Objective A retrospective study of GCTTS in the hand was undertaken to determine whether specific clinic or pathologic factors were associated with an increased risk of recurrence, and to investigate the relationship between the recurrence of GCTTS and its biological indices. Methods 83 patients with histologically proven GCTTS were treated and followed up. The clinical materials were reviewed. Comparison was made between certain factors to determine which were associated with increased recurrence rates. Results The patients were followed for an average of 55 months. 22 patients (26.5%) recurred. Age, gender, site, the origin of tumors, size, bone erosion or destruction, cellularity and the mitoses were not risk factors for recurrence. Tumors without capsule had higher recurrence rate than that with capsule, and the difference was highly significant. The local recurrence rate of Nm23 positive group was 28.3%, and Nm23 negative group was 19.2%, there was no remarkable difference between the groups. The PCNA-LI was 0.448?0.130 in recurrent group and 0.358?0.147 in nonrecurrent group, the difference was statistically significant. The aneuploidy DNA content was presented in 50% of the recurrent tumors, and in 23.2% of nonrecurrent ones. The SPF was 6.98?4.64 in recurrent group and 4.70?2.49 in nonrecurrent group. These values were also significantly different. PCNA-LI, the aneuploidy DNA content and SPF were significantly higher in group without capsule than those in group with capsule. These values were not different between tumors with and without bone destruction, large and small diameter, high and low cellular tumors, as well as high and low mitoses tumors. Conclusion The high proliferative indices of recurrent GCTTS may explain its aggressive biologic behavior. Tumors without capsule possess higher proliferative indices than the ones with capsule, and they have higher recurrent rate. The proliferative indices of the tumors with and without bone distruction are comparable, and the difference of the recurrence rate among groups is not significant.

Objective To study the classification, management and outcome of the injury of hamatometacarpal joint. Methods Retrospective analysis was carried out in 17 patients with injury of hamatometacarpal joint. There were 16 males and 1 female aged 19-51 years old. 3 in left hand and 14 in right hand were injuried. The dominant hands of all were right hand. The injury of hamatometacarpal joint might be classified into 4 major groups based on the condition of the hamate, and subdivided into 2 subtypes based on the isolated dislocation(subluxation) or fracture-dislocation of metacarpal base. Carpometacarpal joint ligment injury without fracture of hamatum and the fourth or fifth metacarpal base dislocation without fracture was defined as typeⅠa. When there was a fracture of the fourth or fifth metacarpal base following typeⅠa was defined as typeⅠb. Avulsion fracture of the back of hamatum and the fourth and/or the fifth metacarpal base dislocation without fracture was defined as type Ⅱa. With the fracture of the fourth or fifth metacarpal base following the typeⅡa was defined as type Ⅱb. Splintered fracture of the back of hamatum with the fourth and/or fifth metacarpal base dislocation without fracture was defined as typeⅢa. With the fracture of metacarpal base following typeⅢa was defined as typeⅢb. The split fracture of coronal side of hamatum with the fourth and/or fifth metacarpal base dislocation and without fracture was defined as type Ⅳa. With fracture of the fourth and/or fifth metacarpal base following type Ⅳa was defined as type Ⅳb. There were 7 typeⅠb, 2 typeⅡa, 1 typeⅡb, 2 typeⅢb, 1 typeⅣa, 4 type Ⅳb in our group. We chose conservative or operative treatment according to the type of injury. Results The follow-up was 4-96 months. The patients had fracture union rate of 100%, and no traumatic osteoarthritis was occurred. There was a statistical significance when the motion of two-side joints was compared post surgery. There was no significant difference between bilateral hand in grip strength. Subjective evaluations of the patients were good or excellent. No complications was occurred. There is no case involved in any complications such as traumatic arthrositis, inflammation, neural injuries and adhesion of tendon. Conclusion The stable injury of hamatometacarpal joint should be ideally treated by closed reduction and immobilization in a well-moulded cast or splint. Satisfactory outcome can be got if keeping under strict surveillance. The unstable or intra-articular fracture should be treated by surgery. The outcome is also satisfactory and the rate of the complication of traumatic arthritis is low in short period follow-up. The outcome of fresh injury is much better than old one.

