Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.
Adult ; Biopsy ; Diagnosis, Differential ; Fasciitis/*diagnosis/surgery ; Female ; Finger Phalanges/pathology/*radiography ; Humans ; Magnetic Resonance Imaging ; Sarcoma/*diagnosis ; Soft Tissue Neoplasms/*diagnosis ; Thumb/*pathology/surgery

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.
Adult ; Biopsy ; Diagnosis, Differential ; Fasciitis/*diagnosis/surgery ; Female ; Finger Phalanges/pathology/*radiography ; Humans ; Magnetic Resonance Imaging ; Sarcoma/*diagnosis ; Soft Tissue Neoplasms/*diagnosis ; Thumb/*pathology/surgery

Although extensor tendon rupture often occurs after volar plating for a distal radius fracture, a flexor tendon rupture is extremely rare. Most reported instances of flexor tendon ruptures after volar plating have involved improper placement of the plate, increased prominence of the distal edge of the plate because of collapse of the fracture site, use of custom-made plates, current steroid use by the patient, or a history of tendon injury. We report a case of delayed rupture of the flexor pollicis longus tendon 40 months after volar plating with a 3.5-mm T-locking compression plate for which the distal edge was located at the transverse ridge level of the distal radius. If symptoms such as tendon irritation occur in this situation, surgeons should consider removing the plate as soon as possible after bony union is achieved.
*Bone Plates ; Female ; Fracture Fixation, Internal/*methods ; Humans ; Middle Aged ; Radius Fractures/*complications/pathology/*surgery ; Rupture ; Tendon Injuries/*etiology/*surgery ; Thumb/physiopathology

OBJECTIVETo investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint.

METHODSBetween May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone.

RESULTSAll the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site.

CONCLUSIONSOur surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.

Aged ; Bone Transplantation ; methods ; China ; Hallux ; Humans ; Ilium ; transplantation ; Necrosis ; etiology ; Postoperative Complications ; pathology ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thumb ; surgery ; Toes