Anterior interosseous nerve syndrome (AINS) is typically characterized by dysfunction of the pure motor branch of the median nerve, primarily affecting the flexor pollicis longus and the flexor digitorum profundus (FDP) of the index finger, and occasionally involving the FDP of the middle finger and the pronator quadratus. Although various etiologies such as compressive neuropathy and isolated neuritis have been proposed, the most recent review describes AINS as a form of neuralgic amyotrophy. Its treatment remains a matter of debate; the most frequently discussed approach is conservative treatment followed by surgical intervention above the medial epicondyle level if recovery is not achieved. In the case described herein, a hematoma resulting from blunt trauma at the forearm level compressed the anterior interosseous nerve (AIN), with clinical features and diagnostic findings very similar to those of typical AINS. Early surgical removal of the hematoma led to complete recovery without complications. Despite the current understanding of AINS pathophysiology and treatment, this case emphasizes the need to consider the possibility of AIN palsy due to forearm lesions. We report on the clinical course and successful treatment of this case to highlight this important consideration.

Purpose: This study presents the outcomes of a modified loop-locking suture technique for repairing complete flexor digitorum profundus (FDP) tendon divisions at the terminal level. Traditional methods, such as pullout sutures or tendon fixation, are commonly used; however, this paper explores the reliability of the loop-locking suture technique. Methods: From June 2011 to January 2024, the modified loop-locking suture technique was performed in 21 cases of FDP tendon division in which the distal stump was less than 1 cm in length. Core and epitendinous sutures were made using polydioxanone 4-0 and poliglecaprone 25 4-0. The study focused on 13 patients aged 24 to 68 years, with an average tendon stump length of 0.61 cm. Ten cases necessitated microsurgical repair involving both arterial and nerve repair. A dorsal protective splint was used for an average of 5 weeks. The outcomes measured included active and passive range of motion, grip strength, and key and pulp pinch. Results: The mean follow-up period was 12 months. No re-ruptures occurred, although two cases required tenolysis. The average active range of motion at the distal interphalangeal joint was 61.5°. Grip strength and pulp pinch averaged 95.3% and 86.8%, respectively, compared to the contralateral side. Flexion contracture was observed in three cases, with no quadriga effect. Conclusion The modified loop-locking suture technique provides sufficient functional recovery for FDP tendon divisions in Zone 1a and distal Zone 1b, even with a short tendon stump.

Injury of the sagittal band, a crucial component of the extensor hood, can occur in various situations, including spontaneous events, trauma, and rheumatic diseases. This case presents a rupture of the sagittal band resulting from chronic irritation caused by a metacarpal head osteoma. A 22-year-old female presented with ulnar subluxation of the extensor tendon at the left third metacarpophalangeal joint, without any history of trauma or pain. Ultrasonography and computed tomography revealed a 1.7 mm-sized bony lesion on the radial side of the metacarpal head, accompanied by a partial tear of the radial sagittal band. Our hypothesis that chronic irritation of the sagittal band by the adjacent bony lesion led to the partial tear was confirmed by intraoperative findings. The lesion was excised, and the radial sagittal band was reconstructed. Histopathological examination confirmed a diagnosis of osteoma. To our knowledge, this is the first reported case of sagittal band rupture caused by an osteoma of the metacarpal head. This case underscores the importance of considering an underlying metacarpal head osteoma in patients with non-rheumatoid joints presenting, in the absence of a traumatic history, with a sagittal band rupture due to chronic irritation.