Objective To explore the value of color Doppler ultrasonography and plasma D-dimer in diagnosis of lower limb deep venous thrombosis (DVT).Methods The clinical data of 70 cases of patients with lower limb DVT diagnosed clinically were retrospectively studied.The lower limb venous of each patient was examined by color Doppler ultrasonography and the plasma level of D-dimer were measured,furthermore the plasma levels of D-dimer in different phase and different type of thrombosis were compared.Results The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of plasma D-dimer and ultrasonography examination in lower limb DVT were 100%,66.7%,97.0%,100%,and 97.1%,and 98.4%,83.3%,98.4%,83.3%,and 97.1%,respectively.The plasma D-dimer in acute phase 〔(6 451?4 012.22) ?g/L〕 and subacute phase 〔(2 063?1831.35) ?g/L〕 of lower limb venous thrombosis were significantly higher than that in normal control group 〔(310?66.70) ?g/L〕,P

Objective: To evaluate the role of the deep radioulnar ligament in the stability of the distal radioulnar joint (DRUJ).Methods: In the study, 14 fresh cadaver upper extremities were randomly divided into two groups.After exposuring the palmar and dorsal deep distal radioulnar ligament, one group was marked as palmar deep radioulnar ligament, and the other group was marked as dorsal deep radioulnar ligament.The pronator teres and the supinator were exposed.A Kirschner wire perpendicular to the bone on Lister tubercle of radius was inserted, then another Kirschner wire on the same level of ulnar inserted when the forearm was in neural position, which was kept parallel to the first Kirschner wire.These specimens were mounted on a specially designed jig which held the limb rigidly, keeping the elbow fle-xion and the ulnar fixation.The radius could freely rotate around the ulnar.Then 50 N force on the pronator teres was applied to simulate the active pronation, and 60 N force on the supinator to simulate the active supination.The active pronation was stimulated, and the displacement of the distal radius was measured with respect to the ulna.The active supination was atimulated, and the displacement of the distal radius was measured with respect to the ulna.The palmar deep radioulnar ligament in one group was cut, then the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.The dorsal deep radioulnar ligament in the other group was cut, and the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.Results: After resection of the palmar deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was statistically significantly different when the forearm was in pronation (t=5.591, P=0.001), but there was no difference when the forearm was in supination (t=0.433, P=0.680).After resection of the dorsal deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was not different when the forearm was in pronation (t=1.000, P=0.356), but there was statistically significant difference when the forearm was in supination (t=6.225, P=0.001).Conclusion: DRUJ is unstable when the forearm is in pronation after resection of the palmar deep ra-dioulnar ligament, and DRUJ is unstable when the forearm is in supination after resection of the dorsal deep radioulnar ligament.

Objective To evaluate the preliminary clinical outcome of the screw fixation of minimally displaced scaphoid fracture assisted by computerized imaging reconstruction and preoperative planning system.Methods From March 2013 to Feburary 2014,Five screws on five patients were treated.We calculated and designed the position of scaphoid screw guide wire and ensured the guide wire centrally placed in the scaphoid by using the computerized imaging reconstruction and preoperative planning system software.The appropriate length of the screw was measured too in the software.We also identified the entry and exit points of the guide wire on the custom orthoses splinting the wrist joint.Five patients with scaphoid fractures were treated with percutaneous screw fixation under the guidance of a C-arm fluoroscopy and a guide wire were inserted based on the entry and exit points calculated preoperatively.All of the scaphoid fracture was nondisplaced or less than 1 mm.The modified MAYO wrist scoring system was used to evaluate the pain,function and range of motion for the wrist joint during follow up.Results Total surgical time was 28.8 min (25-39 min)and Fluoroscopy time was 18.4 s (11-23 s).The fracture healing was observed at routine 8 weeks follow up.No complication such as infection or fixation failure was reported.Modified MAYO wrist score was 83.8 (81-88)at average followup at 15 months (6-12 months).Conclusion Computer assisted percutaneous screw fixation is an effective method for the treatment of nondisplaced scaphoid fractures.It leads to significantly reduced guidewire placement time and radiological exposure time while provides accurate placement of the screw.

