Comparative analysis of the effects of AO mini-plate and Kirschner wire pinning in the metacarpal fractures: A retrospective study

The aim of this study was to investigate the clinical effect of AO miniplate screw internal fixation and Kirschner wire (KW) in the treatment of metacarpal fractures.We retrospectively analyzed the clinical data of 590 metacarpal fracture patients admitted to our hospital from March 2016 to March 2019. Among them, 290 patients were treated with KWs; 300 were treated with AO microplate internal fixation. The clinical, radiological results, time of surgery, and complications were observed and compared between the 2 groups.The imaging characteristics and preoperative fracture types of the 2 groups were similar and comparable (P > .05). The operation time, length of hospital stay, and fracture healing time of AO group were shorter than those of KW group, and the differences were statistically significant (41.22 ± 7.23 vs 25.64 ± 6.29; 7.13 ± 2.38 vs 5.26 ± 1.71; 67.43 ± 22.01 vs 52.57 ± 17.46, P < .05). In addition, the incidence of postoperative complications in AO group was lower than that in KW group (8.3% vs 15.2%, P < .05). In terms of surgical knuckle extension, flexion, and total mobility (compared with the uninjured hand), patients in the AO plate group were significantly improved compared with patients in the KW group, and the difference was statistically significant (4 vs 10 degree; 19 vs 10 degree; 14 vs 29 degree, P < .05); The average degree of finger rotation deformity in AO plate group was significantly lower than that in KW group (1 vs 6 degree, P < .05). In terms of grip strength (compared with the healthy hand), the average grip strength of AO plate group was significantly higher than that of KW group (93% vs 83%, P < .05). Patients in the OA plate group had a lower Disabilities of the Arm, Shoulder and Hand score (P < .05).Compared with KW fixation, AO mini-plate and screw fixation for the metacarpal fracture has a better effect, which can effectively shorten the operation time and reduce the trauma to patients. It can provide patients with better stability and realize the early movement of the palm, promote fracture healing and joint function recovery; it can reduce the incidence of postoperative complications, which has certain safety. In addition, it can effectively reduce the risk of poor finger rotation.

Reconstructive surgery in children to correct ulnar claw hand deformity due to leprosy

OBJECTIVES

To study the impact of tendon transfer surgery for ulnar claw hand correction in children with leprosy.

SUBJECTS AND METHODS

All the children who underwent reconstructive surgery for ulnar nerve paralysis during the period 2007 to 2012 were included in the study. Unassisted angle, grasp contact, pinch contact and functional assessment were the main outcome measures. All the surgical procedures were performed by the same surgeon and pre- and post-operative therapy protocol was same for all the patients. A common surgical audit form was used to record assessments for all the patients.

RESULTS

In this case series, 82 hands of 79 patients with ulnar paralysis were included. All the children had lasso surgery. In 83% of hands, flexor digitorum superficialis of middle or ringer finger was used, while in the remaining patients palmaris longus or extensor carpi radialis longus with fascia lata graft was used as the motor tendon. The unassisted angle decreased in all the patients, indicating correction of claw fingers. Hand function improved after surgery and it showed steady progress during follow-up.

CONCLUSION

The deformity due to leprosy in the hands of children is a tragedy as it hampers the use of hands in daily routine activities, school work and other social interactions. Tendon transfer surgery should be done on children to correct established clawed fingers as it yields good results and helps in facilitating hand function to complete daily activities and lead a normal life.

Hand disorders in the course of systemic and chronic diseases: a review

Systemic and chronic diseases frequently affect function of many organs and systems, not only those from which they derive. The hand is a very complicated structure in the human body and its normal activity is related to undisturbed function of many factors. Therefore, the hand is frequently exposed to harmful effects of systemic diseases. The article reports on disorders and functional disturbances of the hand that, more frequently than in an average population, accompany selected systemic diseases: rheumatoid arthritis, gout, and scleroderma. Hand diseases related to diabetes are a subject of a separate paper. This study reviews typical disorders involving hand structures: joints, tendons and nerves. Their prevention and management is described.

[Soft tissue reconstruction for secondary deformity after correction of Wassel type IV-D thumb duplication]

OBJECTIVE

To investigate an effective therapeutic method for the secondary deformity after the correction of the Wassel type IV thumb duplication.

