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The purpose of this retrospective study was to introduce the use of an alternative vascularized bone graft for treating scaphoid non-union. The vascularized bone graft was harvested from the dorsal base of the third metacarpal bone. From May 2014 to September 2017, 29 patients with scaphoid non-union were treated. Grip and pinch strengths were compared to the contralateral side. The patients rated wrist joint pain on a visual analogue scale. Wrist function was assessed on Mayo Wrist Score. p 0.05 was considered statistically significant. 18 scaphoids healed at 6 weeks and the other 11 at 16 weeks. Follow-up ranged from 28 to 73 months, for a mean 48 months. At final follow-up, mean wrist flexion had improved from 65° (range, 51°-81°) preoperatively to 72° (range, 61-78°) (p 0.05), for a contralateral value of 74° (range, 65°-86°). Mean extension had improved from 56° (range, 44°-72°) to 60° (range, 47°-76°) (p 0.05) for a contralateral value of 66° (range, 52°-80°). Mean wrist pain improved from 4 (range, 3-8) to 2 (range, 0-4) (p 0.05). Mean pinch strength improved from 6.4 kg (range, 5.2-7.3 kg) to 8.6 kg (6.1-9.9 kg) (p 0.05). Mayo Wrist Score improved from 49 (range, 10-65) to 92 (range, 70-100) (p 0.05). Transferring a vascularized bone graft harvested from the base of the third metacarpal bone was an effective alternative for the treatment of scaphoid non-union, achieving bone healing and normal wrist function without significant donor-site morbidity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Purpose: The purpose of this study was to introduce the surgical method of K-wire combined with screw in the treatment of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type B3.1 phalangeal fractures and to compare its clinical, radiological and functional outcomes with K-wire fixation.Methods: This was a retrospective comparative study. From January 2015 to February 2022, we treated 86 patients with AO type B3.1 phalangeal fractures. A total of 71 patients were finally included in the statistical analysis. Thirty-nine patients received K-wires combined with screw, and 32 patients received simple K-wires. The follow-up time was at least 6 months. Outcome measures included general information, operative time, total active motion (TAM), pinch strength, radiological union time, pain assessed by visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complications.Results: The follow-up time was 6-12 months, with an average of 7.9 months. All patients achieved clinical and radiological union. Compared with the K-wire fixation group, the TAM, radiological union time and VAS score of the K-wire combined with screw group had obvious advantages. Compared with the opposite healthy hand, the grip strength of the two groups was similar, and there was no significant difference in the QuickDASH score. The incidence rate of complications in the K-wire combined with screw group (2/39) was lower than that in the K-wire fixation group (7/32).Conclusions: Compared with simple K-wire fixation, K-wire combined with screw in the treatment of AO type B3.1 phalangeal fractures is a safer and reliable surgical method. K-wire controls the rotation and plays a role similar to a "lock". The screw can exert pressure and fix it more firmly. It shortens the time of fracture healing and has a higher TAM and fewer postoperative complications.

Objective. To investigate the effect of annular external fixator-assisted bone transport in the treatment of traumatic massive bone defect of tibia on clinical healing, pain stress, and joint function. Methods. From January 2018 to November 2021, 146 patients with traumatic massive bone defect of tibia were selected as the research objects, and they were divided into observation group (annular external fixator-assisted bone transport, 71 cases) and control group (unilateral external fixator bone lengthening, 75 cases) according to different surgical methods. The therapeutic efficacy, fracture healing-related indexes, and postoperative range of motion of the knee joint were compared between the two groups. Callus healing was evaluated by Fernandez-Esteve callus score, and joint function was evaluated by Paley score, American Knee society score (AKSS), and Baird-Jackson ankle score. The changes of pain mediator (serum substance P (SP), neuropeptide Y (NPY), prostaglandin E2 (PGE2), and tumor necrosis factor-α (TNF-α)) and stress indexes (adrenocorticotropic hormone (ACTH), cortisol (COR), and nor Epinephrine (NE)) were observed before and after treatment in two groups. The incidence of postoperative complications was analyzed. Results. There were no significant differences in total effective rate and bone lengthening between the two groups ( P > 0.05 ). The bone healing time and callus formation time in the observation group were shorter than those in the control group, and the Fernandez-Esteve callus score was higher than that in the control group ( P < 0.05 ). The levels of SP, NPY, PGE2, TNF-α, ACTH, COR, and NE in the observation group were lower than those in the control group ( P < 0.05 ). AKSS and Baird-Jackson scores in the observation group after operation were higher than those in the control group ( P < 0.05 ). There was no significant difference in the incidence of postoperative complications between the two groups ( P > 0.05 ). Conclusion. Annular external fixator-assisted bone transport can promote postoperative fracture healing, reduce pain stress level, and improve joint function of patients with traumatic massive bone defect of tibia.

Triangular fibrocartilage complex (TFCC) lesions are a common cause of ulnar wrist pain. Data, including mental status assessment, were prospectively collected from patients who underwent arthroscopy. The HADS was used to assess the prevalence of depression and anxiety. Patients with degenerative TFCC lesions were at an increased risk of anxiety and depression. Early screening for anxiety and depression in degenerative TFCC lesions patients should be recommended.

BackgroundIn the late stage of traumatic ankle arthritis, the pain symptoms are aggravated and the joint function is obviously limited. However, in the face of young patients with high activity requirements, there are still great challenges in how to preserve the joint and effectively treat traumatic ankle arthritis. Ankle distraction arthroplasty and supramalleolar osteotomy are both options for such medical condition, but the studies comparing their clinical outcomes have been scarce. The purpose of this study is to compare the clinical outcomes of ankle distraction arthroplasty and supramalleolar osteotomy in the treatment of severe traumatic ankle arthritis in young adult patients.MethodsThis was designed a retrospective study, enrolling 73 consecutive young adult patients who underwent ankle distraction arthroplasty (n=32) or supramalleolar osteotomy (n=41) for post-traumatic ankle arthritis from January 2017 to December 2020. All patients had at least 24-month follow-ups. The outcome measures were the comparisons of the pre- and postoperative visual analog scale (VAS) for pain relief, the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, angle range of motion (ROM), complications, patient-rated overall satisfaction and radiological evaluation of changes in ankle joint space width (JSW).ResultsSeventy-three patients (73 ankles) (100%) returned for final evaluation at an average of 32 months (range, 24 to 48 months) follow-up. At an average of 6 months follow-up, both groups achieved significantly improved VAS, AOFAS, ROM and JSW scores compared to those at baseline ( p0.05). Either, both groups did not differ in in the tibial anterior surface angle(TAS), talar tilt angle(TT), tibial lateral surface angle(TLS), except for the correcting the load-bearing line of the ankle and hindfoot. However, at the last follow-up, patient satisfaction and ankle function scores in the ankle distraction arthroplasty group showed a downward trend, while the function scores in the supramalleolar osteotomy group showed an increasing trend, which was statistically significant.ConclusionsBoth ankle distraction arthroplasty and supramalleolar osteotomy are effective treatment options for the severe post-traumatic ankle arthritis in the young adult patients. From the long-term follow-up, however, supramalleolar osteotomy is better than ankle distraction arthroplasty in ankle score and patient satisfaction evaluation.Level of evidence: Level III, retrospective comparative series.