Objective To observe the imaging features of intraosseous ganglion of the wrist. Methods The radiographs (6 cases), CT (4 cases), and MR (1 case) in 6 cases (7 lesions) of surgically confirmed intraosseous ganglion were retrospectively reviewed. Results Typical intraosseous ganglion was seen as sharp margined and cystic lesion with the size of approximately 0.5 cm in diameter. All but one lesion showed no communication with joint. No degenerative changes were seen in the joints nearby. CT was able to depict the lesions better than radiographs in 4 cases. Intraosseous ganglion was seen as slight low signal on T 1WI and slight high signal on T 2WI MR images. Conclusion Intraosseous ganglion was typically seen as sharp-margined and cystic lesion on radiographs, and it could be better demonstrated with CT and MR. With typical imaging appearance, a suggestion to the diagnosis of intraosseous ganglion could be made.

Objective To design technique of local flap transposition to refine the aesthetic appearance of reconstructed fingers by toes transfer.Methods Nine cases with 21 reconstructed finger were included,which involved 6 males and 3 females with an average age of 21.8 years(range,18-34years).A lingual contour flap with a lateral pedicle Was shifted from the inflated distal pulp to the narrow middle part of the"finger"to refine the aesthetic appearance.Overall results were evaluated in terms of the survival of the flap,the appearance improvement and the functional influence of the reconstructed finger.Results All of the flaps survived and healed perfectly.After a mean follow-up of 9.3 months(range,6-12months),the appearance of the reconstructed fingers were impmved apparently.There was little influence on the function of the finger.The results showed that all the patients gained more acceptable fingers.Conclusion From our experience,local flap transposition is a useful method for remolding of reconstructed fingers by toes transfer.

Objective Retrospective analysis of experience of distal upper limb autologous arteriovenous fistula for hemodialysis access and treatment of arteriovenous fistula occlusion was conducted.Methods To summarize the clinical data of 214 cases of initial autologous arteriovenous fistula and 22 cases of treatment of arteriovenous fistula occlusion were carried out from Aug.2007 to Mar.2011,comparing the success rate and long-term patency rate.Results Two hundred and fourteen cases of initial autologous arteriovenous fistula,in which 168 cases were cephalic vein-radial artery side-to-side anastomosis at snuffbox,46 cases were cephalic vein-radial artery end-toside anastomosis at proximal wrist,the success cases were 203 (94.8％),the failed cases were 11 (5.2％),limb edema in 82 cases and there was no steal syndrome and heart failure.The primary patency rate was 95.2％ at 1 year and 91.3％ at 2 years.There were 22 patients accepted treatment of arteriovenous fistula occlusion,in which,8 cases were embolectomy due to acute occlusion,8 cases were thrombectomy and balloon dilation because of anastomotic stricture and thrombosis and 1 failed,5 cases were proximal anastomosis again after chronic occlusion.Conclusions Autologous arteriovenous fistula of the distal upper limb,especially from the place of snuffbox which is the preferred method for autologous arteriovenous fistula.And deal with arteriovenous fistula occlusion actively can often extend the usage time of the autologous blood vessels and improve the life quality of patients.

Objective To investigate the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC) and three-ligament tenodesis for chronic scapholunate dissociation,and to determine its recurrence rate and time after operation.Methods From January 2008 to January 2011,23 patients with chronic scapholunate dissociation were treated in our hospital.Among them,19 patients underwent DILC and 4 underwent three-ligament tenodesis.The average duration of follow-up was 10.1 months.The clinical and radiographic outcomes were recorded preoperatively,at 1 month after pin removal,and at final follow-up.The VAS and DASH questionnaire were used to assess the pre-and post-operative pain,improvement of function and degree of patient satisfaction,respectively.Results The radiographic outcome showed that the abnormal carpal alignment was reduced completely in all patients during operation.At 1 month after pin removal,the mean scapholunate gap was 4.0 mm,and average scapholunate angle was 75°.Compared with those before operation,the scapholunate gap and scapholunate angle were improved.At final follow-up,the mean scapholunate gap was 4.3 mm,and the mean scapholunate angle was 78°; they were worse compared with those at 1 month after pin removal,while there was no statistical difference in both results.The other three radiographic results at final follow-up remain unchanged.The wrist flexion,wrist extension and grip strength decreased from preoperative 66％,69％ and 71％ of the contralateral side to postoperative 52％,50％ and 66％ of the contralateral side.Conclusion Soft tissue reconstruction cannot withstand the large and repetitive forces.Carpal collapse recurs in a short time after dorsal capsulodesis and three-ligament ten-odesis,which mostly happens in 1 month after pin removal.The best way to treat scapholunate dissociation is still unknown.

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.