0.20% the starting and consummating time are longer and only satisfies external debridement and suture without tourniquets.

[Malignant giant cell tumor of the tendon sheaths in the hand].

OBJECTIVES: To retrospectively study on malignant giant cell tumor of tendon sheath (MGCTTS) in the hand, and to evaluate its clinical, histologic, immunohistochemical features and biologic evolution. METHODS: Between January 1991 and December 2001, 10 patients with histologically proven MGCTTS were treated. The clinical material, radiographs and hematoxylin and eosin-stained sections were reviewed. Immunohistochemical studies and nuclear suspensions for flow cytometry were done on paraffin embedded tissue. All patients were followed up. RESULTS: Three of 10 patients in which the diagnosis of MGCTTS was originally considered were excluded after the slides reviewed and immunohistochemical examination performed. In the other 7 patients, one showed malignant and aggressive nature: the lesion recurred several times and the patient eventually died with pulmonary metastases. The immunohistochemical profile of the patient was similar to that reported in benign GCTTS, and the flow cytometry DNA analysis detected aneuploidy. Six cases presented histologic features of malignancy, 4 of them undertook the immunohistochemical examination and their profiles were similar to that reported in benign GCTTS. An aneuploidy DNA pattern was detected in one case on flow cytometry evaluation, diploidy DNA pattern was detected in 3 cases, and their S-phase fraction was 4.5%, 11.6% and 2.6% respectively. All of them had a benign clinical features, they were alive and without evidence of disease from 1.5 to 7.5 years (averagely, 4.5 years) after complete surgical excision or resections with wide surgical margins. None of them had received chemotherapy or radiation therapy. CONCLUSIONS: Malignant giant cell tumor of tendon sheath is an extremely rare malignant tumor, some cases have a poor outcome, the others, despite the histologically malignant features, have a good prognosis if wide surgical excision ablates the tumor completely.

[Clinical analysis of 73 cases of macrodactyly].

OBJECTIVE: To analyze the clinical characteristics of 73 cases of macrodactyly. METHODS: Review the incidence, distribution, characteristic, X-rays, pathogenesis and treatment of involved digits on the base of the clinical documents of 73 macrodactyly which were treated from 1965 to 2006. Twenty-eight cases had been followed-up. RESULTS: Unilateral involved 71 cases, bilateral involved 2 cases. In upper deformities, the most involved digit was the index finger, followed by thumb and middle finger enlargement. In lower deformities, the second toes were affected more. There were 12 cases of static macrodactyly, which were all presented at or soon after birth. Sixty-one cases were progressive macrodactyly: 39 cases presented at birth; 17 cases occurred at about 2 years old; 5 cases were found after age 2. Thirty-seven cases of progressive type presented digital deviation; 3 cases associated with syndactyly; 16 cases complicated with thenar eminence hypertrophy; 8 cases of multiple-digit involved combined with palm and forearm hyperplasia. CONCLUSIONS: Macrodactyly in hand has a preference for the median nerve territory, mainly involving index, thumb and middle finger. Pedal macrodactyly prefers medial plantar nerve territory, the second toe is the most commonly affected. The progressive macrodactyly is more common than static. It may present at birth and combine with syndactyly, digital deviation, thenar eminence hypertrophy, palm and forearm hyperplasia.

[Digital gigantism of the foot: a clinical study of 12 cases].

OBJECTIVE: To summarize the clinical characteristic and outcome of digital gigantism of the foot. METHODS: Retrospectively analyze the clinical documents of cases of digital gigantism of the foot. Twelve 12 cases with 13 feet in this study included 8 male and 4 female with an average 4.6-years-old. All the deformities were found at birth. Multiple toes involved were more than single toe, and tibial toe involved more than fibular. Forefoot was enlarged. All the phalanges involved and partial metatarsal bones were enlarged. Marked increase in subcutaneous fat was found in all cases in the operation which infiltrated interossei and articular capsules. The appearance of the nerves and its branches in the foot were normal and fat infiltrating was not discovered. The operation types included debulking, epiphyseal arrest, amputation, nerve stripping and anastomosis. RESULTS: Seven cases were followed up with mean periods 25.6 months. Functional evaluation according to a criterion formulated by author revealed a result of 2 excellent, 2 good and 3 fair. CONCLUSIONS: Digital gigantism of the foot is an uncommon congenital deformity of the foot characterized by overgrowth of both the soft-tissue and the osseous elements of the enlarged toe and forefoot. Surgical treatment is the unique method, and the goal is to reduce the size of the foot to allow fitting regular shoes and walking readily. There are several types of operations which to be chosen. The indication, the timing of operative intervention and the selection of operation type should be paid more attention.

