OBJECTIVEAlthough most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia fracture-dislocation in children, and to propose the possible indication for the exploration of nerve.

METHODSEight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors?Hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction.

RESULTSThe PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado's Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up.

CONCLUSIONThe findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.

Female ; Fingers ; innervation ; Fracture Fixation, Internal ; Humans ; Male ; Monteggia's Fracture ; complications ; Muscle, Skeletal ; innervation ; Nerve Compression Syndromes ; etiology ; surgery ; Recovery of Function ; Retrospective Studies ; Thumb ; innervation ; Wrist ; innervation

No abstract available.
Carpal Tunnel Syndrome/*ultrasonography ; Electromyography ; Fingers/innervation ; Humans ; Median Nerve/*ultrasonography ; Ultrasonography, Doppler

Lipofibromatous hamartoma of the nerve is a benign tumor, which affects the major nerves and their branches in the human body. It is often found in the median nerve of the hand and is commonly associated with macrodactyly, but it is rarely found in the digital nerves at the peripheral level. This tumor is often found in young adults and may go through a self- limiting course. However, operation is indicated when the tumor size is large or when the associated nerve compressive symptoms are present. We have experienced a rare case of lipofibromatous hamartoma that symmetrically involved the volar digital nerves of both index fingers on the ulnar side. With the aid of a microscope, we dissected and removed the tumor as much as possible without sacrificing the nerve. No sensory change occurred in both fingers and no sign of recurrence was observed upon follow-up.
Adipose Tissue/pathology ; Adult ; Female ; Fingers/*innervation/pathology ; Hamartoma/complications/*pathology ; Humans ; Nerve Compression Syndromes/etiology/*pathology

OBJECTIVETo investigate the clinical outcomes of the use of the perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger in repair of finger pulp defects and sensory reconstruction in children.

METHODSTwenty-three children (31 fingers) with index, middle, ring or little finger pulp defects were hospitalized from September 2012 to December 2013. The area of finger pulp defects ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm. The perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger were used to repair the defects, with the flap size ranging from 1.3 cm × 1.2 cm to 2.2 cm × 1.6 cm. The dorsal branch of the digital proper nerve of the flap was conducted end-to-end anastomosis with the broken end of the nerve of the wound to reconstruct sensation. The donor sites were covered with autologous full-thickness skin obtained from inner aspect of the thigh.

RESULTSPrimary healing of the wounds and donor sites were achieved in all 23 children. All the flaps and skin grafts of donor sites survived. All the patients were followed up for 6 to 20 months, with mean time of 14 months. At the last follow-up, the flaps and donor sites were in good appearance, the finger pulps were mellow and plump, with no obvious pigmentation or cicatricial contracture. The sensation of finger pulps reached S3(+), and the distance of two-point discrimination ranged from 4.5 to 6.0 mm, with mean distance of 5.1 mm. Twenty-one parents of the patients were strongly satisfied with the appearance of the repaired fingers, and the other 2 parents also expressed satisfaction.

CONCLUSIONSTransplantation of the perforator propeller flap based on the end dorsal branch of digital proper artery in the same finger is a safe and reliable method for the repair of index, middle, ring, and little finger pulp defects and sensory reconstruction of children. The flaps are with good blood supply, appearance and sensory function after operation.

Arteries ; innervation ; Child ; Contracture ; Finger Injuries ; surgery ; Fingers ; blood supply ; innervation ; surgery ; Humans ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Wound Healing

OBJECTIVETo investigate the causes and operations for entrapment syndrome of posterior interosseous nerve caused by elbow cyst.

METHODSForm March 2005 to March 2012,5 patients with entrapment syndrome of posterior interosseous nerve caused by elbow cyst were treated with surgical excision and neurolysis including 3 males and 2 females with an average age of 50.4 years old ranging from 35 to 60 years old. The course was from 3 to 10 months with an average of 6.3 months. The main clinical symptoms were pain on the outside of the forearm. The extension muscle power of the metacarpophalangeal joints at the fingers and the wrist had decreased. The EMC showed neurogenic damage or nerve conduction slowing down. According to the functional neurological evaluation standard of British Medical Research Institute ,the motion and sensory function after nerve injury was assessed.

RESULTSPatients were followed up for 3 to 15 months with an average of 8.5 months. Wound healing in patients was good after the operations. There were no significant complications. Three patients were excellent (M4S3+) and 2 patients were good (M3S3). The hand joint function of 5 patients recovered well after operation.

CONCLUSIONThe surgical excision and neurolysis for treatment of entrapment syndrome of posterior interosseous nerve caused by elbow ganglions cyst can remove the entrapment syndrome of the posterior interosseous nerve thoroughly ,promote the neurological function recovery. According to the functional evaluation standard ,operations achieved better therapeutic effect.

Adult ; Bone Cysts ; complications ; Elbow ; innervation ; surgery ; Female ; Fingers ; physiopathology ; Humans ; Male ; Middle Aged ; Nerve Compression Syndromes ; etiology ; physiopathology ; surgery ; Wrist ; physiopathology