OBJECTIVE: To describe the characteristics of short arm deformity in patients with achondroplasia, and summarize the progress of its lenthening and reconstruction, so as to provide reference for clinical diagnosis and treatment. METHODS: The literature on the lenthening of upper limb with achondroplastic short arm deformity at home and abroad in recent years was reviewed, and the characteristics, extension methods, postoperative management, effectiveness evaluation, and related complications of short arm deformity were summarized. RESULTS: Achondroplastic short arm deformity affect the patient's daily perineal hygiene activities. Although the upper limb is proportionately shortened, the humerus is mainly short limb deformity. Bilateral humeral lengthening is a common treatment method, and the traditional lengthening tools are mainly external fixation, guided by Ilizarov distraction osteogenesis concept; intramedullary lengthening is the latest treatment method. Lengthening percentage and healing index are commonly used for clinical evaluation indexes, and complications such as nerve injury may occur during upper limb lengthening. CONCLUSION In addition to appearance improvement, achondroplastic short arm lengthening is of great significance in achieving self-management of individual perineal hygiene. Lenthening and reconstruction methods are constantly being innovated and improved.
Humans ; Achondroplasia/surgery* ; Osteogenesis, Distraction/methods* ; Bone Lengthening/methods* ; Plastic Surgery Procedures/methods* ; Humerus/abnormalities* ; Treatment Outcome ; Ilizarov Technique ; Arm/abnormalities*

Distal radius fractures are a common upper extremity fracture and a considerable number of patients have a stable fracture. In the treatment of distal radius fractures, there is considerable disagreement regarding the need for a strict anatomical restoration with operation in elderly patients. Therefore, nonsurgical treatment is a still important treatment option in distal radius fractures. The radiological parameters of before or after manual reduction are important for deciding whether to perform operation or not. The radiological parameters include dorsal angulation of the articular surface, radial shortening, extent of dorsal comminution, intra-articular displacement, concomitant ulnar metaphyseal fracture, shear fracture, and fracture-dislocation of the distal radio-ulnar joint. In addition, clinical situations of patients, including age, activity level, underline disease, and recovery level, which the patients wish should be considered, comprehensively. For the duration of a splint or cast, three to four weeks are recommended in impacted or minimally displaced fractures and five to six weeks in displaced fractures. After reduction of the displaced fractures, patients should undergo a radiologicical examination every week to check the redisplacement or deformity of the fracture site until two or three weeks post trauma. Arm elevation is important for controlling fracture site swelling and finger exercises, including metacarpophalangeal joint motion, are needed to prevent hand stiffness. Active range of motion exercise of the wrist should be initiated immediately after removing the splint or cast.
Aged ; Arm ; Congenital Abnormalities ; Exercise ; Fingers ; Hand ; Humans ; Joints ; Metacarpophalangeal Joint ; Radius Fractures ; Radius ; Range of Motion, Articular ; Splints ; Upper Extremity ; Wrist

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.
Adult ; Anesthesia, General ; Arm ; Congenital Abnormalities ; Dislocations ; Elbow ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Forearm ; Head ; Humans ; Monteggia's Fracture ; Osteotomy ; Plastics ; Range of Motion, Articular ; Ships ; Supination ; Ulna ; Wounds and Injuries

BACKGROUND: Flatfoot deformity is a lever arm disease that incurs kinetic inefficiency during gait. The purpose of this study was to measure the degree of kinetic inefficiency by comparing the gait analysis data of a flatfoot group with a normal control group. METHODS: The patient group consisted of 26 children (21 males and 5 females) with symptomatic flatfoot. They were examined with gait analysis between May 2005 and February 2014. Exclusion criteria were patients with secondary flatfoot caused by neuromuscular disorders, tarsal coalition, vertical talus, or others. Patients' mean age was 9.5 years (range, 7 to 13 years). The gait analysis data of the study group and the normal control group were compared. RESULTS: The mean vertical ground reaction force (GRF) in the push-off phase was 0.99 for the patient group and 1.15 for the control group (p < 0.05). The mean ankle moment in the sagittal plane during the push-off phase was 0.89 for the patient group and 1.27 for the control group (p < 0.05). The mean ankle power in the sagittal plane during the push-off phase was 1.38 for the patient group and 2.52 for the control group (p < 0.05). The aforementioned results show that patients with pes planovalgus had a reduction of moment, power, and GRF in the push-off phase during gait. CONCLUSIONS: Symptomatic flatfeet had a moment inefficiency of 30% and power inefficiency of 45% during gait compared to feet with preserved medial longitudinal arches.
Ankle ; Arm ; Child* ; Congenital Abnormalities ; Flatfoot* ; Foot ; Gait* ; Humans ; Kinetics ; Male ; Observational Study* ; Talus

