Background: Recently, deep learning techniques have been used in medical imaging studies. We present an algorithm that measures radiologic parameters of distal radius fractures using a deep learning technique and compares the predicted parameters with those measured by an orthopedic hand surgeon. Methods: We collected anteroposterior (AP) and lateral X-ray images of 634 wrists in 624 patients with distal radius fractures treated conservatively with a follow-up of at least 2 months. We allocated 507 AP and 507 lateral images to the training set (80% of the images were used to train the model, and 20% were utilized for validation) and 127 AP and 127 lateral images to the test set. The margins of the radius and ulna were annotated for ground truth, and the scaphoid in the lateral views was annotated in the box configuration to determine the volar side of the images. Radius segmentation was performed using attention U-Net, and the volar/dorsal side was identified using a detection and classification model based on RetinaNet. The proposed algorithm measures the radial inclination, dorsal or volar tilt, and radial height by index axes and points from the segmented radius and ulna. Results: The segmentation model for the radius exhibited an accuracy of 99.98% and a Dice similarity coefficient (DSC) of 98.07% for AP images, and an accuracy of 99.75% and a DSC of 94.84% for lateral images. The segmentation model for the ulna showed an accuracy of 99.84% and a DSC of 96.48%. Based on the comparison of the radial inclinations measured by the algorithm and the manual method, the Pearson correlation coefficient was 0.952, and the intraclass correlation coefficient was 0.975. For dorsal/ volar tilt, the correlation coefficient was 0.940, and the intraclass correlation coefficient was 0.968. For radial height, it was 0.768 and 0.868, respectively. Conclusions The deep learning-based algorithm demonstrated excellent segmentation of the distal radius and ulna in AP and lateral radiographs of the wrist with distal radius fractures and afforded automatic measurements of radiologic parameters.

A twenty-four-year-old patient presented with elbow ankylosis with a range of motion of 5° secondary to failed osteosynthesis 11 months after the internal fixation of an intra-articular distal humerus fracture. The computed tomography scan showed the impaction of the coronoid process into a comminuted fracture of the trochlea, as well as the presence of heterotopic ossification. Intra-articular osteotomy was performed and the range of motion was improved to 90° (20° to 110° flexion). Ten years postoperatively, the range of motion, and the distance in the ulnohumeral joint space, was preserved. In the case of elbow ankylosis secondary to the failed osteosynthesis of the intraarticular distal humerus fracture and malunions with cartilage injury, intra-articular corrective osteotomy may help achieve congruency even when the articular cartilage is damaged.

Background: Volar plate avulsion fractures of the proximal interphalangeal (PIP) joint are a common hand injury and have been treated conservatively with favorable results. We assumed that conservative treatment of volar plate avulsion fractures of the PIP joint would be unsuccessful if the fracture fragment, even if small, was much displaced or rotated and that delayed excision of the avulsion fractures would result in good outcomes. We report clinical and radiological outcomes of conservative treatment of volar plate avulsion fractures of the PIP joint and risk factors for failure of conservative treatment. Methods: We retrospectively reviewed the clinical and radiological outcomes of 88 volar plate avulsion fractures (85 patients) treated conservatively at first. In 18 of these fractures, delayed excision of the fracture fragment was required after an average of 75 days of conservative treatment for limited motion or pain of the joint. We compared parameters between failed cases and successful cases after conservative treatment. Results: Compared to the successful cases, the failed cases had a higher prevalence of joint dislocation at the time of injury and greater pain, larger flexion contracture, and less further flexion after conservative treatment. The shape, comminution, and size of the fracture fragments were not related with the need for operation, but the operative cases had greater displacement and rotation of the fracture fragments than the conservative cases. After fragment excision, postoperative protection of the joint was not necessary, pain was reduced, and the mean range of motion increased. Conclusions The presence of joint dislocation and greater displacement and rotation of the fragments may be associated with the failure of conservative treatment of volar plate avulsion fractures. Failed cases after conservative treatment could be resolved by delayed fragment excision with favorable results. Therefore, it might be appropriate to consider conservative treatment at first in almost all volar plate avulsion fractures of stable PIP joints.

