Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus. All three cases ultimately required amputation due to symmetrical peripheral gangrene. In the first two cases, amputation was delayed, which is typically advantageous as it allows for the clear demarcation of necrotic tissue. However, in the third case, where infection was evident, immediate amputation was necessary despite the patient's overall poor health.

Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus. All three cases ultimately required amputation due to symmetrical peripheral gangrene. In the first two cases, amputation was delayed, which is typically advantageous as it allows for the clear demarcation of necrotic tissue. However, in the third case, where infection was evident, immediate amputation was necessary despite the patient's overall poor health.

Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus. All three cases ultimately required amputation due to symmetrical peripheral gangrene. In the first two cases, amputation was delayed, which is typically advantageous as it allows for the clear demarcation of necrotic tissue. However, in the third case, where infection was evident, immediate amputation was necessary despite the patient's overall poor health.

Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus. All three cases ultimately required amputation due to symmetrical peripheral gangrene. In the first two cases, amputation was delayed, which is typically advantageous as it allows for the clear demarcation of necrotic tissue. However, in the third case, where infection was evident, immediate amputation was necessary despite the patient's overall poor health.

Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus. All three cases ultimately required amputation due to symmetrical peripheral gangrene. In the first two cases, amputation was delayed, which is typically advantageous as it allows for the clear demarcation of necrotic tissue. However, in the third case, where infection was evident, immediate amputation was necessary despite the patient's overall poor health.

BACKGROUND: Fracture–dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture–dislocations of the PIP joint. METHODS: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture–dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months). RESULTS: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8). CONCLUSIONS: For chronic fracture–dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.
Arm ; Bone Wires ; Cicatrix ; Curettage ; Debridement ; Dislocations ; Female ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Range of Motion, Articular ; Shoulder

Macrodactyly is one of the most difficult congenital anomalies to treat. Treatment of macrodactyly requires surgical intervention because it gives rise to esthetic, social, and functional disability including difficulty in wearing shoes. A myriad of surgical techniques has been introduced to reduce the size of macrodactyly. However, treatment of toe macrodactyly has not been spotlighted due to less significant functional and social issues compared with finger macrodactyly. We treated two patients with toe macrodactyly by single stage reduction operation.
Fingers ; Humans ; Shoes ; Toes*

BACKGROUND: Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty. METHODS: The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs. RESULTS: The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71degrees preoperatively to 82degrees postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously. CONCLUSIONS: The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.
Adult ; Aged ; Aged, 80 and over ; Carpometacarpal Joints/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis/*surgery ; Postoperative Complications ; Retrospective Studies ; Tendons/*surgery ; Thumb/*surgery

With advancement in biomechanical and biological research on idiopathic carpal tunnel syndrome, the insight on the pathophysiology of carpal tunnel syndrome has gained much clinical relevance. Open carpal tunnel release is still a gold standard procedure for carpal tunnel syndrome, which has evolved into mini-open procedure with development of new devices. Endoscopic carpal tunnel release has become popular in recent practice of hand surgery with an advantage of early recovery of hand function with minimal morbidity. However, endoscopic carpal tunnel release has its own limitation such as long learning curve with obvious surgical risk reported in the literature. In this review article, various treatment protocols for idiopathic carpal tunnel syndrome are presented with special highlight on endoscopic carpal tunnel release, which is gaining popularity in current practice.
Carpal Tunnel Syndrome/surgery/*therapy ; Endoscopy ; Humans ; Treatment Outcome

BACKGROUND: Few studies have evaluated surgical outcomes in patients with refractory de Quervain's disease using validated outcome measures. We assessed the clinical outcomes of dorsal release of the first extensor compartment for the treatment of de Quervain's disease using the disabilities of the arm, shoulder and hand (DASH) score. METHODS: From October 2003 to May 2009, we retrospectively evaluated 33 patients (3 men and 30 women) who underwent surgical treatment for de Quervain's disease. All patients had a positive Finkelstein test and localized tenderness over the first dorsal compartment. All operations were performed under local anesthesia. A 2-cm-long transverse skin incision was made over the first extensor compartment and the dorsal retinaculum covering the extensor pollicis brevis was incised longitudinally. Preoperative and postoperative clinical evaluation included the use of DASH score, Finkelstein test, and visual analogue scale (VAS) score. RESULTS: In 18 patients (55%), the extensor pollicis brevis tendon compartment was separated from the abductor pollicis longus compartment. Eight patients had intracompartmental ganglia in the extensor pollicis brevis subcompartment. All patients except one had negative sign on Finkelstein test at the last follow-up. The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05). There were no postoperative complications such as subluxation of the tendon of the first dorsal compartment or injury to the sensory branch of the radial nerve. CONCLUSIONS: Intracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease. The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.
Adult ; Aged ; Chronic Disease ; De Quervain Disease/diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; Recovery of Function ; Recurrence ; Retrospective Studies