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.

Carpal coalitions are congenital conditions that can cause ambiguous wrist pain and should be considered as a rare possibility in the differential diagnosis, especially in screening settings such as military hospitals. This case report presents the first domestic report of bilateral lunotriquetral coalitions in a 21-year-old military cook who presented with bilateral wrist pain. A radiographic evaluation confirmed a Minnaar type 3 complete osseous coalition. After conservative treatment, the symptoms improved. This case was rare in the Korean context, and the report provides various radiological images along with a review of previously reported cases in the Korean literature.

Purpose: The aim of this study was to use a mathematical approach to understand the exact location and spacing of microvascular anastomosis, and investigate the effectiveness of a practice model using chicken legs and partial meat from chicken wings. Methods: The suture techniques used for microvascular anastomosis were analyzed mathematically. In addition, chickens of various sizes were dissected to measure the size of blood vessels and compared with the size of blood vessels found in partial meat. Results: When using eight- or nine-point sutures, the positions and intervals were different. Larger chickens had larger blood vessels. In the partial meat samples, the average size of the blood vessels was 0.8 mm for the radial artery, 0.45 mm for the ulnar artery, and 1.3 mm for the tibial artery. Conclusion It is important to understand the location and spacing of sutures through a mathematical analysis of microvascular anastomosis, which enables suturing techniques to be improved. The practice model using chicken legs and partial meat from chicken wings was found to be useful for beginners.

Complex regional pain syndrome (CRPS) is a chronic pain syndrome characterized by intense hyperalgesia and allodynia, with an unclear etiology and limited definitive treatments. This case involves a 23-year-old female patient who developed CRPS following a simple hand laceration from wine glass shards. After initial primary closure, the patient developed scar contracture at the thumb metacarpophalangeal crease, accompanied by erythema, warmth, heaviness, and hypersensitivity throughout the hand, leading to a CRPS diagnosis. A multidisciplinary approach, including anesthesiology and rehabilitation, confirmed nerve adhesion from scar contracture. Surgical intervention successfully released the adhered scar tissue, fascia, and nerve, followed by rehabilitation therapy. The patient’s functional recovery took nearly 6 months. This case highlights that CRPS can result from minor injuries due to scar-induced nerve entrapment and emphasizes the importance of early diagnosis and interdisciplinary treatment for gradual recovery.

Lipomas are benign tumors originating from adipocytes, and less than 1% of lipomas occur in the fingers. While most lipomas can be managed with observation, those occurring in the fingers can cause symptoms and functional impairment due to the proximity of the subcutaneous fat layer to nerves and blood vessels. Herein, the authors report a case of a patient who experienced finger numbness due to a lipoma extending from the fourth proximal phalanx to the middle phalanx. In cases like this, where initial symptoms are present in the finger but the mass is not palpable, it is essential to actively pursue a diagnosis using ultrasonography or magnetic resonance imaging. Also, in cases of lipomas causing symptoms and functional impairment, early removal may be beneficial for alleviating the patient's symptoms.

Purpose: Sclerotic lines have been detected at specific locations on the forearm and metaphysis of the lower extremities (femur and tibia) in some patients with atypical femoral fractures (AFFs) associated with long-term bisphosphonate (BP) use. Herein, we present our preliminary data relating to the factors associated with the occurrence of sclerotic lines in patients diagnosed with AFFs. Methods: We inspected the clinical charts of patients who were prescribed BPs at our institution between 2010 and 2020. Fifty-six patients were finally investigated, including patients with sclerotic line lesions at the radial tuberosity (21 patients), and those without any pathognomonic lesions on either radius on a simple radiograph (35 patients). Results: No significant between-group differences in basic demographic characteristics, bone mineral density, or the total period of BP administration were observed (p>0.05). Multivariate analyses of the variables that exhibited significant between-group differences in the univariate analyses demonstrated that the time since the last BP administration at the time of AFF diagnosis (odds ratio [OR], 0.441) and the concurrent presence of similar lines on the femur (OR, 36.00) were significantly associated with the presence of sclerotic lines on the proximal radius. The cutoff time after the last BP administration at the time of AFF diagnosis was 16.5 months, which may serve as a predictor for the development of a sclerotic line around the radial tuberosity. Conclusion Sclerotic lines on the proximal radius were detected more frequently in patients who had been recently treated with a BP or had similar lines on the lower extremities.

