We present an atypical case of combined comminuted lunate fracture and the scaphoid waist fracture, chip fracture of triquetrum and pisiform. Comminuted scaphoid waist fracture was caused by forced hyperextension of the wrist, similar mechanism to stage I of progressive perilunate instability (PLI), and lunate fracture might be caused by axial compression force, does not appear on the original theory of PLI. We performed closed reduction and screw fixation for the scaphoid fracture and immobilized and mildly distracted the wrist joint with the use of a bridging external fixator to prevent further collapse of comminuted lunate by neutralizing the compression force imposed by the capitate on the lunate. We achieved excellent radiological and clinical outcomes at 29-months of follow-up. We aimed to introduce this rare injury and clinically important points in its treatment with the review of the literature.
External Fixators ; Follow-Up Studies ; Wrist ; Wrist Joint

Transradial percutaneous coronary artery interventions are increasingly used because of low complication rates and patients' convenience. However, the radial artery is more vulnerable to damage due to its small diameter and frequent anatomical variations. We experienced a case of forearm compartment syndrome after transradial percutaneous coronary artery intervention which has not been reported in Korean literature yet. We report the case with a review of the literature.
Compartment Syndromes* ; Coronary Vessels* ; Forearm* ; Percutaneous Coronary Intervention ; Radial Artery

PURPOSE: Metacarpal fracture of a ring and little finger occurs frequently. Percutaneous intramedullary fixation is a simple and effective method with a low incidence of complications. To date, Kirschner wire (K-wire) fixation has been widely used, but this has problems such as pin infection. Moreover it is difficult to start early active motion exercise. So, we replaced the K-wire with a bioresorbable implant and evaluated the results. METHODS: This study was conducted from 2014 to 2016 and involved 10 consecutive patients with 10 metacarpal neck fractures. All cases underwent percutaneous intramedullary fixation using the ActivaPin (Bioretec Ltd.) within 7 days after injury, and the average follow-up period was 13 months. At the final follow-up, all cases were assessed in terms of total active motion (TAM), bony union and angular deformity based on plain radiographs. RESULTS: The patients started active motion exercise within 1 week and regained a full range of motion after average 4 weeks. The TAM results were excellent at 250° to 270° in all cases. Regarding radiographic findings, fractures united in all cases and there were no malunion and knuckle deformity. CONCLUSION: Replacement of a K-wire with a bioresorbable pin prevented soft tissue damage and dorsal scarring. And our percutaneous intramedullary bioresorbable pin fixation technique resulted in early recovery of range of motion and correction of deformity. The patients regained range of motion and returned to daily life early.
Absorbable Implants ; Cicatrix ; Clinical Study* ; Congenital Abnormalities ; Fingers ; Follow-Up Studies ; Fracture Fixation ; Fractures, Bone* ; Humans ; Incidence ; Metacarpal Bones ; Methods ; Neck ; Range of Motion, Articular

PURPOSE: A minimally invasive surgical technique has been introduced to treat carpal tunnel syndrome that causes less pain, minimal scaring, and a rapid recovery. This study was designed to evaluate the safety and effectiveness of the double minimal incision release compared with the open surgery technique. METHODS: A study was performed on 175 cases in 111 patients who were operated on for carpal tunnel syndrome from January 2010 to December 2014. The patients were classified into 2 groups according to the type of surgical technique: 82 cases underwent standard open surgery in group A and 93 cases underwent double minimal incision release in group B. Grip strength and postoperative pain were evaluated 4 and 8 weeks and 6 and 12 months after surgery, and the period of numbness and time needed to resume normal activities were investigated. RESULTS: Group B patients showed better outcomes during the 2 first months after surgery than those of group A patients in numbness, pain, stiffness (p<0.05), less scar pain and tenderness (p<0.001), and shorter time needed to resume normal activities. However, no differences in these parameters were observed between the 2 groups after 6 months (p>0.05). CONCLUSION: Double minimal incision release offered better clinical outcomes until 2 months after surgery compared to the standard open surgery technique and reduced incipient postoperative pain and allowed for earlier resumption of normal activities.
Carpal Tunnel Syndrome* ; Cicatrix ; Hand Strength ; Humans ; Hypesthesia ; Minimally Invasive Surgical Procedures ; Pain, Postoperative

PURPOSE: The purpose of this study was to analyze the results of patients with scaphoid waist nonunion treated with percutaneous screw fixation without bone grafting under local anesthesia. METHODS: We enrolled scaphoid waist nonunion of 15 patients which had no deformity, displacement, evidence of avascular necrosis and bone cyst under 5 mm on its radiological study. All patients were male with an average age of 28.9±6.2 years (range, 17–38 years). The mean time to surgery from initial injury was 10.8±2.2 months (range, 6–14 months). All patients were treated with percutaneous screw fixation without bone grafting via volar approaching under local anesthesia and postoperative radiographs were reviewed and documented the flexion and extension arcs of the injured wrist and uninjured wrist, disability of the arm, shoulder and hand (DASH) score at final follow-up. RESULTS: All 15 patients showed radiological union at an average 5.5±1.0 months. At 12 months follow-up, the flexion and extension arcs of the injured wrist were 95% and 98.5% of the uninjured wrist. The average DASH score at final follow-up was 7±3.9 (range, 0–15). None of these patients showed any complications associated with surgery. CONCLUSION: Percutaneous screw fixation without bone grafting under local anesthesia was reliable primary treatment method for scaphoid waist non-union without displacement or deformation in the fracture site.
Anesthesia, Local* ; Arm ; Bone Cysts ; Bone Transplantation* ; Congenital Abnormalities ; Follow-Up Studies ; Fracture Fixation ; Fractures, Ununited ; Hand ; Humans ; Male ; Methods ; Necrosis ; Scaphoid Bone ; Shoulder ; Wrist

