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Numerous techniques are available for treating finger joint disorders such as osteoarthritis and inflammatory arthritis. Joint fusion and arthroplasty have different concepts but can improve hand function. Joint fusion is indicated in patients with painful finger joints with or without poor soft tissue condition. Implant arthroplasty is indicated for degenerative or inflammatory arthritis in elderly patients because implants may require future revision. Arthroplasty with an autologous osteochondral cartilage graft is an option for young patients with posttraumatic metacarpophalangeal or proximal interphalangeal joint osteoarthritis, whereas vascular joint transfers are rarely used. Surgeons must carefully check each patient’s condition and treatment expectations.

This review analyzes various surgical exposures and implant designs for proximal interphalangeal (PIP) joint pathology. Our literature review found that silicone implants using a volar approach had the best arc of motion, least extension lag, and lowest complication rates compared with all the other implant designs and approaches. Surface replacement arthroplasties had more frequent surgical revisions compared with silicone implants. Continued efforts toward the development of improved PIP joint implants are necessary.

Supplemental Digital Content is available in the text.The pattern of 3-dimensional deformity of the forearm in missed Monteggia fracture and Monteggia-like lesions is very complicated. Recently, computer-assisted preoperative planning using 3-dimensional computed tomography (CT) modeling has been used for the treatment of malunited fractures. We developed a 4-dimensional simulation system by adding the anatomic motion axis to the 3-dimensional CT scan data of the affected arm in 1 position. Our system is based on the motion axis of the forearm passing through the center axis of the radial head and capitellum to the ulnar fovea. We simulate the osteotomy angle and amount of correction to make the radius move around the rotational axis of the forearm without interference between bones. The advantage of our method is the determination of a precise and flexible osteotomy site preoperatively using only the affected side CT image based on the rotational motion of the forearm. A 4-dimensional preoperative simulation system would be useful for chronic Monteggia fracture and Monteggia-like lesions because it would improve preoperative planning.

Supplemental Digital Content is available in the text.

Plate osteosynthesis for oblique fracture of the manubrium sterni is quite rare. We present a case of a 37-year-old man with oblique fracture of the manubrium sterni caused by a traumatic injury. He was operated on using a variable-angle locking compression plate Mesh Plate 2.4/2.7 and had a good postoperative result. We also discuss intraoperative safe techniques such as use of a cement spatula for reduction support tools and depth-limited drilling to prevent excess drilling of the opposite cortex.

Osteochondritis dissecans of the elbow mainly involves the capitellum; however, no authors have reported the condition in the radial head with subluxation of the radial head. We report four cases in which osteochondritis dissecans involved the radial head and was accompanied by radial head subluxation. All patients were male and their ages ranged from 11 to 13 years (average, 11.8 years). All lesions were located at the posteromedial aspect of the radial head with anterior subluxation of the radial head. Fragment removal was performed in one case and ulnar osteotomy in two cases; the remaining case was treated conservatively with the prohibition of sports. Three cases had a good outcome, whereas obvious anterior subluxation of the radial head and limitation of elbow flexion remained in the case treated with fragment removal.