Brachial plexus avulsion significantly increased brain-derived neurotrophic factor (BDNF) release in the spinal cord. Here we investigated the involvement of the BDNF-TrkB-KCC2 pathway in neuropathic pain caused by BPA injury. We hypothesized that activation of BDNF-TrkB may inhibit neuronal excitability by downregulating KCC2 to maintain a high intracellular Cl-concentration. We established a neuropathic pain rat model by avulsion of the lower trunk brachial plexus, and investigated the effects of the TrkB-specific antibody K-252a on the expression of BDNF, TrkB, and KCC2.We randomly divided 40 male SD rats into four groups. In the brachial plexus avulsion group, C8-T1 roots were avulsed from the spinal cord at the lower trunk level. In the K252a group, 5uL K252a was applied intrathecally daily for three days after avulsion. In the sham surgery group, expose only and without damage. The control group did not undergo any treatment. Mechanical hyperalgesia and cold allodynia were analyzed by electronic pain measuring instrument and acetone spray method at different time points on days 1, 3, 7, 10, 14, and 21 after surgery. At 21 days after surgery, the expression of BDNF and TrkB in dorsal horn neurons and GFAP in astrocytes were detected by immunohistochemistry at the C5-T1 segment of the spinal cord. The expression levels of BDNF, TrkB, and KCC2 in the C5-T1 spinal cord were measured by Western Blot at 7 and 21 days.Mechanical hyperalgesia and cold allodynia were significantly reduced in the K252a group compared with the brachial plexus avulsion group. Compared with the BPA group, BDNF, TrkB and GFAP were significantly decreased in the K252a group at 21 days after treatment by immunohistochemical test. In the WB test, the expressions of BDNF and TrkB in the K252a group were quantitatively detected to be decreased, while the expression of KCC2 was increased, which was obvious at 7 and 21 days.BDNF-TrkB-KCC2 pathway can significantly relieve neuropathic pain after BPA, and is a potential target for the treatment of neuropathic pain.

BACKGROUND The purpose of this study was to explore the feasibility of ulnar groove plasty guided by a three-dimensional (3D) printing technique for treatment of moderate to severe cubital tunnel syndrome (CuTS) caused by elbow osteoarthritis. MATERIAL AND METHODS Patients with moderate to severe CuTS secondary to osteoarthritis of the elbow were enrolled in our hospital from April 2015 to March 2018. Based on a previously proposed "elbow canal index", a 1: 1 model of the elbow joint was printed using CT image data collected preoperatively. After computer-aided measurement, the standard for enlargement of the ulnar nerve groove was calculated and a personalized "trial model" was created by 3D reconstruction. After intraoperative exposure of the ulnar nerve sulcus, the proliferative osteoid was burred with a grinding drill, and the cubital enlargement was verified by the trial model. The ulnar nerve was decompressed and reincorporated into the enlarged cubital canal, and the Osborne ligament was zig-zag elongated and reconstructed. RESULTS None of the patients reported experiencing medial elbow instability, medial elbow pain, ulnar nerve subluxation, flexor-pronator weakness, or incision infection. There was significant improvement of the motor nerve conduction velocity, sensory nerve conduction velocity, two-point discrimination of the little finger, grip strength, pinch strength of the thumb and index finger, VAS score, and DASH score in this study (P0.001). CONCLUSIONS Ulnar groove plasty guided by a 3D printing technique may be another effective treatment of moderate to severe CuTS caused by elbow osteoarthritis.

BackgroundPost-traumatic ankle arthritis is increasing, especially in young people and currently there is still lack of solid guidelines regarding its operative treatment. Ankle distraction arthroplasty and supramalleolar osteotomy are both options for such medical condition, but the studies comparing their clinical outcomes have been scarce. This study aimed to address this issue.MethodsThis was designed a retrospective study, enrolling 73 consecutive patients who underwent ankle distraction arthroplasty (n=32) or supramalleolar osteotomy (n=41) for post-traumatic ankle arthritis from January 2015 to December 2018. All patients had at least 24-month follow-ups. The outcome measures were the comparisons of the pre- and postoperative visual analog scale (VAS) for pain relief, the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function.ResultsAt an average of 32 months (range, 24 to 48 months) follow-up, both groups achieved significantly improved VAS and AOFAS scores compared to those at baseline (all p0.05). The ankle distraction arthroplasty group had better postoperative ankle mobility than the supramalleolar osteotomy group, in terms of plantarflexion (37.8±4.2 vs 30.4±3.6, P=0.022), dorsiflexion (36.5±6.4 vs 28.3±5.5, P=0.011), varus (32.1±4.5 vs 27.1±3.1, P=0.029) and valgus (28.4±3.7 vs 25.2±2.8, P=0.047). Either, both groups did not differ in in the tibial anterior surface angle, talar tilt angle, tibial lateral surface angle, except for the correcting the load-bearing line of the ankle and hindfoot. The prevalence of postoperative complication was not significantly different between both groups (28.1% vs 17.1%, P=0.257). ConclusionsBoth ankle distraction arthroplasty and supramalleolar osteotomy are effective treatment options for Takakura-Tanaka stage 3 post-traumatic ankle arthritis, but with respective advantages and disadvantages. In practice, individualized treatment option tailored to the medical conditions and patients' specific need should be considered before a decision is made.

