A case of traumatic bilateral anterior dislocation of the hips complicated by a femoral head fracture is described. The mechanism is discussed and the literature reviewed.
Purpose: To examine postoperative sensory recovery of patients who used Nerbridge® for sensory nerves, and the indications. Subjects and methods: We investigated length of the transplanted nerve, postoperative sensory evaluation, and Disabilities of Arm, Shoulder and Hand (DASH) score in patients who underwent surgery at our center and could be followed up for at least 6 months. The participants were 11 patients (8 men and 3 women) with 17 nerves for study whose mean age at the time of injury was 48 years (15-64 years) and mean follow-up period was 14.4 months (6-28 months). We used the Semmes Weinstein (SW) test for postoperative sensory evaluation. Results: Mean length of the transplanted nerve was 17.3 mm (3-41 mm); the sensory evaluation had 8 patients in the blue range, 6 in the purple range, and 3 in the red range; and the mean DASH score was 16.3 points (1.7-37.5 points). The results tended to be unfavorable for patients with severe injuries such as an amputated finger and those with relatively long transplanted nerves. The results of this study indicated that Nerbridge® worked well with digital nerve deficits on the order of 20 mm. Discussion: When the results following artificial nerve transplants were as good as or better than nerve autografts, the donor site was not problematic and the transplantations with artificial nerves were clearly useful. The product would be decomposed and absorbed in vivo in approximately 3 months. Although the product can be used for a maximum length of 50 mm, in a deficit over 30 mm, the regenerating nerve might be metabolized before reaching its distal nerve stump; thus, a nerve autograft would be preferred in that situation.
We report a case of volar fourth and fifth carpometacarpal (CMC) joint dislocation complicated by a hamate hook fracture. The CMC joint was reduced in a closed fashion and temporally fixed with Kirschner wires. Using intraoperative computed tomography, the displaced fracture of the hamate hook was reduced by open reduction and internal fixation and fixed with a screw. We suggest that this rare injury was caused by the over contraction of the flexor carpi ulnaris and avulsion force from the ligamentous structure around the pisiform, hamate, and metacarpal bones.
The Cold Intolerance Symptom Severity (CISS) questionnaire was introduced by Irwin as a tool for measuring cold intolerance of hand patients. Although there have been many articles on cold intolerance and CISS from Europe, a very few were from Asia. We translated the CISS into Japanese. The aim of this study was to identify a cutoff value for the Japanese CISS in normal population and to evaluate its validity and reliability in hand patients. Translation Process: The original CISS was translated into Japanese by 2 Japanese professional translators independently. The 2 translations were synthesized and then translated backward into English by 2 professional English native translators. An expert panel, consisting of translators, a hand surgeon, and hand therapists, was held to finalize the Japanese CISS. Materials and Methods: One hundred forty-three healthy volunteers answered the Japanese CISS during winter season. The cutoff value was determined using 95% confidence interval. The validity and reliability of the Japanese CISS in hand patients were also investigated. During winter season, 111 outpatients with hand injuries completed the questionnaire and Disabilities of the Arm, Shoulder and Hand (DASH) (9 nerve injuries, 18 finger replantations, 11 tendon injuries, 24 phalangeal fractures, 35 distal radius fractures, 10 complex injuries, and 4 others). The mean age was 52.8 years (range, 16-84). To evaluate the test-retest reliability, 62 patients answered the questionnaire again with a 2-week interval. Statistical Analysis: DASH was used to assess concurrent validity of the Japanese CISS. The Spearman correlation was calculated to assess the correlation between the Japanese CISS and DASH. To evaluate the reliability of the Japanese CISS, Cronbach alpha and the intraclass coefficient (1.1) were calculated for internal consistency and test-retest analysis. Results: In a normal Japanese population, the average CISS score was 16.3 (standard deviation [SD], 15.2). Scores more than 50 were considered to show abnormal cold intolerance. In the hand patients, Spearman correlation between the Japanese CISS and DASH was 0.358, suggesting modest correlation. Cronbach alpha and the intraclass coefficient were 0.917 and 0.896, respectively, which showed the internal consistency, and the testretest reliability of the Japanese CISS was both very good. Discussion: A cutoff value of the Japanese CISS was 50; it was similar to that of the Swedish version of the CISS. The Japanese version of the CISS was proved to be reliable with high internal consistency and test-retest reliability. It indicates good conceptual equivalence of Japanese version and comparability of interpretation.
Background: The coronoid process has not received much attention in the treatment of traumatic injuries of the elbow until recent years. In addition, there are few studies in the literature that explore the arthroscopic treatment thereof. Purpose: To study the feasibility of arthroscopically assisted treatment of coronoid process types I and II fractures. Materials and Methods: From February 2009 to October 2015, 11 patients underwent surgery for a coronoid process fracture associated with other injuries. There were all males with a mean age of 43 (28-61) years and follow-up of 14.5 (4-28) months. In all patients, arthroscopic reduction and transosseous fixation of the fracture were carried out using a FiberWire (Arthrex, Naples, Florida) suture, and the associated bony and ligamentous injuries were also repaired. After surgery, a splint was used for 18 days, and physical therapy was started after its removal. Range of motion was measured, function was assessed with the Mayo Elbow Performance Scoring (MEPS) questionnaire, pain by Visual Analogue Scale (VAS), and disability using the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire. Results: Ten fractures were type II and 1 fracture was type I. Nine patients had an associated injury of the radial collateral ligament, whereas 1 had an associated injury of the ulnar collateral ligament. Six had an associated fracture of the radial head (5 osteosynthesis and 1 fragment excision). Six patients were diagnosed as terrible triad of the elbow. Mean time to bone healing was 5 weeks. All patients had a stable elbow. The range of flexion and extension at the end of follow-up was 131.5° (120-140) to 9.5° (0-25), and pronosupination was 89° (80-90) to 86° (70-90). MEPS was 90.7 (70-100) points, VAS at rest 0 points, active VAS 0.6 (0-2), and force VAS 2.6 (0-5); finally, DASH questionnaire was 13.6 (4.5-20.5) points. No postoperative complications were reported. One patient developed mild residual pain. Conclusions: Although our series presents a limited number of cases, we believe this work shows the feasibility of an arthroscopically assisted treatment in fractures of the coronoid process using a high strength transosseous suture fixation and repairing the associated injuries when necessary.
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