METHODS

9 cases of Wassel W-D Complex thumb deformities in children with postoperative secondary deformity, including 6 males and 3 female, were treated. The age ranged from 2.0 to 14 years old with an average of 5.3 years old. During the operation, the anatomical structure was dissected to observe the structure and alignment of the flexor tendon as well as anatomical structure of the joint. In the meantime, the flexor pollicis longus tendon was shifted, A2 pulley was reconstructed, joint capsule was released and contracted, the end point of thenar was shifted. Kirschner wires fixation were used for about 4-5 weeks, the brace fixation for about 3 months.

RESULTS

All the patients had radial side skin contracture of the interphalangeal joint, radial deviation of the thumb tip, radial side contracture and ulnar relaxation of the joint capsule. Flexor hallucis longus tendon was located in front of the radial side of the proximal phalanx, with no wrapped sheath or A2 pulley. Flexor hallucis longus tendon was attached to the thumb tip substrate, of which 1/3 was located in the center and 2/3 in the radial side. The thumb tip rotated about 10 degrees-15 degrees to the radial side. The patients were followed up for 6-38 months, with an average of 24 months. We adopted Tada standard to evaluate the follow-up results as excellent in 7 cases, good in 1 case, poor in 1 case.

CONCLUSIONS

Soft tissue reconstruction for the secondary deformity after the correction of the Wassel type IV-D thumb duplication is an effective method. Application of the brace after removal of Kirschner wires has an important role in preventing the secondary deformity.

Inherited epidermolysis bullosa - the spectrum of complications

Epidermolysis bullosa is a group of inherited diseases that are characterized by skin and mucosal fragility and blister formation. A wide variety of extracutaneous manifestations can develop as well as various complications of the disease such as severe anemia, growth retardation, esophageal stenosis, mutilating deformities of hands and feet, glomerulonephritis leading to chronic renal failure, and many others. One of the most important and often occurring complications is the development of cutaneous squamous cell carcinomas that grow and metastasize quickly. The objective of this paper is to give dermatologists a review of major complications encountered in patients with epidermolysis bullosa. Since these complications occur so often and can be considered to be part of the clinical picture, it is mandatory to develop a multidisciplinary well-educated team involved in follow-up and treatment of these patients.

[Hand deformity in adult rheumatoid arthritis and juvenile chronic arthritis]

Adult rheumatoid arthritis (RA) is the most common of rheumatoid diseases, that may cause hand dysfunction in some patients. Its equivalent in children is juvenile chronic arthritis (JCA). The aim of our study was to evaluate differences in hand deformity between children with JCA and adults with RA. The prospective study was performed on two groups of patients: 15 with JCA (average age 13.1 years, range from 9 to 18 years) and 15 with RA (average age 53.6 years, range from 42 to 60 years). Both groups were similar in terms of Seyfried classification system and duration of the disease--7.9 years for children and 8.6 for adults. Clinical assessment was performed according to Swanson and Seyfrieda classification system. Patients with RA had only radial wrist "deviation" and those with JCA had both radial and ulnar wrist deviation. In MCP joints in adult's group fingers were always in ulnar position and in children's group finder position was opposite to wrist position. "Swan neck" deformity of fingers from II to V was found in both groups. "Buttonhole deformity" was more often seen in older group. Pain of wrist and in IP joints was more often found and was more severe in RA group. Hypertrophy of synovium and subluxation of IP and wrist joust were found with similar frequency in both groups. In other joints subluxation was rare. Concluding, radial wrist deviation is typical for RA patients. Children with JCA had both radial and ulnar wrist deviation. In MCP joints deformity is always opposite to wrist deviation.

Systemic sclerosis

Systemic sclerosis (scleroderma) is a rare generalized disorder of connective tissue origin. This condition is predominantly a clinical diagnosis, based on the clinical signs and symptoms. Here is a case report of 26-year-old female patient with the classical features of this disease. This case is reported for its rarity and variable expressivity. This article also reviews the literature of this uncommon condition.