BackgroundPost-traumatic ankle arthritis is increasing in young people and it is very important to preserve the ankle range of motion in young patients. This study aimed to compare ankle distraction arthroplasty versus supramalleolar osteotomy for post-traumatic ankle arthritis.MethodsThis retrospective study reviewed 32 consecutive patients who underwent surgery for post-traumatic ankle arthritis from January 2015 to December 2018 after failure of conservative treatment. Thirteen ankles that underwent ankle distraction arthroplasty were age-, sex-, and body mass index-matched with 19 ankles that underwent supramalleolar osteotomy. Patients returned for clinical and radiologic follow-up at an average of 32 (range, 24–48) months postoperatively. Outcomes were the comparison of the pre- and postoperative Visual Analog Scale (VAS) pain scores and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, subjective patient-rated satisfaction, and ankle function.ResultsThe VAS and AOFAS scores of the two groups were significantly improved at final follow-up compared with preoperatively (pConclusionsAnkle distraction arthroplasty and supramalleolar osteotomy both achieved good pain relief and improved function in patients with traumatic ankle arthritis.Level of evidence: Level III, retrospective comparative series.

Purpose This study aimed to compare the radiographic and functional results of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type C2/C3 fracture of distal radius between volar locking plate (VLP) and external fixation (EF). Methods It was a retrospective comparative study. Between January 2015 and March 2018, a total of 62/117 patients who underwent EF (23) or VLP fixation (39) for AO type C2/C3 distal radius fractures were assessed. The follow-up period was at least 12 months. Gartland–Werley scale and the disabilities of the arm, shoulder, and hand (DASH) scale were used to evaluate the overall functional outcomes; wrist range of motion and grip strength were measured. The radiographic parameters included radial inclination, volar tilt, radial length, ulnar variance, and articular step-off. All of the comparisons were performed using SPSS 21.0. Results The mean follow-up time was 17.1 months. At final visit, VLP performed better in wrist flexion (69.7° vs 62.3°, p 0.05). The ulnar variance and articular step-off was significantly more improved in VLP than EF group, being 0.6 vs 1.6 mm (p = 0.002) and 0.5 vs 1.2 mm (p = 0.007). The overall rate of complications did not differ in both groups (28.2% vs 34.5%) (p = 0.587). Conclusions Compared to EF, VLP fixation showed better performance in wrist mobility, correction of ulnar variance, and improving articular congruence, but with the comparable overall functional outcomes and complication rate.

The aim of this report was to introduce the use of modified dynamic high-frequency ultrasound-guided needle aponeurotomy for Dupuytren's contracture. From January 2014 to February 2019, the technique was used in 42 consecutive patients who suffered from Dupuytren's contracture: 38 male and 4 female; mean age, 57 years (range, 32-80 years). Assessments comprised total active extension deficit and total active flexion of the fingers, active range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, and EQ-5D index. Recurrence was defined as ≥20° flexion contracture. Compared to the opposite hand, preoperative total active extension deficit and total active flexion were 105° ± 32° and 221° ± 33°, respectively. The mean active range of motion of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints was 42° ± 24°, 37° ± 26° and 62° ± 14°, respectively. Mean follow-up was 27 months (range, 24-35 months). There were no cases of tendon rupture or neurovascular injury. Total active extension deficit and total active flexion at the final follow-up were 17° ± 11° and 225° ± 32°, respectively. The mean active range of motion of metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints was 73° ± 28°, 89° ± 24° and 63° ± 16°, respectively. The pre- and post-operative DASH scores were 18 ± 10 and 5 ± 2, respectively. Health-related quality of life on EQ-5D index improved from 0.72 ± 0.28 pre-operatively to 0.88 ± 0.72 post-operatively (p 0.05). Recurrence rates in the metacarpophalangeal joint and proximal interphalangeal joint were 7% and 11%, respectively. The modified dynamic high-frequency ultrasound-guided needle aponeurotomy is a safe and effective way to treat Dupuytren's contractures. Ultrasound visualization ensures that the cords can be completely transected. Dynamic ultrasound decreases the risk of iatrogenic injury to the neurovascular bundles and tendons, and decreases the recurrence rate. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Background The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features. Methods From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression. Results The proportions of depression and anxiety were 17.9% (n = 44) and 14.2% (n = 35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety. Conclusions In patients with CuTS, the proportions of depression and anxiety were 17.9% and 14.2%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.

OBJECTIVE The objective of this prospective randomized study was to compare ulnar nerve decompression and anterior subfascial transposition with versus without supercharged end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer for advanced cubital tunnel syndrome, to describe performing the nerve transfer through a small incision, and to investigate predictive factors for poor recovery following the procedure. METHODS Between January 2013 and October 2016, 93 patients were randomly allocated to a study group (n = 45) and a control group (n = 48). Patients in the study group were treated with supercharged motor nerve transfer via a 5-cm incision following decompression and anterior subfascial transposition. Patients in the control group were treated with decompression and anterior subfascial transposition alone. Postoperative pinch strength and compound muscle action potential amplitude (CMAPa) were assessed. Function of the limb was assessed based on the Gabel/Amadio scale. Between-group data were compared, and significance was set at p < 0.05. Potential risk factors were collected from demographic data and disease severity indicators. RESULTS At the final follow-up at 2 years, the results of the study group were superior to those of the control group with regard to postoperative pinch strength (75.13% ± 7.65% vs 62.11% ± 6.97%, p < 0.05); CMAPa of the first dorsal interossei (17.17 ± 5.84 mV vs 12.20 ± 4.09 mV, p < 0.01); CMAPa of abductor digiti minimi (11.57 ± 4.04 mV vs 8.43 ± 6.11 mV, p < 0.01); and excellent to good results (0.67 for the study group vs 0.35 for the control group, p < 0.05). Multivariate analysis showed that the advanced age (OR 2.98, 95% CI 2.25–4.10; p = 0.003) in the study group was related to unsatisfactory outcome in the patients. CONCLUSIONS In the treatment of advanced cubital tunnel syndrome, additional supercharged end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer may produce a better function of the hand. The authors also found that cases in the elderly were related to unsatisfactory postoperative results for these patients and that they could be informed of the possibility of worsening surgery results.