BACKGROUND: The restriction of wrist motion results in limited hand function, and the evaluation of the range of wrist motion is related to the evaluation of wrist function. To analyze and compare the wrist motion during four selected tasks, we developed a new desktop motion analysis system using the motion controller for a home video game console. METHODS: Eighteen healthy, right-handed subjects performed 15 trials of selective tasks (dart throwing, hammering, circumduction, and winding thread on a reel) with both wrists. The signals of light-emitting diode markers attached to the hand and forearm were detected by the optic receptor in the motion controller. We compared the results between both wrists and between motions with similar motion paths. RESULTS: The parameters (range of motion, offset, coupling, and orientations of the oblique plane) for wrist motion were not significantly different between both wrists, except for radioulnar deviation for hammering and the orientation for thread winding. In each wrist, the ranges for hammering were larger than those for dart throwing. The offsets and the orientations of the oblique plane were not significantly different between circumduction and thread winding. CONCLUSIONS: The results for the parameters of dart throwing, hammering, and circumduction of our motion analysis system using the motion controller were considerably similar to those of the previous studies with three-dimensional reconstruction with computed tomography, electrogoniometer, and motion capture system. Therefore, our system may be a cost-effective and simple method for wrist motion analysis.
Forearm ; Hand ; Methods ; Range of Motion, Articular ; Video Games* ; Wind ; Wrist*

Three Stener-like lesions of the metacarpophalangeal joint of the fingers and a rupture of the first dorsal interosseous muscle mimicking the lesion in the index finger were observed. Two cases in the little fingers had a true Stener's lesion. In one case in the index finger, the ruptured ligament was retracted and located under the intact sagittal band, which was also observed by preoperative magnetic resonance imaging (MRI). Rupture of the first dorsal interosseous muscle was misdiagnosed preoperatively as a Stener's lesion in the index finger by ultrasonography. MRI should be an essential differential diagnostic exam for collateral ligament ruptures of the metacarpophalangeal joint of the fingers.
Collateral Ligaments ; Fingers* ; Ligaments ; Magnetic Resonance Imaging ; Metacarpophalangeal Joint* ; Rupture ; Ultrasonography

Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment. We report two cases of fixed lunate flexion deformity after a distal radius fracture, in which reduction and fixation of fresh fracture or corrective osteotomy of malunion were not successful. Arthritic changes were observed in the radiolunate joint on arthroscopy. Thus, fixed flexion deformity of the lunate might be associated with posttraumatic arthritic change in the radiolunate joint.
Arthroscopy ; Congenital Abnormalities* ; Joints ; Ligaments ; Osteotomy ; Posture ; Radius Fractures* ; Radius* ; Wrist Joint

Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment. We report two cases of fixed lunate flexion deformity after a distal radius fracture, in which reduction and fixation of fresh fracture or corrective osteotomy of malunion were not successful. Arthritic changes were observed in the radiolunate joint on arthroscopy. Thus, fixed flexion deformity of the lunate might be associated with posttraumatic arthritic change in the radiolunate joint.
Arthroscopy ; Congenital Abnormalities* ; Joints ; Ligaments ; Osteotomy ; Posture ; Radius Fractures* ; Radius* ; Wrist Joint

BACKGROUND: Buddy taping is a well known and useful method for treating sprains, dislocations, and other injuries of the fingers or toes. However, the authors have often seen complications associated with buddy taping such as necrosis of the skin, infections, loss of fixation, and limited joint motion. To our knowledge, there are no studies regarding the complications of buddy taping. The purpose of this study was to report the current consensus on treating finger and toe injuries and complications of buddy taping by using a specifically designed questionnaire. METHODS: A questionnaire was designed for this study, which was regarding whether the subjects were prescribed buddy taping to treat finger and toe injuries, reasons for not using it, in what step of injury treatment it was use, indications, complications, kinds of tape for fixation, and special methods for preventing skin injury. Fifty-five surgeons agreed to participate in the study and the survey was performed in a direct interview manner at the annual meetings of the Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand, in 2012. RESULTS: Forty-eight surgeons (87%) used buddy taping to treat finger and toe injuries, especially proximal interphalangeal (PIP) injuries of the hand, finger fractures, toe fractures, metacarpophalangeal injuries of the hand, and PIP injuries of the foot. Sixty-five percent of the surgeons experienced low compliance. Forty-five percent of the surgeons observed skin injuries on the adhesive area of the tape, and skin injuries between the injured finger and healthy finger were observed by 45% of the surgeons. CONCLUSIONS: This study sheds light on the current consensus and complications of buddy taping among physicians. Low compliance and skin injury should be considered when the clinician treats finger and toe injuries by using buddy taping.
Adult ; Finger Injuries/*therapy ; Foot Injuries/*therapy ; *Fracture Fixation/adverse effects/methods ; Humans ; Middle Aged ; Physicians/statistics & numerical data ; Questionnaires ; Splints/*adverse effects ; Surgical Tape ; Toes/*injuries

