Objective To explore the clinical effect of reconstructing distal radioulnar ligament with al-lograft tendon under wrist arthroscopy in the treatment of chronic PalmerⅠD type triangular fibrocarti-lage complex injury complicated with distal radioulnar joint instability.Methods Clinical data of 15 pa-tients with chronic PalmerⅠD type triangular fibrocartilage complex injury and admitted to our hospital between January 2017 to January 2020 were retrospectively analyzed.All of them were treated with wrist arthroscopic allograft tendon reconstruction of distal radioulnar ligament.During the postoperative follow-up,the wrist range of motion and grip strength were evaluated,while the wrist pain and wrist function were assessed using the visual analogue scale(VAS)and modified Mayo score.Results All pa-tients were followed up twelve to twenty-four months,with an average of(18.15±2.20)months.The postoperative VAS score was(2.56±0.69),significantly better than the preoperative one(6.78±1.24)(P<0.05).Moreover,the postoperative ratio of grip strength between the affected and the healthy hand was(76.18±9.72)%,significantly better than that of(50.18±6.79)%(P<0.05),with increased grip strength.Meanwhile,the postoperative rotational motion of wrist joint[(151.09±12.38)°]improved significantly compared with that before operation[(142.87±10.19)°](P<0.05).According to the modi-fied Mayo score,8 cases were excellent,6 cases were good,and 1 case was fair,reaching an excel-lent and good rate of 93.33%.Conclusion Wrist arthroscopic reconstruction of distal radioulnar liga-ment with allograft tendon is effective in the treatment of chronic PalmerⅠD type triangular fibrocarti-lage complex injury with lower radioulnar joint instability,relieving pain and promoting grip strength and rotational motion.

Objective:To investigate the efficacy of arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with triangular fibrocartilage complex (TFCC) injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 30 patients with old ununited fractures of the ulnar styloid process combined with TFCC injury (with pressing pain of the ulnar wrist and decreased grip strength) admitted to Sichuan Provincial Orthopedic Hospital from June 2018 to June 2023, including 18 males and 12 females, aged 40-54 years [(47.6±5.4)years]. All the patients had Hauck type II fractures. A total number of 17 patients had fractures on the left side and 13 on the right side. Arthroscope-assisted reduction and anchor fixation of the ulnar styloid process were performed and the injured TFCC was repaired simultaneously. The visual analogue scale (VAS) scores for ulnar-sided wrist pain before surgery, at 3 and 6 months after surgery, and at the last follow-up were compared. Anteroposterior and lateral X-rays of the wrist joint were taken at 1-6 months after surgery to observe the fracture healing. The ranges of motion of wrist flexion and extension, wrist radial-ulnar deviation, and forearm rotation, Cooney wrist function scores, and grip strengths before surgery, at 3 and 6 months after surgery, and at the last follow-up were compared. The occurrence of intraoperative and postoperative complications was observed.Results:All the patients were followed up for 12-16 months [(13.5±2.3)months]. At 3, 6 months after surgery and at the last follow-up, the VAS scores for ulnar-sided wrist pain were (3.1±0.8)points, (1.4±0.8)points, and (1.2±0.5)points respectively, which were all lower than (7.1±0.8)points before surgery ( P<0.05). The VAS scores at 6 months after surgery and at the last follow-up were lower than that at 3 months after surgery ( P<0.05), while there were no significant difference between the scores at 6 months after surgery and at the last follow-up ( P>0.05). Fractures healed well in the 28 patients, with the healing time of 3-4 months [(3.0±1.3)months], while 2 patients had delayed union. There were no significant differences in the ranges of motion of wrist flexion and extension or radial-ulnar deviation before surgery, at 3 and 6 months after surgery, and at the last follow-up ( P>0.05). At 3, 6 months after surgery and at the last follow-up, the ranges of motion of forearm rotation were (149.9±10.8)°, (158.6±10.5)°, and (159.0±11.1)° respectively, which were all greater than (131.7±11.0)° before surgery. The ranges of motion of forearm rotation were greater at 6 months after surgery and at the last follow-up than that at 3 months after surgery ( P<0.05), while there were no significant difference between the angles at 6 months after surgery and at the last follow-up ( P>0.05). At 3, 6 months after surgery and at the last follow-up, the Cooney wrist function scores were (51.7±5.8)points, (74.8±6.2)points, and (84.3±6.6)points respectively, which were all higher than (39.8±6.1)points before surgery ( P<0.05), and the scores gradually increased at each time point after surgery ( P<0.05). At the last follow-up, the Cooney wrist function scores of 13 patients were evaluated as excellent, 15 good, and 2 fair, with an excellent and good rate of 93.3%. At 3, 6 months after surgery and at the last follow-up, the grip strengths of the affected side were (21.6±2.5)kg, (36.6±2.5)kg, and (45.7±5.8)kg respectively, which were all greater than (14.6±2.5)kg before surgery ( P<0.05), and the grip strengths gradually increased at each time point after surgery ( P<0.05). No bone fragment fragmentation occurred during the surgery. No internal fixation failure occurred after the surgery, and there was no secondary ulnar tissue irritation or injury to the dorsal branch of the ulnar nerve. Conclusion:Arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with TFCC injury has advantages of good bone and soft tissue healing, relieved wrist pain, increased grip strength, improved wrist rotation range and function, and fewer complications.