Purpose: Cubital tunnel syndrome (CuTS) is the second most common peripheral entrapment neuropathy. This study aimed to assess the prevalence of anxiety and depressive symptoms and explore associated factors among CuTS patients.Methods: This is a cross-controlled study. We used the Hospital Anxiety and Depression Scale to assess the prevalence of depression and anxiety. We calculated the proportion of depression and anxiety symptoms and compared characteristics between groups. Univariate analysis and multivariate regression were carried out to identify variables that were independently associated with anxiety and depression.Results: A total of 246 individuals diagnosed with CuTS were included. The results of the HADS demonstrated that 17.8% (n = 44) of the patients presented possible/probable depression, and 14.2% (n = 35) presented possible/probable anxiety. Logistic regression analysis revealed that diabetes Mellitus was independently associated with depression. And modified McGowan grade was independently associated with anxiety.Conclusions: Patients with cubital tunnel syndrome were at an increased risk of anxiety and depression. Abnormal mental states may have a negative impact in the course and outcome of the disease. Early screening for anxiety and depression in CuTS patients should be recommended.

The purpose of this study was to evaluate the use of a three-dimensional half-ring distraction frame for thumb phalangeal lengthening. From February 2009 to March 2015, 23 patients (23 thumbs) with thumb loss were treated with a half-ring distraction frame. Active movements of the metacarpophalangeal (MCP) joint were measured with a goniometer. These measurements were compared with the opposite hand. Differences were considered statistically significant at p0.05. Clinical outcome was assessed based on the modified Mayo score. Bone union and good alignment were achieved in all patients. The mean distraction time was 44 days (range, 35-62 days). The mean time to union was 20 days (range, 49-86 days). The mean palmar and radial abduction of the thumb was 60° (range, 53°-65°) and 63° (range, 58°-70°), respectively; on the uninjured side, these measurements were 62° (range, 56°-65°) and 64° (range, 60°-73°), respectively (p0.05). The mean extension-flexion arc of the MCP joint was 46° (range, 40°-50°); the measurement on the uninjured side was 48° (40°-54°) (p0.05). The mean follow-up period was 51 months (4.25 years) (range, 48-65 months). The mean modified Mayo Score was 138 (range, 113-145). There were 19 excellent, 3 good, and 1 fair results. The half-ring distraction frame is a viable alternative for thumb lengthening as it provides stable, three-dimensional fixation, resulting in good hand function.

The aim of the study was to present a novel treatment strategy for Bennett fractures using a tension-band wiring technique performed through a small incision with loupes and a headlight. Additionally, this study compared this technique with the conventional percutaneous pinning technique.Between January 2014 and January 2017, the tension-band wiring technique was used in 37 patients with Bennett fractures (study group). The range of motion, pinch and grip strengths, and hand function were assessed at the final follow-up. A control group comprising 35 patients treated with the percutaneous pinning technique was included in the study for comparison. A p-value0.05 was considered statistically significant. (Clinical Trial Registration number: ISRCTN64894535 at http://www.isrctn.com/ISRCTN64894535 ) Results: No fixation failure or infection occurred in either group. Radiographic fracture healing was achieved in all cases. Follow-up lasted over 1 year. The mean Kapandji opposition score was 9.31 (range 8-10) points in the study group and 8.45 (range 7-10) points in the control group (p 0.05). The mean Disabilities of the Arm, Shoulder, and Hand score was 1.06 (range 0-2) in the study group and 1.77 (range 0-3) in the control group (p 0.05). The mean Smith and Cooney Score were 90 (range 80-100) in the study group and 85 (range 75-100) in the control group (p 0.05).The tension-band wiring technique using loupes and headlights enables reduction and fixation of Bennett fractures under direct visualization of the deep operative field. Restoration of thumb function using the tension-band wiring technique is significantly better than that observed with the conventional percutaneous pinning technique.

The purpose of the study was to introduce percutaneous reduction and fixation of paediatric talar neck fractures. The study also included a comparison between the technique and the conventional open surgery. From October 2003 to May 2013, 23 children (group A) with closed two-part talar neck fractures were treated with percutaneous reduction. For comparison, another group of 26 children (group B) were treated with the conventional open surgery. A p value < 0.05 was considered statistically significant. In group A, bone healing was achieved in all cases at a mean of eight weeks. At the mean follow-up of 27 months, mean plantar flexion and dorsiflexion reached 96% of the opposite, normal, side. There were 20 excellent and three good results. In group B, bone healing occurred in 21 of 26 cases at a mean of 11 weeks. Nonunion was noted in five patients, among whom three were combined with avascular necrosis of the talar body. Mean follow-up was 29 months; mean plantar flexion and dorsiflexion reached 94% of the opposite normal side. There were 13 excellent, six good, two fair and five unsatisfactorily results. There were significant differences in the time to bone healing and in ankle-joint motion and function (p

This study aims to compare the outcomes of intramedullary nail (IMN) and volar locking plate (VLP) fixation for treatment of extra-articular or simple intra-articular distal radius fractures. PubMed, Embase, Medline and Cochrane Collaboration Central databases were searched for studies that compared the results of IMN and VLP fixation for the treatment of distal radius fractures up to March 2016. Stata 11.0 was used to perform the meta-analysis. Six randomized controlled trials (RCT) and two retrospective studies were included in this review, including 463 patients. No significant differences were found between two treatment methods in terms of any functional score, radiographic parameters and motion range in the late post-operative period (6, 12 and 24 months). However, IMN did better than VLP at the post-operative six weeks and three months, no matter which functional scoring system was used. The incidence of carpal tunnel syndrome (CTS) was 8.7% in the VLP group, significantly higher than that (0.8%) in the IMN group (OR, 0.183; 95%CI, 0.045–0.74). But for other complications, such as infection (OR, 0.449; 95%CI, 0.095–2.114), tendious damage (OR, 0.931; 95%CI, 0.238–3.648), tenosynovitis (OR, 0.806; 95%CI, 0.209–3.108), algodystrophy (pain) (OR, 0.795; 95%CI, 0.291–2.173) and radial nerve paraesthesia (OR, 1.8143; 95%CI, 0.834–3.942), no significant differences were found (P > 0.05). Compared to VLP, IMN could provide better early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome, which could be of particular help in restoring confidence for workers with specialized manual skills to return to their prior jobs. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and large samples are required to verify this conclusion.