Full-thickness nail bed defects with exposure of the distal phalanx are difficult to reconstruct with limited options for bone coverage. A subcutaneous flap can effectively cover bone exposure, followed by a nail bed graft. We report a case of successful nail bed reconstruction using this approach, incorporating a split-thickness nail bed graft. A 59-year-old woman sustained injuries to the nail bed of the right middle finger from a blender blade. The defect, measuring 1.2 × 0.6 cm, was located in the center of the nail bed with associated bone exposure. Both lateral nail folds remained intact and our aim was to reconstruct the defect without disrupting these structures. A subcutaneous flap incorporating the digital artery was elevated. The flap was then transposed beneath the lateral nail fold and uninjured nail bed to provide coverage for the defect. This technique allowed for the reconstruction of the damaged area while preserving the vascular supply and ensuring adequate soft-tissue coverage. Three weeks post-surgery, the flap survived, and the eponychial folds were all preserved, allowing for a subsequent split-thickness nail bed graft. At 12 months post-surgery, the outcome was evaluated as “very good” according to Zook’s criteria.

Anterior interosseous nerve syndrome (AINS) is typically characterized by dysfunction of the pure motor branch of the median nerve, primarily affecting the flexor pollicis longus and the flexor digitorum profundus (FDP) of the index finger, and occasionally involving the FDP of the middle finger and the pronator quadratus. Although various etiologies such as compressive neuropathy and isolated neuritis have been proposed, the most recent review describes AINS as a form of neuralgic amyotrophy. Its treatment remains a matter of debate; the most frequently discussed approach is conservative treatment followed by surgical intervention above the medial epicondyle level if recovery is not achieved. In the case described herein, a hematoma resulting from blunt trauma at the forearm level compressed the anterior interosseous nerve (AIN), with clinical features and diagnostic findings very similar to those of typical AINS. Early surgical removal of the hematoma led to complete recovery without complications. Despite the current understanding of AINS pathophysiology and treatment, this case emphasizes the need to consider the possibility of AIN palsy due to forearm lesions. We report on the clinical course and successful treatment of this case to highlight this important consideration.

Purpose: This study presents the outcomes of a modified loop-locking suture technique for repairing complete flexor digitorum profundus (FDP) tendon divisions at the terminal level. Traditional methods, such as pullout sutures or tendon fixation, are commonly used; however, this paper explores the reliability of the loop-locking suture technique. Methods: From June 2011 to January 2024, the modified loop-locking suture technique was performed in 21 cases of FDP tendon division in which the distal stump was less than 1 cm in length. Core and epitendinous sutures were made using polydioxanone 4-0 and poliglecaprone 25 4-0. The study focused on 13 patients aged 24 to 68 years, with an average tendon stump length of 0.61 cm. Ten cases necessitated microsurgical repair involving both arterial and nerve repair. A dorsal protective splint was used for an average of 5 weeks. The outcomes measured included active and passive range of motion, grip strength, and key and pulp pinch. Results: The mean follow-up period was 12 months. No re-ruptures occurred, although two cases required tenolysis. The average active range of motion at the distal interphalangeal joint was 61.5°. Grip strength and pulp pinch averaged 95.3% and 86.8%, respectively, compared to the contralateral side. Flexion contracture was observed in three cases, with no quadriga effect. Conclusion The modified loop-locking suture technique provides sufficient functional recovery for FDP tendon divisions in Zone 1a and distal Zone 1b, even with a short tendon stump.

Anterior interosseous nerve syndrome (AINS) is typically characterized by dysfunction of the pure motor branch of the median nerve, primarily affecting the flexor pollicis longus and the flexor digitorum profundus (FDP) of the index finger, and occasionally involving the FDP of the middle finger and the pronator quadratus. Although various etiologies such as compressive neuropathy and isolated neuritis have been proposed, the most recent review describes AINS as a form of neuralgic amyotrophy. Its treatment remains a matter of debate; the most frequently discussed approach is conservative treatment followed by surgical intervention above the medial epicondyle level if recovery is not achieved. In the case described herein, a hematoma resulting from blunt trauma at the forearm level compressed the anterior interosseous nerve (AIN), with clinical features and diagnostic findings very similar to those of typical AINS. Early surgical removal of the hematoma led to complete recovery without complications. Despite the current understanding of AINS pathophysiology and treatment, this case emphasizes the need to consider the possibility of AIN palsy due to forearm lesions. We report on the clinical course and successful treatment of this case to highlight this important consideration.