Objective:To investigate the efficacy of arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with triangular fibrocartilage complex (TFCC) injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 30 patients with old ununited fractures of the ulnar styloid process combined with TFCC injury (with pressing pain of the ulnar wrist and decreased grip strength) admitted to Sichuan Provincial Orthopedic Hospital from June 2018 to June 2023, including 18 males and 12 females, aged 40-54 years [(47.6±5.4)years]. All the patients had Hauck type II fractures. A total number of 17 patients had fractures on the left side and 13 on the right side. Arthroscope-assisted reduction and anchor fixation of the ulnar styloid process were performed and the injured TFCC was repaired simultaneously. The visual analogue scale (VAS) scores for ulnar-sided wrist pain before surgery, at 3 and 6 months after surgery, and at the last follow-up were compared. Anteroposterior and lateral X-rays of the wrist joint were taken at 1-6 months after surgery to observe the fracture healing. The ranges of motion of wrist flexion and extension, wrist radial-ulnar deviation, and forearm rotation, Cooney wrist function scores, and grip strengths before surgery, at 3 and 6 months after surgery, and at the last follow-up were compared. The occurrence of intraoperative and postoperative complications was observed.Results:All the patients were followed up for 12-16 months [(13.5±2.3)months]. At 3, 6 months after surgery and at the last follow-up, the VAS scores for ulnar-sided wrist pain were (3.1±0.8)points, (1.4±0.8)points, and (1.2±0.5)points respectively, which were all lower than (7.1±0.8)points before surgery ( P<0.05). The VAS scores at 6 months after surgery and at the last follow-up were lower than that at 3 months after surgery ( P<0.05), while there were no significant difference between the scores at 6 months after surgery and at the last follow-up ( P>0.05). Fractures healed well in the 28 patients, with the healing time of 3-4 months [(3.0±1.3)months], while 2 patients had delayed union. There were no significant differences in the ranges of motion of wrist flexion and extension or radial-ulnar deviation before surgery, at 3 and 6 months after surgery, and at the last follow-up ( P>0.05). At 3, 6 months after surgery and at the last follow-up, the ranges of motion of forearm rotation were (149.9±10.8)°, (158.6±10.5)°, and (159.0±11.1)° respectively, which were all greater than (131.7±11.0)° before surgery. The ranges of motion of forearm rotation were greater at 6 months after surgery and at the last follow-up than that at 3 months after surgery ( P<0.05), while there were no significant difference between the angles at 6 months after surgery and at the last follow-up ( P>0.05). At 3, 6 months after surgery and at the last follow-up, the Cooney wrist function scores were (51.7±5.8)points, (74.8±6.2)points, and (84.3±6.6)points respectively, which were all higher than (39.8±6.1)points before surgery ( P<0.05), and the scores gradually increased at each time point after surgery ( P<0.05). At the last follow-up, the Cooney wrist function scores of 13 patients were evaluated as excellent, 15 good, and 2 fair, with an excellent and good rate of 93.3%. At 3, 6 months after surgery and at the last follow-up, the grip strengths of the affected side were (21.6±2.5)kg, (36.6±2.5)kg, and (45.7±5.8)kg respectively, which were all greater than (14.6±2.5)kg before surgery ( P<0.05), and the grip strengths gradually increased at each time point after surgery ( P<0.05). No bone fragment fragmentation occurred during the surgery. No internal fixation failure occurred after the surgery, and there was no secondary ulnar tissue irritation or injury to the dorsal branch of the ulnar nerve. Conclusion:Arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with TFCC injury has advantages of good bone and soft tissue healing, relieved wrist pain, increased grip strength, improved wrist rotation range and function, and fewer complications.