Oral-clinical findings and management of epidermolysis bullosa

Epidermolysis bullosa (EB) is a diverse group of disorders that have as a common feature blister formation with tissue occuring at variable depths in the skin and/or mucosa. This article reports two cases of EB and review oral-clinical findings of the EB types and approaches for managing the oral-clinical manifestations. While systemic treatment remains primarily palliative, it is possible to prevent destruction and subsequent loss of the dentition through appropriate interventions and dental therapy.

[Repair of flexor contracture of the hand]

OBJECTIVE

To investigate the etiology of the flexor contracture of the hand, to diagnose and to explore its surgical treatment.

METHODS

From May 1997 to June 2004, 212 cases of flexor contraction of the hand were treated with scar excision, thorough loosening the contracture, covering the secondary skin defects with free skin grafting, "Z"-plasty, double "V-Y" plasty, transposition of the palmar dorsum flap of the hand and iliac-inguinal flap. There were 163 males and 49 females, whose ages ranged from 3 to 61. There were 85 cases of left hands, 54 cases of right hands, and 73 cases of both hands. Contracture sites were as follow: 117 cases were in fingers, 32 cases located in palms and 63 cases were in both. Causes of deformity were as follow: 29 cases derived from burn and explosion, 127 cases came from contracture of palmar aponeurosis, 31 cases were because of traffic accident and machine extrusion, 5 cases for getting an electric shock, 14 cases for improper postoperative immobility, and 6 cases for other reasons. Course of diseases lasted for 2 to 24 months.

RESULTS

149 cases were followed up for 4 to 30 months. One fingertip was in necrosis and ended in nub plasty because of inappropriate time to leave hospital. Flexion contracture recurred in 7 cases, skin necrosis occurred to 3 cases whose scars were healed in the end, poor restoration of function was observed in 2 children patients for lack of exercise, and 2 skins contracted after free cut skin grafting. Others got satisfactory results.

CONCLUSION

Once the pathogenesis and contracture factors are clearly known, timing and correct surgical measures are chosen, thorough contracture is loosened, and early postoperative exercises are performed, good effect will be achieved.

Striatal deformities of the hand and foot in Parkinson's disease

Striatal deformities of the hand and foot are abnormal postures that are common in patients with advanced Parkinson's disease (PD); they can present in the early stages of PD and in other parkinsonian disorders. Over a century ago, Charcot and Purves-Stewart recognised these deformities, which cause substantial functional disability and discomfort. The term striatal is used because pathology in the neostriatum (putamen and caudate) has been suggested to cause the deformities, but the pathogenesis is unknown. Misdiagnosis of the deformities is common-particularly when they occur early and in the absence of cardinal parkinsonian signs, such as tremor, bradykinesia, and rigidity-because the hand deformities are similar to those in rheumatoid arthritis, equinovarus foot deformity typically suggests an orthopaedic problem, and toe extension may be thought to be the Babinski sign of upper-motor-neuron syndromes. Here we review the background and clinical features of these deformities to highlight these commonly unrecognised and poorly understood parkinsonian signs.

A novel mutation, Thr65Ala, in the MPZ gene in a patient with Charcot-Marie-Tooth type 1B disease with focally folded myelin

Charcot-Marie-Tooth type 1B disease is a demyelinating neuropathy caused by mutations in the Myelin Protein Zero gene. It is inherited in an autosomal dominant fashion. So far only a few patients with a focally folded myelin phenotype on nerve biopsy have been shown to have mutations in the Myelin Protein Zero gene. In this report we describe a Polish patient with Charcot-Marie-Tooth type 1B disease. Sural nerve biopsy demonstrated focally folded myelin. Molecular genetic analysis of the coding region of the Myelin Protein Zero gene revealed a novel mutation, Thr65Ala, in exon 2 of the Myelin Protein Zero gene.

Palmaris longus--a muscle with multiple uses in leprosy-affected hands

The present paper reviews the anatomy of palmaris longus muscle and also the situations where palmaris longus muscle has been used as an independent motor or as a donor of tendon graft material. Its relevance in leprosy-affected hands is also discussed because the muscle is usually spared in hand palsies consequent to leprotic neural damage. The advantages and disadvantages of its use in different operative procedures have been analyzed. The author's experience with this muscle in the correction of hand deformities in leprosy is described.