PURPOSE: To evaluate the anti-subsidence effect of suspensionplasty using abductor pollicis longus (APL) tendon in carpometacarpal (CMC) arthritis of the thumb. METHODS: From June 2009 to May 2016, hematoma distraction arthroplasty (HDA; group A, 10 cases) and HDA with suspensionplasty using APL tendon (group B, 7 cases) were performed in total 17 patients with CMC arthritis. The K-wire was fixed from 1st metacarpal to 2nd metacarpal in both group to maintain the empty space for 6 weeks until the fibrous tissue fill the space. We measured the preoperative trapezium space height with picture archiving and communication (PACS) system and compare the height with that was measured postoperatively. Additionally the subsidence rate checked sequentially with follow-up plain radiography. RESULTS: The subsidence ratios (subsidence/trapezium height) were average 33.2% in group A and 31.4% in group B. There is no statistical difference between two groups. Six weeks after pin removal almost of subsidence occurred, and then from 3 months after surgery to 6 months after surgery, few subsidence was occurred and it is average only 8% of total subsidence. The trial of distraction the empty space when perform the Kirschner wire (K-wire) fixation, it does not influence the prevention of subsidence. Between distraction height and subsidence, there was no statistical relevance. CONCLUSION: Although suspensionplasty was known as one of methods to prevent the subsidence, it is thought to be not very helpful method to prevent subsidence of thumb in CMC arthritis.
Arthritis* ; Arthroplasty ; Carpometacarpal Joints ; Follow-Up Studies ; Hematoma ; Humans ; Methods ; Radiography ; Tendons ; Thumb*

The characteristic of primary osteoarthritis of the elbow is marginal osteophyte and loose body formation with relatively preserving cartilage, manifesting as a painful and limited motion arc. In moderate degenerative changes, a debridement that remove the bony impingement as a basis of the surgical treatment can be performed by arthroscopic as well as open procedure. This article tries to suggest the indication of arthroscopic or open procedure by comparative analyzing the advantages and disadvantages of each method. As a result, arthroscopic procedure may be recommended when the range of motion is greater than 100° and main symptom is pain, on the other hand open debridement may be recommended when the range of motion is less than 100°, main symptom is limited motion, especially further flexion and ulnar neuropathy is accompanied.
Arthroscopy* ; Cartilage ; Debridement ; Elbow* ; Hand ; Methods ; Osteoarthritis* ; Osteophyte ; Range of Motion, Articular ; Ulnar Neuropathies

Primary cutaneous cryptococcosis is a fungal infection caused by Cryptococ cus neoformans which is frequently occurred in the immunosuppressed host. The treatment of primary cutaneous cryptococcosis is mainly fluconazole, and the prognosis is relatively good. We report a case of primary cutaneous cryptococcosis due to intravenous line on the left forearm after lumbar stenosis surgery in a patient with rheumatoid arthritis, who finally underwent second, fourth, and fifth ray amputation.
Amputation ; Arthritis, Rheumatoid* ; Constriction, Pathologic ; Cryptococcosis* ; Fluconazole ; Forearm ; Humans ; Immunocompromised Host ; Injections, Intravenous ; Prognosis ; Surgical Flaps

Extensor tendon rupture is well known complication following distal radius fracture after either conservative treatment or volar plating. However, there are not many reports in literature about concomitant ruptures of other extensor tendons. We report a case of delayed rupture of extensor pollicis longus (EPL), second extensor digitorum communis (EDC II), and extensor indicis proprius (EIP) tendons 4 weeks after volar plating for distal radius fracture. Due to the absence of EIP, EIP transfer was discouraged for EPL reconstruction. Thumb and index finger extension was restored by palmaris longus tendon graft for EPL and EDC II.
Fingers ; Radius Fractures* ; Radius* ; Rupture* ; Tendons* ; Thumb ; Transplants

When hand injuries caused by human bite are overlooked and they can progress to pyogenic arthritis. Pyogenic arthritis is difficult to treat and can make severe sequelae in the joints. We report a case of pyogenic arthritis of the hand that occurred after human bite injury in adolescent treated with wide debridement and external fixator. Our literature searches revealed that the use of external fixator is good treatment option for the treatment of pyogenic arthritis of the hand.
Adolescent* ; Arthritis* ; Bites, Human ; Debridement ; External Fixators ; Hand ; Hand Injuries ; Humans ; Joints ; Metacarpophalangeal Joint*