Objective:To explore indications for replantation of proximal proper digital artery and establishing extrinsic arterial perfusion pressure in the treatment of special type of severed digits with avulsion over 12.0 hours of warm ischemia, and to analyse the factors that affected the survival rate of the replanted digits.Methods:From September 2014 to January 2022, 8 patients with severed digits and prolonged warm ischemia were treated by transposition of adjacent digital artery together with the technique of extrinsic arterial perfusion pressure in the Department of Wrist and Hand Surgery, the Orthopaedic Hospital in Sichuan Province. During the operation, the defected proximal proper digital artery was reconstructed and repaired with vein graft, one side of the digital artery was repaired with an inverted "Y" vein graft, and one side of "Y" vein was bridged and anastomosed to repair the original digital artery. On the other side, the adjacent proximal proper digital arteries were transpositioned and anastomosed to gain an extrinsic arterial perfusion pressure, which increased the distal haemodynamic and reconstituted the blood supply. Of the 8 patients (9 severed digits) : 1 had severed index and middle fingers, 2 had severed index fingers, 4 had severed thumbs and 1 had severed little finger. All the patients were males, aged 16-63 years old, at 37.6 years old in average. Warm ischemia time of the severed digits were 12.3-20.6 hours, with 17.4 hours in average. The survival rate of replanted digits was observed after surgery. Postoperative follow-ups were conducted through telephone or WeChat reviews.Results:Follow-up time was 6-26 months, at 8.3 months in average. Retrospective analysis was performed. Vascular compromises occurred in 3 patients 4 digits (arterial insufficiency in 1 digit, venous congestion in 3 digits), skin necrosis occurred in 1 patient (1 digit) and digit necrosis in 1 patient (1 digit). Overall, 8 of the 9 replanted digits survived. According to the Replantation Function Evaluation Standard of Hand Surgery Association of Chinese Medical Association, the digit function after replantation was evaluated at excellent in 6 digits, good in 1 digit and poor in 1 digit.Conclusion:For a severed digit with an ischemia time over 12.0 hours, the survival rate can be improved by transposition of an adjacent digital artery to provided extrinsic arterial perfusion pressure.

Objective:To explore the surgical procedure and effect of reconstruction of 2 adjacent soft tissue defects of digits with free twin-lobed flap of carpal cutaneous branch of ulnar artery.Methods:From January 2015 to February 2022, 6 patients (10 digits) with 2 adjacent soft tissue defects of digits were treated by free twin-lobed flap of the carpal cutaneous branch of ulnar artery in the Department of Hand and Wrist Surgery of Sichuan Orthopaedic Hospital. All patients were males, aged 35-53 years old, with an average age of 39.5 years old. Three patients were with soft tissue defects in palmar of index and middle fingers, 1 in palmar of middle and ring fingers, 1 in palmar and dorsal of thumb and 1 in palmar and radial of index finger. Nerves in 5 injured digits of 3 patients and the defected digital flexor tendons in 2 digits of 2 patients were reconstructed. The defects were 2.5 cm× 1.5 cm - 4.0 cm× 2.0 cm in size. The sizes of the flaps were 7.5 cm×2.0 cm-10.0 cm×3.0 cm. The donor sites were directly sutured. All of the defects were treated in emergency surgery. The survival rate of flaps was observed after surgery. All patients were included in postoperative follow-up via telephone or WeChat reviews after discharge to observe the flaps and function recovery of digits.Results:All flaps survived without complication. Venous occlusion occurred in 1 digit, which was relieved after suture removal and heparin dressing for 3 days. Follow-ups lasted 12-16 (mean 12.8) months. The texture and appearance of the flaps were satisfactory. Sensory recovery was at S 3-S 3+ with static two-point discriminations (TPD) at 7-12 mm in the digits with sensory reconstruction. In the digits without nerve repair, the flaps gradually regained protective sensation and the function of digits satisfactorily recovered at 6 months after surgery. According to the Evaluation Standard of Upper Limb Function of Hand Surgery Branch of the Chinese Medical Association, 5 patients were in excellent and 1 in good. Conclusion:Using a free twin-lobed flap with carpal cutaneous branch of ulnar artery to reconstruct 2 adjacent defects of digits can benefit from the thickness of flap being similar to the skin of hand and a hidden donor site together with satisfactory appearance, texture and function of the flap. It is an effective method in reconstruction of 2 adjacent soft tissue defects of digits.

Aggregatibacter aphrophilus is a member of the normal flora of the human oral cavity and pharynx, a Gram-negative fastidous bacteria, belonging to agglomerates, which is a normal mixed oropharyngeal flora in humans, most commonly colonized on the surface of oral mucosa. This bacterial infection is rare in clinical practice, and it is difficult to culture and identify the bacteria, which is easy to be missed. A patient with intracranial infection was admitted to Huaihe Hospital, who showed fever and headache as the main clinical manifestations, and Aggregatibacter aphrophilus was detected by the metagenomic next-generation sequencing of cerebrospinal fluid. The patient′s symptoms were significantly improved after anti-infection treatment.