Objective:To explore the utility of the muscle redistribution technique (MRT) in the signal recognition of an intelligent bionic prosthesis.Methods:Between December 2016 and April 2017, 4 male patients were treated with muscle redistribution procedures. Among them, 3 were upper limb amputees of the distal 1/3 of the forearm, at the carpometacarpal joint and at the midcarpal joint. One was a lower limb amputee at the distal 1/3 of the lower leg. In each case, 4-6 muscles and tendons in the stump were transferred and the tendons were anchored in different areas of the skin. When the muscle contracted actively, the tendon pulled the skin, resulting in obvious deformation of the skin in different areas. The skin′s deformation, capacitance signal data and postoperative complications were used as indicators in the evaluations. To measure the capacitance signals the patients were asked to grip, flex and extend the wrist, and flex and extend the fingers , or dorsi- and plantar-flex the ankle, and flex and extend the toes. With the help of capacitance sensors the limb′s deformation was analyzed.Results:Three months after the surgery the patients were able to actively control contraction of the transferred muscle and produce skin deformation. At the final follow-up, the effective deformation rate was 80% (16/20). Two kinds of classifiers were identified by linear discriminant analysis and quadratic discriminant analysis. In the upper limb, the overall recognition accuracies were 97.27% and 100% respectively, and the recognition accuracy of each action was 100%. In the lower limb, the overall recognition accuracies were 95.32% and 100%, and the recognition accuracy of each action was again 100%. In one case wound healing was delayed and several dressing changes were required.Conclusions:MRT can effectively output motion intentions and increase the number and intensity of motion signals. The procedure provides a novel way for better control of intelligent bionic prostheses.

Thumb duplication is one of the most common congenital limb deformities and clinical manifestations vary with malformations in multiple structures. A comprehensive and accurate assessment of abnormal structure and severity is more important than classification before the operation. The principle of surgery is to remove the unwanted structure, keep the useful parts, and reconstruct a good-looking thumb with acceptable functions. There are two major surgical techniques: "excision and reconstruction procedure" , and "combined procedure" . At present, the etiology research of thumb duplication has made considerable progress but its pathogenesis remains unclear. The classifications are still not good enough to guide the treatment and evaluate the outcome in clinical practice. For complex polythumb deformity, the treatment result are far from expected. And this "simple" deformity remains a challenge for surgeons. This article was written on the basis of many classic literatures and the author’s experiences in the treatment of more than 3 000 cases of thumb duplication. The treatment principles of the vast majority of thumb duplication and refinement of the operation details were summarized and we hoped that it could be helpful to doctors with related specialties who often dealed with polythumb deformity.

Thumb duplication is one of the most common congenital limb deformities and clinical manifestations vary with malformations in multiple structures. A comprehensive and accurate assessment of abnormal structure and severity is more important than classification before the operation. The principle of surgery is to remove the unwanted structure, keep the useful parts, and reconstruct a good-looking thumb with acceptable functions. There are two major surgical techniques: "excision and reconstruction procedure" , and "combined procedure" . At present, the etiology research of thumb duplication has made considerable progress but its pathogenesis remains unclear. The classifications are still not good enough to guide the treatment and evaluate the outcome in clinical practice. For complex polythumb deformity, the treatment result are far from expected. And this "simple" deformity remains a challenge for surgeons. This article was written on the basis of many classic literatures and the author’s experiences in the treatment of more than 3 000 cases of thumb duplication. The treatment principles of the vast majority of thumb duplication and refinement of the operation details were summarized and we hoped that it could be helpful to doctors with related specialties who often dealed with polythumb deformity.

Objective To systematically investigate PIK3CA mutations in isolated macrodactyly.Methods Overgrowth tissues from 12 isolated macrodactyly patients who were treated at Department of Hand Surgery,Beijing Jishuitan Hospital from May to August 2017 were collected during operation.There were 6 male and 6 female patients with average age of 4.5 years.DNA was tested for PIK3CA mutation using a targeted Sanger DNA sequencing method.Samples with negative Sanger result were tested with a next generation DNA sequencing(NGS) panel targeting 47 cancer hotspot genes including PIK3CA.Results By targeted Sanger sequencing,PIK3CA mutations were detected in 9 of the 12 patients,with mutation level ranging from 7％ to 27％.The PIK3CA mutations observed were p.His1047Arg,p.His1047Leu,p.Glu545Lys,and p.Glu542Lys.NGS found p.Glu453Lys in one additional patient,allowing the total positive rate to 10/12.All PIK3CA mutations detected in the study were cancer hotspot mutations.Among all tissue types tested,adipose tissue had the highest mutation detection rate (9/9),followed by nerve(10/12) and skin(10/12).Conclusions A high proportion of isolated macrodactyly patients carry a PIK3CA mutation.Adipose,nerve,and skin are ideal tissue resources for PIK3CA mutation detection.Targeted Sanger sequencing with reflex to NGS represents a cost-effective strategy to test PIK3CA mutations in isolated macrodactyly.