Arthroscopic Management of Perilunate Injuries.

The key to successful treatment of perilunate injuries is to achieve early anatomic reduction and maintain the carpal alignment. Open surgery may lead to capsular scarring and joint stiffness. Furthermore, there is increased chance of damage of the already tenuous blood supply to scaphoid and the torn ligaments. Recently, arthroscopic-assisted management of perilunate injuries has been suggested. This article describes the surgical technique and outcome of this minimally invasive approach for perilunate injuries.

Contralateral C7 Nerve Root Transfer for Function Recovery in Adults: A Meta-analysis.

BACKGROUND: Root avulsion to all 5 roots of the brachial plexus is a common presentation and keeps a major reconstructive challenge. The contralateral C7 (CC7) nerve transfer has been used in treating brachial plexus avulsion injury (BPAI) since 1986. However, the effectiveness of the procedure remains a subject of controversy. The aim of this meta-analysis was to study surgical outcomes regarding motor and sensory recovery after CC7 nerve transfer. METHODS: Chinese or English (i.e., "contralateral c-7", "contralateral c7", "c7 nerve root", and "seventh cervical nerve root") keywords were used for a literature search for articles related to CC7 nerve transfer in several databases (i.e., PubMed, Cochrane, Embase, CNKI, CQVIP, and Wanfang Data). Clinical research articles were screened, and animal studies as well as duplicate publications were excluded. Muscle strength and sensory recovery were considered to be effective only when the scores on the United Kingdom Medical Research Council scale were equal to or higher than M3 and S3, respectively. RESULTS: The overall ipsilateral recipient nerve recovery rates were as follows: the efficiency rate for muscle strength recovery after CC7 nerve transfer was 0.57 (95% confidence interval [CI]: 0.48-0.66) and for sensory recovery was 0.52 (95% CI: 0.46-0.58). When the recipient nerve was the median nerve, the efficiency rate for muscle strength recovery was 0.50 (95% CI: 0.39-0.61) and for sensory was 0.56 (95% CI: 0.50-0.63). When the recipient nerve was the musculocutaneous nerve and the radial nerve, the efficiency rate for muscle strength recovery was 0.74 (95% CI: 0.65-0.82) and 0.50 (95% CI: 0.31-0.70), respectively. CONCLUSIONS: Transfer of CC7 nerves to musculocutaneous nerves leads to the best results. CC7 is a reliable donor nerve, which can be safely used for upper limb function reconstruction, especially for entirely BPAI. When modifying procedures, musculocutaneous nerves and median nerve can be combined as recipient nerves.

Restoration of thumb opposition by transposing the flexsor pollicis brevis muscle: thirteen-year clinical application.

BACKGROUND: To repair late median nerve injury, many methods have been used in the past years. The aim of this study was to review a thirteen-year experience in restoration of thumb opposition by transposing flexor pollicis brevis muscle. METHODS: From July 1992 to August 2005, 63 patients without thumb opposition because of late median never injury were treated by transposing the flexor pollicis brevis muscle. All the patients had received primary nerve repair after the jnjury. The interval between the injury and the second operation was (1.87 +/- 2.31) years (6 months to 4.2 years). The patients were followed up for 3 to 48 [months mean (22.93 +/- 2.31) months]. A functional evaluation system designed in 1992 were used to estimate the outcomes of the patients. RESULTS: All the patients gained excellent functional results without complications and disabilities during follow-up. CONCLUSIONS: Restoration of thumb opposition by transposing flexsor pollicis brevis muscle has the following advantages: 1. Operative trauma is minimal; 2. It is not necessary to transpose other tendons; 3. Except for the thumb in opposition, movements of other fingers and the wrist are not restricted postoperatively.

[Clinical analysis of 16 cases of epithelioid sarcoma].

OBJECTIVE: To introduce the clinical features of a rare malignant soft tissue tumor. METHODS: Review the clinical findings, pathologic features and results of the treatment of 16 cases of the epithelioid sarcoma in extremities, which were treated in our hospital from 1992 to 2004. Analyze the follow-up results of 14 cases. RESULTS: The tumors occurred chiefly in young adults (mean age 30 years) and commonly involved soft tissue of the hand. Follow-up (average 25 months, from 1 to 112 months) information on 14 patients revealed relentless clinical course with frequent recurrence (71%). There was a significant difference between those patients in whom had a marginal and radical resection, both in recurrence rate and disease-free survival rate. CONCLUSION: It is safe to choose the radical resection of this disease after the tumor reoccurs.