BACKGROUND: Although closed reduction and percutaneous pinning is accepted as the treatment of choice for displaced supracondylar fracture of the humerus, there are some debates on the pinning techniques, period of immobilization, elbow range of motion (ROM) exercise, and perceptions on the restoration of elbow ROM. This study was to investigate the consensus and different perspectives on the treatment of supracondylar fractures of the humerus in children. METHODS: A questionnaire was designed for this study, which included the choice of pinning technique, methods of elbow motion, and perception on the restoration of elbow ROM. Seventy-six orthopedic surgeons agreed to participate in the study and survey was performed by a direct interview manner in the annual meetings of Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand. There were 17 pediatric orthopedic surgeons, 48 hand surgeons, and 11 general orthopedic surgeons. RESULTS: Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning, p = 0.017) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. Hand surgeons and general orthopedic surgeons tended to be more concerned about elbow stiffness after supracondylar fracture than pediatric orthopedic surgeons, and favored gentle passive ROM exercise as elbow motion. Pediatric orthopedic surgeons most frequently adopted active ROM exercise as the elbow motion method. Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient's age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor. CONCLUSIONS: More investigation and communication will be needed to reach a consensus in treating pediatric supracondylar fractures of the humerus between the different subspecialties of orthopedic surgeons, which can minimize malpractice and avoid medicolegal issues.
Age Factors ; Attitude of Health Personnel ; Bone Nails ; Chi-Square Distribution ; Child ; Consensus ; Elbow Joint/physiology ; Exercise Therapy/*methods ; Fracture Fixation, Internal/*methods ; Humans ; Humeral Fractures/rehabilitation/*surgery ; Orthopedics ; Questionnaires ; *Range of Motion, Articular ; Splints ; Statistics, Nonparametric ; Time Factors

BACKGROUND: Although closed reduction and percutaneous pinning is accepted as the treatment of choice for displaced supracondylar fracture of the humerus, there are some debates on the pinning techniques, period of immobilization, elbow range of motion (ROM) exercise, and perceptions on the restoration of elbow ROM. This study was to investigate the consensus and different perspectives on the treatment of supracondylar fractures of the humerus in children. METHODS: A questionnaire was designed for this study, which included the choice of pinning technique, methods of elbow motion, and perception on the restoration of elbow ROM. Seventy-six orthopedic surgeons agreed to participate in the study and survey was performed by a direct interview manner in the annual meetings of Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand. There were 17 pediatric orthopedic surgeons, 48 hand surgeons, and 11 general orthopedic surgeons. RESULTS: Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning, p = 0.017) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. Hand surgeons and general orthopedic surgeons tended to be more concerned about elbow stiffness after supracondylar fracture than pediatric orthopedic surgeons, and favored gentle passive ROM exercise as elbow motion. Pediatric orthopedic surgeons most frequently adopted active ROM exercise as the elbow motion method. Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient's age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor. CONCLUSIONS: More investigation and communication will be needed to reach a consensus in treating pediatric supracondylar fractures of the humerus between the different subspecialties of orthopedic surgeons, which can minimize malpractice and avoid medicolegal issues.
Age Factors ; Attitude of Health Personnel ; Bone Nails ; Chi-Square Distribution ; Child ; Consensus ; Elbow Joint/physiology ; Exercise Therapy/*methods ; Fracture Fixation, Internal/*methods ; Humans ; Humeral Fractures/rehabilitation/*surgery ; Orthopedics ; Questionnaires ; *Range of Motion, Articular ; Splints ; Statistics, Nonparametric ; Time Factors