Ganglion is a common benign tumor and is likely to cause paralysis of posterior interosseous nerve by compressiononce occurred in proximal radial area. A 25- year old female patient, who was suffering from forearm pain and trouble with extending her fingers after intramuscular stimulation, visited this hospital. We diagnosed as the common extensor muscle rupture by physical examination. But, on the basis of preoperative MRI, she was diagnosed with incomplete posterior interosseous nerve paralysis caused by ganglion of the proximal radius. We performed the surgical excision and obtained a satisfactory result without any evidence of recurrence at the 1 year follow-up after surgery. Incomplete compressive neuropathy of posterior interosseous nerve sometimes confused with spontaneous rupture of the common extensor muscle, which can lead to inappropriate surgical treatment. Careful preoperative examination is essential to avoid misdiagnosis. We report this case with review of the relevant literature, because of rarity of incomplete compressive neuropathy of posterior interosseous nerve by ganglion.
Diagnostic Errors ; Female ; Fingers ; Follow-Up Studies ; Forearm ; Ganglion Cysts ; Humans ; Muscles ; Paralysis ; Physical Examination ; Radius ; Recurrence ; Rupture ; Rupture, Spontaneous ; Stress, Psychological

PURPOSE: Nailbed repair using fine 6-0 or 7-0 absorbable sutures can be technically demanding and time-consuming. We describe a simpler method of nailbed repair using 2-octyl cyanoacrylate (Dermabond(R)) topical adhesive. MATERIALS AND METHODS: Fifteen consecutive patients with nailbed injuries not involving the germinal matrix were repaired with Dermabond(R). There were 7 simple lacerations, 4 stellate lacerations and 4 severe crush injury according to Zook's classification. The appearance of the nail at twelve months was graded according to ridging, splitting, deformity, and sheen of the nail. RESULTS: Nailbed repairs using Dermabond(R) took on average 3.2 minutes to complete. Six patients had excellent aesthetic results, Eight had good results, and one patient with a crush injury had a fair result. There were no complications. CONCLUSION: Dermabond(R) is a useful tool for rapidly repairing acute nailbed injuries. The outcome of repairing injuries not involving the germinal matrix is similar to that expected for suture repairs of similar injuries.
Adhesives ; Congenital Abnormalities ; Cyanoacrylates ; Humans ; Lacerations ; Nails ; Sutures

PURPOSE: To evaluate retrospectively the clinical results of modified extension block technique for large mallet fracture. MATERIALS AND METHODS: From May 2006 to August 2007, we reviewed 16 patients who got surgery with large mallet fracture. Surgical indications included fractures involving more than 33% of the articular surface or fractures associated with subluxation of the distal interphalangeal joint. The average age was 32.6 years old. The average time from injury to surgery was 10days. We performed modified extension block technique in all patients. The pins were removed between 5 to 6 weeks when we confirmed bone union by radiology. Function outcomes were determined by using the Crawford criteria. RESULTS: The average fracture fragment size was 52% of the joint surface. Average time to fracture union was 5.4weeks(4.5~7.5weeks). At a mean follow-up of 8.2months(5-13months) average extension loss was 3degrees (0-10degrees )and average flexion was 77degrees (60-85degrees ). According to Crawford classification, 81.3% of paitents had excellent or good results. There were 2 nail deformity. CONCLUSION: Modified extension block technique can make up for the weak points of traditional techique in the treatment for large mallet fracture.
Congenital Abnormalities ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Nails ; Retrospective Studies

PURPOSE: To evaluate the radiological and clinical outcomes of the operative treatment for the unstable distal radius fractures with displaced ulnar styloid process fractures. MATERIALS AND METHODS: From 2002 to 2005, 17 patients with unstable distal radius fractures with displaced ulnar styloid process fractures were treated operatively, using external fixation or internal fixation for distal radius and open reduction with tension band wiring for ulnar styloid process fractures. We evaluated postoperative outcomes with Mayo wrist score, range of motion, ulnar side wrist pain, wrist stress test, grip strength as well as radiological evaluation. RESULTS: All ulnar styloid process fractures were completely united, and according to Mayo wrist score, 7 cases(41%) were excellent, 8 cases(47%) were good. 14 cases(82%) had no ulnar wrist pain and 15 cases(88%) had grip strength more than 50% when compared with the normal side. Posterior instability of ulnar head occurred at 1 case. CONCLUSION: We got acceptable clinical and radiological results of operative treatment of ulnar styloid process fractures and concluded that ulnar styloid process fractures combined with distal radius fractures should be carefully evaluated and treated operatively according to their fracture types.
Exercise Test ; Hand Strength ; Head ; Humans ; Radius ; Radius Fractures ; Range of Motion, Articular ; Wrist