Objective To systematically investigate PIK3CA mutations in isolated macrodactyly.Methods Overgrowth tissues from 12 isolated macrodactyly patients who were treated at Department of Hand Surgery,Beijing Jishuitan Hospital from May to August 2017 were collected during operation.There were 6 male and 6 female patients with average age of 4.5 years.DNA was tested for PIK3CA mutation using a targeted Sanger DNA sequencing method.Samples with negative Sanger result were tested with a next generation DNA sequencing(NGS) panel targeting 47 cancer hotspot genes including PIK3CA.Results By targeted Sanger sequencing,PIK3CA mutations were detected in 9 of the 12 patients,with mutation level ranging from 7％ to 27％.The PIK3CA mutations observed were p.His1047Arg,p.His1047Leu,p.Glu545Lys,and p.Glu542Lys.NGS found p.Glu453Lys in one additional patient,allowing the total positive rate to 10/12.All PIK3CA mutations detected in the study were cancer hotspot mutations.Among all tissue types tested,adipose tissue had the highest mutation detection rate (9/9),followed by nerve(10/12) and skin(10/12).Conclusions A high proportion of isolated macrodactyly patients carry a PIK3CA mutation.Adipose,nerve,and skin are ideal tissue resources for PIK3CA mutation detection.Targeted Sanger sequencing with reflex to NGS represents a cost-effective strategy to test PIK3CA mutations in isolated macrodactyly.

Objective: To evaluate the role of the deep radioulnar ligament in the stability of the distal radioulnar joint (DRUJ).Methods: In the study, 14 fresh cadaver upper extremities were randomly divided into two groups.After exposuring the palmar and dorsal deep distal radioulnar ligament, one group was marked as palmar deep radioulnar ligament, and the other group was marked as dorsal deep radioulnar ligament.The pronator teres and the supinator were exposed.A Kirschner wire perpendicular to the bone on Lister tubercle of radius was inserted, then another Kirschner wire on the same level of ulnar inserted when the forearm was in neural position, which was kept parallel to the first Kirschner wire.These specimens were mounted on a specially designed jig which held the limb rigidly, keeping the elbow fle-xion and the ulnar fixation.The radius could freely rotate around the ulnar.Then 50 N force on the pronator teres was applied to simulate the active pronation, and 60 N force on the supinator to simulate the active supination.The active pronation was stimulated, and the displacement of the distal radius was measured with respect to the ulna.The active supination was atimulated, and the displacement of the distal radius was measured with respect to the ulna.The palmar deep radioulnar ligament in one group was cut, then the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.The dorsal deep radioulnar ligament in the other group was cut, and the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.Results: After resection of the palmar deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was statistically significantly different when the forearm was in pronation (t=5.591, P=0.001), but there was no difference when the forearm was in supination (t=0.433, P=0.680).After resection of the dorsal deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was not different when the forearm was in pronation (t=1.000, P=0.356), but there was statistically significant difference when the forearm was in supination (t=6.225, P=0.001).Conclusion: DRUJ is unstable when the forearm is in pronation after resection of the palmar deep ra-dioulnar ligament, and DRUJ is unstable when the forearm is in supination after resection of the dorsal deep radioulnar ligament.

Triangular fibrocartilage complex (TFCC) plays an important role in maintaining stability of the distal radioulnar joint (DRUJ),buffering the ulnar carpal axial impaction and holding the proximal carpal bones.Patients with injured TFCC may suffer pain over the ulnar side of the wrist and DRUJ instability.Many of them may have difficulty in undertaking daily activities,leading to even psychological problems.With the development of arthroscopic technology and updated understanding of the mechanisms of TFCC injury,great progress has been made in the diagnosis and treatment of the traumatic injury,especially in the arthroscopy-assisted treatment.