Purpose The purpose of this retrospective study was to report the results of reconstruction of segmental bone defects of the proximal phalanges using a reverse metacarpal vascularized bone flap harvested from the third metacarpal bone. Methods From August 2012 to May 2017, 17 patients with segmental osteomyelitis or necrotic bone of the proximal phalanges were treated. There were 15 male and 3 female patients, with a mean age of 36 years (range, 19–65 years). The mean size of bone defects was 26 × 9 × 9 mm (range, 16 × 6 × 7 mm to 35 × 10 × 7 mm); and the mean size of bone flaps was 27 × 8 × 7 mm (range, 15 × 7 × 4 mm to 40 × 8 × 7 mm). Results The mean follow-up period was 26 months. The mean motion arc of the metacarpophalangeal joints was 56° (range, 22°–90°). The mean pinch strength of the injured fingers was 3.1 kg (range, 2–3.6 kg), and the mean pinch strength of the normal contralateral side was 6.9 kg (range, 4.2– 8.5 kg). Conclusions The reverse metacarpal bone flap may promote osseous healing in reconstructing segmental defects of the proximal phalanges. Type of study/level of evidence Therapeutic IV.

To investigate the effectiveness of radial-lateral forearm free perforator flap on repairing of soft tissue defects in the finger.Between January 2017 and May 2018, 26 cases of finger skin defects were treated with radial-lateral forearm free perforator flap based on the radial branch of the posterior interosseus artery. There were 21 males and 5 females, with an average age of 26.6 years (range, 19-56 years). The cause of injury included the cutting injury in 16 cases and crush injury in 10 cases. The interval between injury and admission was 30 minutes to 4 hours (mean, 1.5 hours). The injury located at thumb in 6 cases, index finger in 8 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 3 cases; and at the dorsum of finger in 6 cases, the lateral side in 6 cases, and the palm in 14 cases. All wounds were accompanied with the tendon and bone exposures, and phalangeal fractures occurred in 10 cases. The size of the defects ranged from 2.0 cm×1.0 cm to 4.0 cm×2.5 cm. And the size of the flap ranged from 2.5 cm×1.5 cm to 4.5 cm×3.0 cm. All wounds at donor sites were sutured directly.All the 26 cases were followed up 4-12 months (mean, 7 months). The 24 flaps survived uneventfully after operation, and the wounds healed by first intention. Partial necrosis occurred at the distal part in 2 flaps, and secondary healing achieved after debridement and dressing. All incisions at donor sites healed by first intention. The appearance and texture of all flaps were satisfactory. The two-point discrimination of the flaps was 5-10 mm (mean, 8 mm) at 4 months after operation. Sensory of the flaps was grade SThe radial-lateral forearm free perforator flap in repairing of the soft tissues in finger can shorten the disease duration, reduce the damage of the donor site, and improve the patients' quality of life.探讨前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损的临床疗效。.2017 年 1 月—2018 年 5 月，采用以骨间后动脉桡侧分支为蒂的前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损 26 例。男 21 例，女 5 例；年龄 19～56 岁，平均 26.6 岁。致伤原因：切割伤 16 例，挤压伤 10 例。受伤至入院时间为 30 min～4 h，平均 1.5 h。损伤指别：拇指 6 例，示指 8 例，中指 6 例，环指 3 例，小指 3 例。其中指背侧 6 例，指侧方 6 例，指掌侧 14 例。创面均伴肌腱及骨外露，10 例伴指骨骨折。清创后手指皮肤缺损范围为 2.0 cm×1.0 cm～4.0 cm×2.5 cm。皮瓣切取范围为 2.5 cm×1.5 cm～4.5 cm×3.0 cm。供区均直接缝合。.患者均获随访，随访时间 4～12 个月，平均 7 个月。其中 24 例皮瓣顺利成活，创面Ⅰ期愈合；2 例皮瓣远端部分坏死，经对症处理后愈合。供区切口均Ⅰ期愈合。皮瓣外形满意，质地柔软。术后 4 个月皮瓣两点辨别觉为 5～10 mm，平均 8 mm；皮瓣感觉恢复至 S前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损可缩短病程，减低供区损害，提升患者的生活质量。.

The purpose of this study was to introduce a new surgical technique of carpal tunnel release through double small incisions, and to compare the technique with the standard open release and endoscopic release.Two hundred and seven patients were allocated randomly into group A (n = 73), B (n = 65), or C (n = 69). Patients in group A were treated with carpal tunnel release by means of double small incisions. Patients in group B were treated by means of the standard incision. Patients in group C had endoscopic release.Preoperatively, the mean severity of symptoms of groups A, B, and C was 3.7 ± 0.58, 3.8 ± 0.62, and 3.7 ± 0.52, respectively; and the mean functional status was 3.2 ± 0.71, 3.2 ± 0.71, and 3.5 ± 0.64, respectively. At the final follow-up of 3 years, the mean severity of symptoms of the groups was 1.2 ± 0.45, 1.2 ± 0.31, and 1.5 ± 0.36, respectively; and the mean functional status was 1.2 ± 0.38, 1.2 ± 0.41, and 1.5 ± 0.42, respectively. Patient satisfaction was 95 ± 4.2, 90 ± 5.8, and 93 ± 4.4, respectively. There were no significant differences between groups regarding symptom severity or function status (p0.05). For scar appearance, there were significant differences between groups A and B and between B and C, but not between A and C; for patient satisfaction, there were significant differences in all comparisons.Carpal tunnel release by means of double small incisions is a minimally invasive and less technically challenging procedure with good nerve visualization, resulting in good appearance of scars.Therapeutic, II.

The objective of this study (ClinicalTrials.gov ID: NCT03031015) is to compare the treatments of hand proximal phalanx shaft fractures with external-fixation technique using the combination of K-wires and bone-cement vs. open reduction and internal fixation technique using a miniature plate-and-screw system.A total of 107 patients (134 cases) were randomly allocated to group A (67 cases in 56 patients) and B (64 cases in 51 patients). Fingers in group A were treated with bone-cement K-wire fixation, and fingers in group B were treated using a plate-and-screw system.Follow-ups lasted 2 years. In group A, active range of motion of proximal interphalangeal joint reached 93% ± 6.7% of the opposite fingers. In group B, the data reached 86% ± 14.4% of the opposite fingers. Based on total active motion scoring system, we obtained 21 excellent and 46 good results in group A; and 9 excellent, 50 good, and 5 fair results in group B. There was a significant difference with regards to the function of the fingers (p 0.05).The bone-cement K-wire fixation may be another option for the treatment of shaft fractures of proximal phalanges. The minimally invasive technique allows early joint motion, resulting in minimal complications and good functional recovery.