Purpose: Numerous studies have focused on techniques for detecting foreign bodies in soft tissue in the hand, but removal remains a subject of interest. In this study, we describe the microscope-assisted removal of foreign bodies in the hand. Methods: We reviewed records of patients treated for foreign bodies in the hand at our department from July 2013 to May 2023. In 16 patients aged 23 to 55 years, the following variables were analyzed: the cause of trauma; the time interval from trauma to surgery; the location, type, size, and number of foreign bodies; patient complaints; imaging technique; and procedure type. Under local anesthesia, a slit incision was made at the suspected site. Foreign bodies were completely removed using micro-instruments under microscopic guidance. Results: Stab injuries were the most common (n=13), and there was one case each of abrasion, traffic accident, and bee sting. The middle finger (n=5) was the most affected, followed by the thumb (n=4), index (n=3), little finger (n=2), ring finger (n=1), and palm (n=1). Foreign bodies included glass (n=6), wood (n=4), seashell (n=2), fish bone, a pencil tip, a bee stinger, and metal. Their size ranged from 1 to 20 mm. Patient complaints included a foreign body sensation, localized pain, swelling, discoloration, and a skin lesion. X-ray examinations were performed in all cases, and ultrasonography was conducted in five cases. Conclusion A microscopic approach allows precise, safe, and complete removal of foreign bodies without tissue damage, highlighting the efficacy of this technique in hand surgery.

Accessory extensor pollicis longus tendons are rare tendon anomalies. This report describes the case of a 54-year-old man who presented with pain and difficulty extending his thumb. Upon initial examination, despite a history of trauma, he could extend the interphalangeal joint, but with limited range. During the surgical exploration, an accessory extensor pollicis longus tendon was unexpectedly discovered. This tendon ran parallel to the extensor pollicis longus on the radial side and then attached to the distal phalanx of the thumb. Accessory extensor tendons are more commonly found on the ulnar side than on the radial side of the hand; therefore, this case is notable due to the unusual location of the tendon. After appropriate repair surgery, the patient successfully regained a normal range of motion. While previous classifications of extensor tendon anomalies have focused on the relationship between the extensor indicis proprius and extensor digitorum communis, this case suggests that it is also necessary to consider the relationship with the extensor pollicis brevis tendon. This case highlights the importance of recognizing tendon variations, especially in trauma situations. Detecting such variations preoperatively using imaging can significantly impact the treatment plan and surgical approach.

Ganglion cysts originating from the volar wrist joint are usually found on the volar side. A case report has described a patient with a dorsal wrist ganglion originating from the scapholunate ligament and appearing at a volar location. However, no cases of volar wrist ganglia appearing on the dorsal wrist have been reported. Herein, we present a rare case of a large dorsal ganglion cyst originating from the volar scaphotrapeziotrapezoidal (STT) joint that pierced the first dorsal interosseous muscle, leading to dorsal bulging. A 40-year-old woman presented with a progressively growing mass over the dorsal aspect of her left wrist and mild pain. Preoperative imaging showed a ganglion cyst originating from the volar side of the STT joint. The ganglion was successfully removed through open surgery. In conclusion, since ganglion cysts occurring in the dorsal wrist, especially if there is deviation to the radial side, may originate from the volar midcarpal joint, magnetic resonance imaging is necessary to reduce the risk of recurrence and minimize the likelihood of postoperative complications.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare disease characterized by vascular malformations, port-wine staining, and soft tissue and bone hypertrophy. Lesions occur in the lower extremities in 95% of cases, whereas only 5% occur in the upper extremities. Several case reports have described the treatment of fractures in the lower extremities in patients with KTWS. However, the risk of massive bleeding, bone deformity, and poor bone quality can lead to suboptimal surgical outcomes. No reports describing the treatment of forearm shaft fractures in KTWS could be found in the English-language literature. Intramedullary nailing is difficult due to the deformed bone and the risk of nonunion. Open reduction and internal fixation (ORIF) should be considered with caution in KTWS patients due to the risks of intraoperative bleeding and wound problems. The authors report that satisfactory results were obtained with ORIF after preoperative vascular embolization in a 60-year-old KTWS patient with fractures in both bones of the forearm.