Objective To evaluate the treatment effects of middle and proximal phalangeal fractures with lateral fixation of mini-titanium plate.Methods From December 2011 to April 2015,56 patients (64 phalanges) suffered from closed middle and proximal phalangeal fractures were treated with lateral fixation of mini-titanium plate.There were 48 males and 8 females,aged from 17 to 65 years (average,36.3 years).Fractures included 25 cases of middle phalangeal fracture and 39 cases of proximal phalangeal fracture.According to site of fracture,12 cases were middle phalangeal condyle fractur,7 cases were middle phalangeal shaft fracture,6 cases were middle phalangeal base fracture,10 cases were proximal phalangeal condyle fracture,22 cases were proximal phalangeaal shaft fracture and 7 cases were proximal phalangeal base fracture.According to the type of fracture,13 cases were transverse,9 cases were short oblique,11 cases were long oblique,6 cases were spiral and 25 cases were comminuted fracture.All phalangeal fractures were exposed by lateral approach,in which the lateral band and oblique fibers of proximal phalanx were excised to fully expose proximal phalangeal fracture.After the reduction,the fractures were fixed with mini-titanium plate laterally.The Disabilities of the Arm,Shoulder and Hand (DASH)and the bilateral fingers total active motion (TAM) were employed to evaluate the functions.All patients took X ray during follow-up.Results All 56 patients were followed up from 9 to 47 months,average (14 ± 6) months.Phalangeal fractures were healed from 7 to 14 weeks,average (8.8 ± 2.4) weeks without loss of fixation or malunion.At final follow-up,DASH score were from 1.7 to 7.5,with an average of 4.8 ± 2.2.TAM of the fingers was excellent (＞ 90％ TAM of the contralateral side) in 33/64 (51.5％) cases,good (75％-90％ TAM of the contralateral side) in 30/64 (46.9％) cas es,fair (50％-75％ TAM of the contralateral side) 1/64 (1.6％) cases.Conclusion Lateral approach fully exposes middle and proximal phalangeal fractures and less interferes with the extensor mechanism.Lateral fixation with mini-titanium plate could provide stability and allow early motion.This technique may be an optional choice in clinical practice.

Objective:To investigate the outcomes of applying microvascular anastomotic coupling de-vices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical out-come.Methods:From March to September 2013,19 injured arteries from 18 male patients who presen-ted at Department of Hand Surgery,Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures.COUPLER,a microvascular anastomotic coupling device was applied in these artery injury repair operations.The 19 repaired arteries included 3 brachial arteries,6 ulnar arteries and 10 radial arteries.After the procedures,all the 18 patients were then fol-lowed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality.Results:The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was (71.5 ± 40.9)d with the longest follow-up time as 116 d and shortest as 14 d.No patient returned to the opera-ting room after the procedures and after being dismissed from the hospital.None of the 18 cases were re-ported to have problems with circulation and thrombosis formation in their upper extremities.Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends.Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis;while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery.These evidences indicated that the outcomes of our initial evalua-tion for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were posi-tive.Conclusion:Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures.The procedures are quick,effective and safe. The clinical application of this microvascular anastomotic coupling device in artery injures is promising, however,additional evidences through further clinical investigation with more cases are warranted.

Objective:To evaluate the outcomes of lesser arc perilunate injuries (Perilunate disloca-tions)treated with arthroscopically assisted mini-invasive reduction and fixation.Methods:Between 2012 and 2014,5 patients who had a perilunate dislocation were treated with arthroscopically assisted re-duction and percutaneous fixation.The mean follow-up was 17.8 months (range,10 to 32 months). Clinical outcomes were evaluated on the basis of range of motion;grip strength;Mayo wrist score;Quick disabilities of the arm,shoulder and hand questionnaire;and patient-rated wrist evaluation score.Radio-graphic evaluations included carpal alignments and any development of arthritis.Results:The range of flexion-extension motion of injured wrist averaged 84% of the values for contralateral wrist.The grip strength of the injured wrist averaged 90% of the values for the contralateral wrists.The mean Quick Disabilities of the arm,shoulder and hand score was 1 ,and the mean Patient-Rated Wrist Evaluation score was 5 .According to the Mayo wrist scores,the overall functional outcomes were rated as excellent in all the patients.Reduction obtained during the operation was maintained within normal ranges in all the patients.Arthritis had not developed in any patient at the end of the follow-up.Conclusion:Arthroscopic mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate dislocations according to our early results.