Background The purpose of this article was to introduce calcaneal lengthening for partial traumatic loss of the calcaneus. Effectiveness with the use of the technique was also assessed. Methods From January 2013 to May 2016, calcaneal lengthening was performed in 15 patients who sustained a partial traumatic loss of the tuberosity portion of calcaneus. There were 13 men and 2 women with an average age of 36 years (range, 19–53 years). Combined Achilles tendon rupture was noted in 7 patients, and the tendon was reinserted to the calcaneus before calcaneal lengthening. Calcaneal lengthening was performed using an Ilizarov frame. Clinical outcome was assessed based on the American Orthopedic Foot and Ankle score. Results The mean loss of calcaneus was 27% (range, 19%–35%). Calcaneal lengthening (mean total time is157 days; range, 111–226 days) included three periods, i.e., latency (mean 7 days; range, 7–9 days), distraction (mean 43 days; range, 32–57 days), and consolidation (mean 108 days; range, 84–162 days). The mean amount of lengthening was 28% (range, 19%–38%). The mean follow-up duration was 25 months (range, 24–27 months). Based on the American Orthopaedic Foot and Ankle, there were 8 excellent, 6 good, and 1 fair result. Conclusions For the treatment of partial traumatic loss of the calcaneus, calcaneal lengthening using an Ilizarov frame is a preferable technique to restore the length of calcaneus and foot function.

Background The objective of this report is to introduce an external-fixation technique using the combination of K-wires and cement. Methods From February 2009 to January 2015, 51 patients with shaft fractures of middle phalanges were treated with cemented K-wire fixation. The mean age of patients at surgery was 41 years. The mean time interval from injury to operation was 6 ± 5.78 days. Injured digits included index (n = 18), long (n = 15), ring (n = 7), and little (n = 11) fingers. Types of fractures were transversal (n = 32), short oblique or spiral (n = 5), and comminuted (n = 14) fractures. Active range of motion of the fingers was measured. Total active motion was scored based on the American Society for Surgery of the Hand. All measurements were compared with those on the opposite fingers. Patients also reported on their satisfaction using the 100-mm visual analogue scale. Results At the final follow-ups of 2 years, range of motion of metacarpophalangeal joint, proximal phalangeal joint, and distal interphalangeal joint reached 97% ± 2.88, 93% ± 6.65, and 96% ± 3.22 of the opposite fingers, respectively. Based on Total active motion scoring system, we obtained 36 excellent and 15 good results. Based on VAS, patient satisfaction was 96 ± 3.44. Conclusions The cemented K-wire fixation is a reliable technique for the treatment of shaft fractures of middle phalanges. The technique is a minimally invasive procedure with minimal complications. Level of evidence Therapeutic study, Level IVa.

Purpose To describe the reconstruction of small defects on the dorsum of the hands using a first dorsal metacarpal artery-based fascial flap harvested through the borders of the defect. Methods From January, 2015 to May, 2017, 29 patients (29 hands) with soft tissue defects on the dorsum of the hand were treated using a first dorsal metacarpal artery-based fascial flap. At final follow-up, we measured range of motion of the metacarpophalangeal joints and the first web span. Results Average size of the defects was 2.7 × 2.5 cm. Average size of the flaps was 2.9 × 2.7 cm. Average length of the pedicle was 2.9 cm. All flaps survived. Range of motion of the second to fourth metacarpophalangeal joints reached 93% to 98% of the opposite hand. The span of the first web reached 98% of the opposite hand. Conclusions A first dorsal metacarpal artery-based fascial flap can be an alternative for reconstruction of small defects on the dorsum of the hands. Flap harvesting through the border of the defect avoided an additional scar at the donor site. Type of study/level of evidence Therapeutic IV.

OBJECTIVE: This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw (ATLPS) and anterograde intramedullary (AIM) fixation for treating unstable metacarpal and phalangeal fractures. METHODS: Adult patients with isolated fresh unstable metacarpal and phalangeal fractures who met the inclusion criteria were enrolled into this prospective study from July 2013. Patients were divided into ATLPS or AIM groups when they were admitted to our department after considering their work requirement, fracture complexity, and surgeon's experience and were then treated accordingly. Relevant demographic, clinical and preoperative clinical data were collected and analyzed. Clinical examination and radiograph evaluation were performed 1 week and 1, 3, and 6 months postoperatively. Outcome measures were visual analog scale (VAS) scores for pain, total range of motion (ROM) of the injured digit, Quick Disabilities of the Arm, Shoulder, and Hand scores (Quick‐DASH) and grip strength (percentage of the contralateral corresponding digit). RESULTS: From July 2013 to September 2014, 76 patients were treated by AIM and 71 by ATLPS. Age, sex, time from injury to operation, dominant hand, injury mechanism, fracture location, fracture type and participant occupation were similar in both groups (P > 0.05). Operations were all performed well and followed by uneventful postoperative functional recoveries. At 3‐month follow‐up, all clinical outcomes were significantly better in the AIM than ATLPS group (P < 0.05) except for VAS pain scores. However, at 6‐month follow‐up, the differences were no longer significant, indicating similar results for both types of fixation. Patients in the AIM group developed significantly more complications (P = 0.037). Sick leave was significantly longer in the AIM group (P = 0.02). CONCLUSIONS: AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early, but not the later, postoperative period; the latter is associated with significantly more complications. Patients treated by ATLPS require shorter sick leave, which is of particular benefit to workers with specialized manual skills.

Purpose To describe and assess a tension band wiring technique for the treatment of Bennett fractures and to compare this technique of open reduction and internal fixation versus closed reduction and percutaneous pinning. Methods From July 2005 to April 2008, we treated 56 Bennett fractures in 56 patients using tension band wiring. The mean age of the patients was 32 years. There were 37 dominant hands and 19 nondominant hands. The mean time between the injury and operation was 5 days. In this open tension band fixation group, the mean joint surface involvement was 39%, and all injuries were associated with carpometacarpal joint subluxation. At final follow-up, we assessed the thumbs for range of motion and assessed the hands for pinch and grip strength. For comparison, we also included 21 patients who were treated using closed reduction and percutaneous pin fixation from January 2003 to May 2005. Results We noted no fixation failures in the open reduction internal fixation group. Radiographic fracture healing was achieved in all patients at a mean time of 4 weeks. Patient follow-up averaged 39 months. At final follow-up, the mean extension-flexion arc of the first carpometacarpal joint was 49°. Mean thumb abduction was 82° and mean pinch and grip strength of the injured hands were 7.4 and 43.0 kg, respectively. There were no significant differences between groups regarding the extension-flexion arc of the first carpometacarpal joint and grip strength. The 2 groups were similar in thumb abduction and pinch strength. Conclusions Open tension band wiring is a useful and reliable technique and presents another fixation option for the treatment of Bennett fractures. Type of study/level of evidence Therapeutic II.