BACKGROUND: Random type small V-Y advancement flap is widely used for facial reconstruction with advantages including good color and texture match. However, the flap is not as widely used in the extremities and back as in the face because of apprehension of the relatively poor vascularity as a risk factor of flap necrosis. We used a small bilateral V-Y advancement flap for the repair of extremity and back defects from various causes. Competent clinical outcomes are described. METHODS: Between 2007 and 2014, 24 patients (48 flaps) with skin defects in the upper or lower extremities and back were enrolled. The site of the defect was on back (n=6), forearm (n=7), upper arm (n=2), lower leg (n=5), thigh (n=3), and axilla (n=1). RESULTS: Among the 48 flaps, 47 survived (no event: 42 flaps, total necrosis: 1 flap, partial necrosis: 5 flaps). All partial necrotized flaps healed in 3–4 weeks with conservative care. However, debridement and skin grafting was required for the total necrosis flap. One total necrosis and two partial necroses occurred on the anterolateral side of the lower leg. Two partial necroses occurred on the paraspinal area. CONCLUSIONS: Contour deformities including central depression and the dog-ear deformity were not observed. Small bilateral V-Y advancement in the extremity and back could be a safe and useful flap, if thick subcutaneous fat and subcutaneous plexus were saved. But areas with thin subcutaneous fat layer, such as the anterolateral lower leg, are poor candidates and carry the increased risk of improper subcutaneous pedicle circulation.
Arm ; Axilla ; Congenital Abnormalities ; Debridement ; Depression ; Extremities* ; Forearm ; Humans ; Leg ; Lower Extremity ; Necrosis ; Reconstructive Surgical Procedures ; Risk Factors ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Surgical Flaps ; Thigh

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

Management of pediatric spinal deformities requires an accurate prediction of growth spurts to allow for timely initiation of treatment and prevention of curve progression. Determining remaining growth potential is also important for avoiding prolonged unnecessary treatment, e.g. bracing for patients nearing skeletal maturity. Many clinical and radiological growth parameters have been developed to aid clinicians in growth prediction. Of these, several commonly used measures such as height and arm span growth trends, timing of menarche, and the Risser sign are mostly retrospective and lack strong predictive utility. Bone age assessments, such as digital skeletal age and the distal radius and ulna classification, are more accurate parameters, but further research is required to determine interethnic variations and develop their role in management decisions.
Arm ; Braces ; Classification ; Congenital Abnormalities ; Female ; Humans ; Menarche ; Radius ; Retrospective Studies ; Spine* ; Ulna

Intrathoracic meningoceles are relatively rare entities found in patients with neurofibromatosis type I (NF1). Given that both the BRCA1 and NF-1 genes are located on the same long arm of chromosome 17, one would expect concurrence of neurofibromatosis and breast cancer. However, incidence of such co-disorders is very rare in the literature. Here, the authors report a case of a 50-year-old female patient with NF-1 and concurrent cancer of the left breast, who had a huge bilobulated intrathoracic meningocele with thoracic dystrophic scoliosis, treated surgically via a posterior-only approach for the meningocele and spinal deformity in the same setting.
Arm ; Breast Neoplasms* ; Breast* ; Chromosomes, Human, Pair 17 ; Congenital Abnormalities ; Female ; Humans ; Incidence ; Meningocele* ; Middle Aged ; Neurofibromatoses* ; Neurofibromatosis 1* ; Scoliosis

Angular deformity of extremities in children and adolescents with residual growth is not a rare condition in orthopaedics. Asymmetrical physeal suppression or guided growth method, one of the surgical techniques for correction of angular deformity, is a method of inducing plastic deformation by application of constant external force to a growing bone. Internal fixation devices used for asymmetrical physeal suppression include staples, transphyseal screws, and tension band plates, most representatively the 8-plate. Temporary hemiepiphysiodesis using staples is reported to show a success rate of 60% to 80%. Epiphysiodesis using transphyseal screws has several advantages over staples or 8-plates; smaller skin incision, shorter operation time, no postoperative splint or cast, faster return to daily life. Advantages of 8-plates over staples or transphyseal plates include a longer moment arm, which enables better correction of angular deformity and less suppression of the growth of the nearby normal growth plate. Asymmetrical physeal suppression is a simple and effective surgical method in correcting angular deformity of extremities of children and adolescents. Each of three internal fixation devices discussed in the current article has strengths and weaknesses and superiority in terms of angular correction power and complication rate, however further study is needed. Therefore, the most appropriate device should be selected according to the condition of each patient.
Adolescent ; Arm ; Child* ; Congenital Abnormalities* ; Extremities ; Growth Plate ; Humans ; Internal Fixators ; Lower Extremity ; Plastics ; Skin ; Splints

Wolf-Hirschhorn syndrome is a congenital disorder associated with partial deletion of the short arm of chromosome 4. The majority of patients showed characteristic facial anomalies - so called "Greek-Helmet" appearances - mental retardation, growth retardation, and developmental delay. Here we report the case of a 3-year-old girl who was diagnosed as having Wolf-Hirschhorn syndrome immediately at birth with distinct facial anomalies and an abnormal chromosomal karyotype [46,XX,del(4)(p14)]. The patient later presented with status epilepticus and magnetic resonance imaging showed periventricular nodular heterotopia.
Arm ; Child, Preschool ; Chromosomes, Human, Pair 4 ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Female ; Humans ; Intellectual Disability ; Karyotype ; Magnetic Resonance Imaging ; Parturition ; Periventricular Nodular Heterotopia* ; Status Epilepticus* ; Wolf-Hirschhorn Syndrome*