Epiphysiodesis for bilateral irregular closure of the distal radial physis in a gymnast

Wrist pain is a common complaint in gymnasts. Repetitive stress on the distal radial physis may lead to either gradual slipping of the epiphysis or growth disturbances. In some cases growth disturbances of the distal radial physis lead to triangulation of the distal radius and secondary ulnar overgrowth, and eventually a Madelung-like deformity. The present case report is the first to describe the outcome of epiphysiodesis of the distal radial and ulnar growth plates in a skeletally immature gymnast as a surgical treatment to prevent Madelung's deformity.

Major limb deformities as complications of vascular access in neonates

Four case histories are used to illustrate orthopaedic complications of vascular access in neonates. The two main pathologies, extravasation and thrombosis, are discussed and the management of each outlined. Mechanisms of avoidance of such complications are described and advocated.

Surgical treatment and postoperative splinting of recessive dystrophic epidermolysis bullosa

Digital contractures and pseudosyndactyly, common manifestations in recessive dystrophic epidermolysis bullosa, cause significant functional impairment. The deformities progress with time, although surgery may delay the progression. The role of surgical intervention, hand therapy, and the use of prolonged splinting was examined in seven children (nine hands) with recessive dystrophic epidermolysis bullosa with an average age of 5 years, 8 months (range, 1 year, 10 months to 16 years, 4 months). The technique of surgery, postoperative regimen, and splinting differ from those previously reported. Surgery includes "de-cocooning" the hand and fingers, manipulating contracted joints, and full-thickness skin grafting to dermal defects. Surgery and the postoperative regimen of rigid night splints and web-retaining gloves for day wear has allowed arrest or minimal progression of contractures in complaint patients in short-term follow-up study of an average of 17 months (range, 12-28 months). An interdisciplinary team of physicians and surgeons, therapists, and nurses makes this care regimen possible and influences family compliance.

Thenar hypoplasia in Klippel-Feil syndrome due to aberrant radial artery

A 10-year-old boy with Klippel-Feil syndrome had progressive atrophy of the left thenar eminence and absence of left radial pulse. Neurophysiologic studies and angiography were normal. However, duplex sonography over the wrists revealed an aberrant left radial artery. We speculate that the thenar atrophy in this patient is congenital, which may be due to the anomaly of the left radial artery, and is further compromised by vascular compression in the thoracic outlet.

[Pachydermodactyly: report of a case]

This 20 year old white patient complained of progressive thickening of his fingers over a period of four years. The second, third and fifth fingers of each hand indeed appeared podgy. The soft tissue on each side of the first phalanx was swollen, firm without adherence to the bone. The skin of the interdigital space was hyperpigmented and lichenified. This case illustrates the clinical and histologic features of digital fibromatosis which are discussed.

[Maffucci syndrome and ovarian tumor]

Maffucci's syndrome was first described in 1881 and results of a mesodermic dysembryoplasia, congenital but not hereditary. Pathogenic hypothesis are multiple. This syndrome is characterized by the occurrence of multiple haemangiomas in the soft tissue, and multiple enchondromas of the bones. The association of ovary tumor is however exceptional. Four cases are reported in the literature; we report the fifth case.

The anatomy and treatment of camptodactyly of the small finger

Having observed an anomalous insertion of the lumbrical muscle in 74 consecutive operations for correction of camptodactyly of the small finger, we have concluded that the loss of normal lumbrical action is the principal cause of the intrinsic minus deformity seen in this condition. Other anatomic abnormalities observed in this series of patients are those of the superficial tendon in 47%, the x-ray appearance of the proximal interphalangeal (PIP) joint in 15%, and a fixed flexion contracture of the PIP joint in 66%. Fifty-seven percent of our patients had PIP flexion contracture of more than 45 degrees. To determine the contribution of these anomalies to this deformity, we analyzed a series of 53 patients who had been followed up for at least 1 year. The study revealed that these conditions are interdependent and that each had an adverse effect on the final operative results. Treatment included a transfer of the superficial tendon of the ring or little finger to the extensor mechanism of the little finger in all cases and other procedures as dictated by the individual situation. Overall, the joint contracture was reduced from 49 degrees to 25 degrees, but only 33% of the patients regained full flexion of the small finger.