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Closed nontraumatic flexor tendon ruptures are classified as spontaneous, infiltrative tenosynovial, iatrogenic, or attritional ruptures based on their mechanism. Attritional ruptures occur over rough bone surfaces that result from various pathologies. Here, we present a case of attritional rupture of the flexor digitorum profundus of the little finger due to pisotriquetral arthritis. [ABSTRACT FROM AUTHOR]

Background: Detection of dorsal cortical penetration of distal locking screws is difficult owing to the irregular shape of the dorsal surface of the distal radius. This study was designed to analyze two-dimensional morphological characteristics of the distal radius on axial magnetic resonance image, and to suggest a guideline for evaluation of screw length in distal radius fractures on the fluoroscopic or plain X-ray true lateral image. Methods: Anteroposterior length and lateral width of the distal radius, distance between the highest and the lowest point of the dorsal cortex (deceptive length), and widths of the first to second (hazard zone) and the third to fifth extensor compartments (safe zone) at the Lister tubercle level were measured on 104 axial magnetic resonance images by two hand surgeons. Results: The mean length and width of the distal radius at the Lister tubercle level were 22.96 mm and 30.42 mm, respectively. The mean hazard zone and safe zone widths were 8.72 mm and 19.43 mm, respectively. The mean deceptive length was 4.07 mm and the deceptive length did not have a relationship with height, sex, and age of subjects. Conclusions: We suggest that 4 mm be used as a reference value for the evaluation screw length at the safe zone. If the vertical distance between a distal screw tip and the peak of the Lister tubercle is lesser than 4 mm on a fluoroscopic or plain X-ray true lateral image, dorsal cortical penetration should be suspected. When dorsal cortical penetration at the hazard zone is suspected, both oblique or pro-supination views should be checked. [ABSTRACT FROM AUTHOR]

Purpose To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. Methods Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels’ cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels’ entry points. Results The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. Conclusions This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. Clinical relevance This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis. [ABSTRACT FROM AUTHOR]

Background: The pedicled latissimus dorsi (LD) flap serves an important function in breast reconstruction, but its utility is limited by its inability to provide sufficient breast volume.Objectives: The purpose of this preliminary report was to review the techniques and outcomes of utilizing fat-grafted, volume-enhanced LD flap transfer with fat grafting recipient sites in autologous breast reconstruction.Methods: A retrospective study was performed of 10 patients (14 breasts) who underwent autologous breast reconstruction utilizing the LD flap transfer technique and simultaneous fat grafting between August 2012 and September 2014. Multilayer, multisite fat grafting was performed to the LD muscle, LD skin paddle, mastectomy skin flaps, and the pectoralis major and serratus muscles simultaneously with the LD flap transfer.Results: Three patients underwent an immediate breast reconstruction, four underwent a delayed breast reconstruction, and four underwent a tertiary breast reconstruction following previously failed breast reconstructions (one patient underwent each of the first two procedures, one on each breast). The average age of the patients was 55 years (range, 39-76 years), the average body mass index of the patients was 29.3 (range, 19.6-39.9), and the average fat grafting volume for the patients was 176 mL (range, 50-300 mL). There was 100% flap survival and complete wound healing. No seroma or fat grafting-related complications were clinically detected. Three patients required additional fat grafting.Conclusions: The fat-grafted, volume-enhanced LD flap procedure with fat grafting recipient sites offers a simple and safe technique for autologous breast reconstruction, with low morbidity and fast recovery. It can be a useful alternative to utilizing abdomen-based flaps in autologous breast reconstruction or could be performed to salvage both implant-based and free-flap breast reconstructions. LEVEL OF EVIDENCE 4: Therapeutic. [ABSTRACT FROM AUTHOR]