Purpose An extensive traumatic defect at the level of the proximal phalanx of the thumb presents difficulty in replantation. We report bilobed second dorsal metacarpal artery–based island flap harvested from both the index and middle fingers for reconstruction of the defect and preservation of the normal thumb length. Methods From March 2004 to October 2008, 15 patients (11 men and 4 women; mean age, 35 y; range, 18 to 55 y) with completely or incompletely amputated thumbs associated with extensive defects in the proximal phalanx had replantation and reconstruction. In all cases, a bilobed second dorsal metacarpal artery–based island flap was used due to the large size of the defect. After flap transfer, anastomoses between the veins of the distal part of the thumb and the flap were performed. At the final follow-up, we assessed the mean active range of motion of the metacarpophalangeal and interphalangeal joints of the thumb and the span of the first web in the thumbs that survived. Active motion of the donor fingers was also assessed. Results In this series, 13 thumbs survived and 2 failed. All flaps survived completely. At the mean follow-up of 27 months (range, 24 to 29 mo), the mean active motion arcs of metacarpophalangeal and interphalangeal joints were 32° (range, 15° to 45°) and 31° (range, 0° to 47°), respectively. Full active range of motion was observed in all patients in both the metacarpophalangeal and the proximal interphalangeal joints of the donor index and middle fingers. Conclusions Bilobed second dorsal metacarpal artery–based island flap transfer is a useful and reliable technique for thumb replantation when there is an extensive defect in the proximal phalanx and when a single-digit dorsal metacarpal artery island flap is too small. Type of study/level of evidence Therapeutic IV.

Background: The objective of this study is to report a temporary, ex vivo, distal extremity revascularization technique providing distal perfusion and allowing for a staged repair of complex iliofemoral injury. In addition, the objective of this report is to provide outcome data after this novel procedure including mortality, limb salvage, and quality of limb assessment. Methods: From February 1993 to December 2005, temporary ex vivo posterior tibial artery revascularization from the uninjured (donor) to the injured extremity was performed in 14 patients. All patients had blunt iliofemoral artery injury with class III or IV hemorrhagic shock. An end-to-end anastomosis between the two posterior tibial arteries was performed. Muscle strength of both legs was measured using the Medical Research Council scale and grade 5 means normal strength. Results: The mean age at surgery was 35 years ± 7.4 years (mean ± SD). All patients with ipsilateral legs survived. Patency of the bypass was achieved in all cases. At a mean time of 30 days ± 10 days after injury, the injured iliofemoral artery was reconstructed, and the bypass was transected 7 days later. At the final follow-up, the muscle strength of both legs was of grade 5 based on Medical Research Council scale. Static two-point discrimination test scores were similar on both feet. Conclusions: Temporary ex vivo revascularization of the posterior tibial artery is a feasible option in selecting patients with blunt iliofemoral artery injury with ischemia and severe physiologic derangements. This unconventional method provides extremity perfusion distal to the injury and maintains neuromuscular viability during an interval period, allowing for a staged, proximal revascularization after improvement in the patient's physiologic condition.

Purpose The aim of this study was to describe and assess a surgical technique for the treatment of mallet finger fractures using a pull-out wire with K-wire stabilization of the distal interphalangeal (DIP) joint in extension. Methods From May 2003 to January 2008, we performed pull-out wire fixation of the fracture fragment with stabilization of the DIP joint using a K-wire in 65 closed mallet finger fractures in 65 patients with a mean age of 32 years (range, 18–48). The mean time between the injury and surgery was 8 days (range, 0–19 d). In this cohort, the mean joint surface involvement was 39% (range, 30% to 49%) and all injuries were associated with DIP joint subluxation. Fifteen days after surgery, the digits were assessed for skin necrosis, skin breakdown, and wound and wire track infection. Patient follow-up lasted 24 to 27 months, with a mean period of 25.5 months. The fingers were assessed for loss of extension and flexion of the DIP joints. We graded the results using Crawford's criteria. Results Fracture reduction was maintained and all fractures united. We found no skin necrosis, skin breakdown, infection, or nail deformities. At the final follow-up, the mean extensor loss of the DIP joints was 7° (range, 0° to 37°). The mean flexion loss of the DIP joints was 1° (range, 0° to 15°). We noted extensor loss of the joint less than 10° in 57 digits and 10° to 15° (mean, 13°) in 8 digits. Based on Crawford's criteria, 52 digits were excellent, 8 were good, 4 were fair, and one was poor. Conclusions Pull-out wire fixation of the reduced fracture fragment and K-wire stabilization of the DIP joint is a useful technique for the treatment of mallet finger fractures. Type of study/level of evidence Therapeutic IV.

Purpose The second dorsal metacarpal artery flap from the middle finger is a reconstructive technique that can be used to repair extensive volar defects in a normal-length thumb. However, few reports advocate using it for coverage of volar thumb defects. In this article, an anatomic study of 9 flaps used for resurfacing thumb defects is presented along with the clinical experience of the authors. Methods From 2004 to 2006, 9 patients (6 men and 3 women; mean age, 33 years; range, 18–51 years) with extensive volar defects of their normal-length thumbs had reconstruction using the described technique. In all cases, the first dorsal metacarpal artery flap technique was unable to be used because of injury. Donor sites were covered using full-thickness skin grafts. After surgery, the thumb was immobilized with a splint, followed by rehabilitation. During the follow-up period, which lasted 24 to 30 months, flap-site skin quality, scar contractures, and finger mobility were assessed. The range of motion of the hand was measured by a goniometer. Sensibility was evaluated by the 2-point discrimination test and the Semmes-Weinstein monofilament test. Cold intolerance was also assessed. Results Patient postoperative courses were uneventful, and all flaps survived completely without complication. Good coverage was obtained in all cases. Full active range of motion was observed in all patients in both the donor finger and the thumb. The mean Semmes-Weinstein sensitivity and 2-point discrimination scores of the flap were 4.02 g and 8.4 mm, respectively. Mild cold intolerance was observed in all of the thumbs. Conclusions The second dorsal metacarpal artery flap from the middle finger is a single-stage flap that produces good results. Although its pedicle length is limited, it is reliable and can be used as an alternative for reconstruction of extensive thumb-pulp defects, especially when the first dorsal metacarpal artery flap cannot be used. Type of study/level of evidence Therapeutic IV.

