Schwannomas of the hand and wrist: long-term results and review of the literature

PURPOSE

To review the long-term results of 14 cases of histopathologically confirmed schwannoma of the hand and wrist treated with intracapsular tumour removal.

METHODS

All operations were performed under loupe magnification and microsurgical dissection, and the tumour was removed after capsular (including endoneurium) incision. Patients were assessed for any residual symptoms. Sensory testing of light touch and pain was carried out.

RESULTS

The mean age of the patients at the time of operation was 38.4 years (range, 11-78 years), and the mean follow-up period was 12.6 years (range, 3-36 years). Ten of the tumours were located in the median nerve distribution, whereas 4 in the ulnar nerve distribution. Four tumours were at the wrist level, 3 at the palm level, and 7 at the digital level (3 in the index finger). Only 5 patients were correctly diagnosed preoperatively. Neurological loss was not recovered in one patient in whom the tumour was resected with the digital nerve. No recurrence or muscle atrophy was noted at the latest follow-up.

CONCLUSION

Meticulous dissection with magnification can achieve complete tumour removal without neurological loss or recurrence. Intracapsular tumour removal provides good results with a low complication rate.

Cementless total knee arthroplasty in ochronotic arthropathy: a case report with a 4-year follow-up

Alkaptonuria is an inherited metabolic disorder characterized by the absence of the enzyme homogentisic acid oxidase, which leads to the accumulation of homogentisic acid, produced during normal metabolism of phenylalanine and tyrosine. Ochronosis, which is the dark pigmentation of connective tissues in patients with long-lasting alkaptonuria, can cause severe cartilage destruction in large joints and the vertebral column. Knee joint involvement, which occurs at relatively early ages, can be quite restrictive. Arthroplasty may be the treatment of choice in these patients because of limited mobility and diffuse involvement of the joint. We report a 48-year-old man who had been treated with cementless total knee arthroplasty. Theoretically, there are no bone ingrowth deficits that might be detrimental for the stabilization of cementless prostheses in ochronotic arthropathy because the bone tissue is not primarily affected by the disease. The 4-year follow-up of cementless total knee arthroplasty was satisfactory without any evidence of loosening.

Treatment of displaced pylon fractures with circular external fixators of Ilizarov

Twenty cases of pylon fractures were treated with IIizarov circular external fixators using the technique of ligamentotaxis. Fourteen men and six women, ranging in age from 20 to 59 years, with open or closed distal tibial fractures were included in this study. The fractures were classified according to the AO system and distributed as seven C1, eight C2, and five C3 fractures. Independent from the type of fracture, six were grade II open according to the Gustilo-Anderson classification. For all fractures, an external fixator was constructed, after reduction by traction and olive wires. Mean follow-up was 29 months. All fractures healed by 14 weeks postreduction. The results were assessed using Weber's criteria: 5 (25%) had excellent results, 10 (50%) good, and 5 (25%) poor results. This technique lowers the rated complications of open reduction and internal fixation, and allows restoration of joint-surfaces, reconstruction of length, and alignment of the extremity while maintaining a sufficient range of motion at the joint. We concluded that use of the Ilizarov circular external fixator enables good results in selected ankle traumas when applied with good indications, planning, and surgical experience.