Purpose: Although anterior transposition of the ulnar nerve is a commonly performed procedure for treatment of cubital tunnel syndrome, there are concerns that surgical mobilization puts blood supply to the nerve at risk. The purpose of this study was to compare the effects of subcutaneous anterior transposition (SAT) and in situ decompression (ISD) on the ulnar nerve''s histologic and electrophysiologic properties in a rabbit model. Methods: We assigned 30 male, young adult New Zealand white rabbits to 1 of 3 groups (each group, n = 10). The extensive dissection–SAT group underwent complete neurolysis of the right ulnar nerve from brachial plexus to wrist and a subsequent SAT, the ISD group underwent ISD with 4-cm-long exposure of the ulnar nerve, and the SAT group underwent SAT with 4-cm-long circumferential neurolysis of the ulnar nerve. We killed the animals 7 days after the operation. We assessed electrophysiologic changes by finding the percentage of compound motor action potential of the surgical limb compared with the contralateral limb, and histologic changes by ischemic fiber degeneration. Results: The extensive dissection–SAT group showed a significantly lower percentage of compound motor action potential and higher grade of ischemic fiber degeneration than the ISD and SAT groups. On the other hand, the percentage of compound motor action potential and the grade of ischemic fiber degeneration were similar between the latter 2 groups without a statistically significant difference. Conclusions: This study demonstrated that surgical mobilization of the ulnar nerve during SAT has an effect similar to ISD on the nerve''s histologic and electrophysiologic properties at the 7th postoperative day in a rabbit model. Clinical relevance: In a rabbit model, ISD and SAT appear to affect histologic and electrophysiologic findings of the ulnar nerve equally at postoperative day 7, which suggests that they would have the same relative safety in a clinical setting. [Copyright &y& Elsevier]

Skeletal metastasis is a common event during the advanced stage of a malignant tumour, but metastasis to the hand is rare (about 0.1% incidence). We have seen seven cases of metastatic malignant tumour of the hand since 1983, and report them here. [ABSTRACT FROM AUTHOR]

This study reports a rare case of complete dislocation of the thumb metacarpal with extreme displacement. Although there are several reported cases of similar injury in earlier published reports, metacarpals of all the cases remained in situ. In this case, the metacarpal was totally displaced out of the hand. Although open reduction and internal fixation were performed, the clinical outcome was unsatisfactory because of severe soft tissue damage. [ABSTRACT FROM AUTHOR]

Abstract: We report here on an unusual case of recurrent dissociation of a polyethylene tibial insert from its metal baseplate after high-flex posterior-stabilized (PS) Genesis II total knee arthroplasty with using the mini-subvastus approach. After the 1st episode of dissociation, which had happened 1month after the primary surgery, we changed the tibial insert and found damages on the dovetails and the post of the retrieved insert. Unfortunately, the patient suffered the same dissociation 1month after the tibial insert was changed. This case illustrates that incomplete seating of the insert due to limited surgical exposure and anterior impingement of the high-flex PS post may contribute to the risk of dissociation. [Copyright &y& Elsevier]

Purpose To describe the demographics, diagnosis, management, and outcomes of capitate fractures in the adult and pediatric population treated in our institution. Methods We performed a retrospective chart and radiographic review of 53 patients with capitate fractures treated in our institution between 2002 and 2015. Patients’ demographic characteristics, mechanism of injury, management including surgery-related data, and outcomes, including complications, were recorded. A radiographic evaluation of the location and pattern of the fracture was performed. Results Capitate fractures were prevalent in young males and older females. Fracture location was variable with 9 different locations; in addition 80% of patients had an associated fracture in the wrist or hand. The most common fracture pattern was the transscaphoid, transcapitate perilunate dislocation. Most diagnoses were made with the aid of advanced imaging. Within this series, there was only 1 case (4%) of fracture nonunion and there were no cases of avascular necrosis of the proximal pole in limited follow-up. Isolated capitate fractures were significantly more common in children. In addition, children had better functional outcomes than adults. Conclusions This series provides updated information on this rare injury. Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort. Type of study/level of evidence Therapeutic IV. [ABSTRACT FROM AUTHOR]