The aim of the present study was to treat intraosseous ganglia of the carpal bones with injectable bone cement grafting. Between January 2012 and December 2013, 4 patients (3 men and 1 woman) presenting with wrist pain and activity limitation were diagnosed with intraosseous ganglion of the carpal bones by radiography. The patients were treated with minimal invasive curettage and bone cement injection surgery. All patients were followed up for a mean time of 17 months (range, 12-22 months). The wrist pain was significantly reduced in all patients following surgery. In addition, the activity range and grip strength were also improved compared with the preoperative parameters. Subsequent to treatment, the Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score presented mean values of 78.8 (range, 75-80) and 11 (range, 7.7-15.0), respectively. These results suggested that the patients showed a good recovery. All patients were satisfied with the postoperative results and returned to work within 4 weeks. In conclusion, bone cement injection is an effective and safe therapeutic strategy for the treatment of intraosseous ganglia of the carpal bone.

In the original publication of this paper, the author name was incorrectly presented.

To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger.Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm x 1.5 cm to 4.0 cm x 2.0 cm, and the flap area ranged from 2.5 cm x 2.0 cm to 4.5 cm x 2.5 cm. All the donor sites were directly sutured.The flaps of 25 cases survived well after operation, and wound healed by first intention; 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension.The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.

To study the anatomical basis of micro transverse flap pedicled with the superfical palmar branch of radial artery from the palmar wrist for using this free flap to repair soft tissue defect of the finger.Thirty-eight fresh upper limb specimens (22 males and 16 females; aged 26-72 years with an average of 36 years; at left and right sides in 19 limbs respectively) were dissected and observed under operating microscope. Two specimens were made into casting mould of artery with bones, and 2 specimens were injected with red emulsion in radial artery. Thirty-four specimens were injected with 1% gentian violet solution in the superfical palmar branch of the radial artery. A transverse oval flap in the palmar wrist was designed, the axis of the flap was the distal palmar crease. The origin, distribution, and anastomosis of the superfical palmar branch of the radial artery were observed.The superficial palmar branch of the radial artery was constantly existed, it usually arises from the main trunk of the radial artery, 1.09-3.60 cm to proximal styloid process of radius. There were about 2-5 branches between the origin and the tubercle of scaphoid bone. The origin diameter was 1.00-3.00 mm, and the distal diameter at the styloid process of radius was 1.00-2.90 mm. The venous return of flap passed through 2 routes, and the innervations of the flap mainly from the palmar cutaneous branch of the median nerve. The area of the flap was 4 cm x 2 cm-6 cm x 2 cm.The origin and courses of the superficial palmar branch of the radial artery is constant, and its diameter is similar to that of the digital artery. A transverse oval flap pedicled with the superfical palmar branch of radial artery in the palmar wrist can be designed to repair defects of the finger.

Malunion of fifth metacarpal neck fractures may present an aesthetic problem that needs surgical correction. This article reports palmar opening wedge osteotomy for the treatment of malunion of fifth metacarpal neck fractures in 21 hands. The length of the fifth metacarpal was increased using the technique. We also present long-term results in patients using the technique. Palmar opening wedge osteotomy is a successful surgical technique for the treatment of malunion of fifth metacarpal neck fractures.

Purpose To describe the reconstruction of traumatic defects in the head of the proximal phalanx using an osteoarticular pedicle flap from the capitate. Methods From January 2004 to December 2007, we treated 15 patients with traumatic defects of the head of the proximal phalanx at our institution. All of these injuries involved 1 condyle of the proximal phalanx. There were 11 male and 4 female patients; the mean age was 32 years. The injuries occurred in the index (n = 6), middle (n = 7), and ring (n = 2) fingers. At the final follow-up, we assessed space narrowing of the proximal interphalangeal joint and flap necrosis using plain radiography. We measured active motion and pinch and grip strength of the hand and compared all measurements with those on the opposite side. Patients rated injured-joint pain and donor-joint pain using a visual analog scale. We assessed hand function using the Disabilities of the Arm, Shoulder, and Hand scale. Results Patient follow-up averaged 52 months. At the final follow-up, we noted narrowing of the proximal interphalangeal joint in 3 cases, but we observed no flap necrosis. The mean active motion arc of the injured and opposite proximal interphalangeal joints was 50° and 96°, respectively. The mean pinch strength of the injured and opposite hands was 5.8 and 6.5 kg, respectively. The mean grip strength of the injured and opposite hands was 39 and 40 kg, respectively. We noted mild recipient joint pain in 6 patients and mild donor joint pain in 1 patient. The mean score of the Disabilities of the Arm, Shoulder, and Hand questionnaire was 9. Conclusions We used an osteoarticular pedicle flap from the capitate to resurface traumatic defects of the head of the proximal phalanx. This approach is acceptable for restoring the contour of the phalangeal head. Type of study/level of evidence Therapeutic IV.

Purpose To describe the use of a pedicled osteoarticular flap harvested from the base of the third metacarpal for the treatment of traumatic defects of the metacarpophalangeal (MCP) joints. Methods From February 2006 to January 2008, we included in the study 15 patients with posttraumatic defects of the MCP joints. The mean age of the patients was 35 years. The injured MCP joints were located in the thumb (n = 6) and index (n = 4), middle (n = 4), and ring fingers (n = 1). Of the 15 patients, 10 presented with acute injuries and 5 with old injuries. At follow-up, we assessed active motion and pinch strength and compared all measurements with those from the opposite hand. In patients with old MCP joint injuries, we also compared preoperative and postoperative motion and pinch strength. We assessed hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Results At the final follow-up (mean, 28 mo), the mean motion arc of the reconstructed MCP joints and the opposite joints was 46° and 91°, respectively, and the mean pinch strength of the injured and opposite sides was 5.4 and 7.1 kg, respectively. For the 5 patients with old injuries to the fingers, the mean preoperative and postoperative motion arc was 2° and 43°, and the mean preoperative and postoperative pinch strength was 1.6 and 5.3 kg, respectively. The mean Disabilities of the Arm, Shoulder, and Hand score of the entire patient series was 9, whereas the mean preoperative and postoperative scores of the 5 patients with old injuries were 44 and 17, respectively. Conclusions The use of a pedicled osteoarticular flap harvested from the base of the third metacarpal is a reliable technique for the treatment of traumatic defects of the MCP joints. Type of study/level of evidence Therapeutic IV.