Purpose: This study presents the outcomes of a modified loop-locking suture technique for repairing complete flexor digitorum profundus (FDP) tendon divisions at the terminal level. Traditional methods, such as pullout sutures or tendon fixation, are commonly used; however, this paper explores the reliability of the loop-locking suture technique. Methods: From June 2011 to January 2024, the modified loop-locking suture technique was performed in 21 cases of FDP tendon division in which the distal stump was less than 1 cm in length. Core and epitendinous sutures were made using polydioxanone 4-0 and poliglecaprone 25 4-0. The study focused on 13 patients aged 24 to 68 years, with an average tendon stump length of 0.61 cm. Ten cases necessitated microsurgical repair involving both arterial and nerve repair. A dorsal protective splint was used for an average of 5 weeks. The outcomes measured included active and passive range of motion, grip strength, and key and pulp pinch. Results: The mean follow-up period was 12 months. No re-ruptures occurred, although two cases required tenolysis. The average active range of motion at the distal interphalangeal joint was 61.5°. Grip strength and pulp pinch averaged 95.3% and 86.8%, respectively, compared to the contralateral side. Flexion contracture was observed in three cases, with no quadriga effect. Conclusion The modified loop-locking suture technique provides sufficient functional recovery for FDP tendon divisions in Zone 1a and distal Zone 1b, even with a short tendon stump.

Purpose: We aimed to determine whether the clinical outcomes of antegrade and retrograde extra-articular Kirschner wire (K-wire) pinning differed in proximal phalanx base fractures. Methods: This retrospective study investigated 73 patients aged ≥18 years with extra-articular proximal phalanx base fractures that were treated by closed K-wire pinning between January 2014 and June 2023. Patients were analyzed according to whether the K-wire fixation was antegrade or retrograde. We analyzed demographics, injury characteristics, the number of K-wires applied, surgical duration, the interval before implant removal, and when physical therapy was started. Radiological outcomes included the amount of time required for radiographically confirmed bone union. Clinical outcomes consisted of complications, total active motion (TAM), and the Michigan Hand Outcomes Questionnaire (MHQ). Results: We treated 29 and 44 patients using antegrade and retrograde K-wire fixation, respectively. The overall complication rate was higher in the antegrade group than in the retrograde group (13.8% vs. 9.1%), although this difference was not statistically significant. Similarly, no significant between-group differences were detected in the length of time required for bone union and implant removal, TAM, and MHQ scores. Conclusion Proximal phalanx base fractures were equally and effectively treated by antegrade and retrograde K-wire fixation. Therefore, the direction of K-wire fixation can be chosen based on surgeons’ preferences and experience.

Purpose: This retrospective study aimed to identify factors influencing hand flexor tendon rerupture and to develop preventive strategies for patients who have undergone hand flexor tendon repair. Methods: In total, 287 patients who underwent hand flexor tendon repair between January 2011 and June 2022 were included. Patients with thumb injuries, amputations, bone injuries, extensor tendon injuries, and those with less than 3 months of follow-up were excluded. Patients were divided into rerupture and non-rerupture groups. Events leading to ruptures were also investigated. The two groups were compared according to sex, age, occupation, smoking status, history of diabetes mellitus, injury characteristics, core suture method, and timing of the rehabilitation course. Results: Of the 287 patients, 19 experienced rerupture (6.6%). The mean time to rerupture was 25.3 days. Reruptures occurred due to unknown causes in nine cases (47.4%), noncompliance with medical recommendations in seven cases (36.8%), and trauma in three cases (15.8%). Among the investigated factors, little finger injury and concurrent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) ruptures were significantly associated with rerupture. Little difference was noted in the core suture methods and timing of the rehabilitation course between the two groups. Conclusion To minimize the risk of rerupture, patients should strictly adhere to medical recommendations and avoid any activities that could cause trauma for at least 1 month after surgery, which is the critical period for tendon remodeling. Patients with little finger injuries as well as concurrent FDS and FDP ruptures require special attention and careful monitoring.