PURPOSE: The aim of this study was to evaluate the preliminary results using the 4+5 extensor compartmental vascularized bone graft for the treatment of stage III Kienbock's disease and to report the usefulness of this procedure. METHODS: A retrospective study was carried out on five patients who had undergone 4+5 extensor compartmental vascularized bone graft for stage III Kienbock's disease between Jan. 2005 and Aug. 2006. All patients were composed of two patients in stage IIIA and three patients in stage IIIB according to Lichtman classification. The radiographic findings were evaluated by carpal height ratio, Stahl's index, ulnar variance and scapholunate angle. The clinical outcome was assessed using the Mayo wrist score. RESULTS: The mean age of 43.4 years(range, 21-61) and the mean follow up of 23.6 months(range, 14-31) were presented. All patients were satisfied and the mean Mayo wrist score was 78(range, 70-85). Two patients showed further lunate collapse on follow-up radiographs. Four patients had no pain in the activity of daily living, one patient had a mild occasional pain. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft for the surgical treatment of stage III Kienbock's disease is the effective treatment showing satisfactory clinical results, but a lunate collapse proceeds. Before this operation, the possibility of lunate collapse should be considered.
Follow-Up Studies ; Humans ; Osteonecrosis ; Retrospective Studies ; Transplants ; Wrist

PURPOSE: To evaluate the results of the external neurolysis of the scarred peripheral nerves present with the posttraumatic neuralgia refractory to the conservative treatment for at least 6 months with or without vein wrapping and/or free fat graft to prevent scar reformation. MATERIALS AND METHODS: In 8 patients with posttraumatic neuralgia of the peripheral nerve unresponsive to conservative treatment for at least 6 months, only neurolysis was done in 6 cases. Vein wrapping with free fat graft was concomitantly added after neurolysis in one case and free fat graft was added in the other case. The inclusion criteria were neuralgia felt anatomically along the affected nerve, positive Tinel sign at the scarred site and aggravation of pain with passive motion of the adjacent joint. Affected were digital nerves (two cases), ulnar nerve at the wrist (one case), median nerve (one case), peroneal nerve around knee (one case), posterior tibial nerves (two cases) and plantar nerve (one case). Patients were assessed for the disappearance of neuralgia and Tinel sign and subjective satisfaction with VAS (no pain, 0 and no change or aggravated, 10 compared to contra-lateral side) RESULT: Neuralgia was absent in four cases and persisted in four cases. Average VAS was 5.8 (0~10). According to the degree of the scarred surroungings, neuralgia was persisted after only neurolysis in four cases of the severely scarred 5 cases, but in one case having free fat graft added, neuralgia was absent. In partially scarred two cases, neurolysis with or without additional procedures (free fat graft and vein wrapping) brought the same result of VAS. In one case of good surroundings, neuralgia was absent after neurolysis. Tinel sign was absent in 4 cases where neuralgia had disappeared. CONCLUSION: Prevention of re-adhesion after neurolysis seems to be very important to yield good results. Vein wrapping and/or free fat grafting may be effective methods to be applicable if the adjacent tissue looks scarred
Cicatrix ; Humans ; Joints ; Knee ; Median Nerve ; Neuralgia ; Peripheral Nerves ; Peroneal Nerve ; Tibial Nerve ; Transplants ; Ulnar Nerve ; Veins ; Wrist

Heterotopic ossification is defined as a reactive disease with mature lamellar bone formation in soft tissue. We experienced a case of heterotopicc ossification occurred on the thenar eminence and the thumb without trauma. We report this rare case with a review of the relevant literature.
Ossification, Heterotopic ; Osteogenesis ; Thumb

Because of extensive vascular injury, reconstruction of ring avulsion injury is classically believed to be challenging for a hand surgeon. We report a case of ring avulsion injury treated by debridement of the damaged artery and interpositioning vessel graft with a healthy proper palmar digital artery, which lead to successful functional recovery.
Arteries ; Debridement ; Glycosaminoglycans ; Hand ; Transplants ; Vascular System Injuries

A 50-year-old man who had a gout presented with a difficulty in flexing his left small finger. Operative exploration revealed a rupture of the deep flexor tendons because of gouty tophus on flexor tendon sheath infiltration. The patient underwent single stage tendon graft using the palmaris longus tendon, resulting in satisfactory results. Gouty tophus infiltration should be considered as one of causes of flexor tendon rupture of the fingers in patients with a long history of gout.
Fingers ; Gout ; Humans ; Middle Aged ; Rupture ; Tendons ; Transplants

Heterotopic ossification was defined as the formation of mature lamellar bone in soft tissues. Heterotopic ossification of the hand has been rarely reported. Plain radiograghs of a 71-years-old female patient who had denied a definite trauma history showed a diffuse mass with calcified density between the ulnar styloid process and the 5th metacarpal bone of his right hand. Histopathologic assessment revealed heterotopic ossification with acute cellulitis. There was no evidence of recurrence for 3-year follow-up after wide excision.
Cellulitis ; Female ; Follow-Up Studies ; Hand ; Humans ; Ossification, Heterotopic ; Recurrence