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A chronic traumatic hyperextension of the proximal interphalangeal (PIP) joint can result from traumatic volar plate (VP) disruption. For the treatment of this disorder, reconstruction procedures have been traditionally recommended, because the condition of the VP was not considered susceptible to repair due to retraction or attenuation. The purpose of this paper is to present the operative technique and report the clinical results of late VP repair. Late VP repair was performed for chronic, post-traumatic hyperextension deformity of the PIP joint of the little finger resulting from VP disruption in seven consecutive patients. The range of motion and the lateral stability of the PIP joint were evaluated. The radiographic images were also used to evaluate the alignment and degenerative changes of the PIP joint. Clinical results were classified according to Catalano's criteria. Intraoperative findings showed that the VP could be mobilised and repaired in all cases. The hyperextension was well corrected, and none showed recurrence of the initial deformity. Average flexion of the PIP joint was 92° (range = 75-98°), and flexion contracture was 9° (range = 0-20°). On clinical evaluation, there were two excellent, three good, and two fair results. The postoperative radiographs revealed no degenerative change in the PIP joint in six patients. Late VP repair is a successful and reliable alternative and more physiologic than other reconstruction methods. One should first consider late VP repair, despite a long interval between injury and repair.

Low hepatic CYP3A activity may significantly contribute to the risk for steroid-induced ONFH.

Low hepatic cytochrome P4503A (CYP3A) activities might play an important role for inducing osteonecrosis of the femoral head (ONFH) by corticosteroids. However, the relationship between hepatic CYP3A activity and steroid-induced ONFH is unknown. We have examined the relationship between hepatic CYP3A activity and the inducibility of ONFH in a rabbit model. Sixty rabbits were divided into three groups. Hepatic CYP3A inducer (phenobarbital, group P; n ¼ 15), inhibitor (itraconazole, group I; n ¼ 15), or saline (group C, n ¼ 30) was administrated for 3 weeks before intramuscular methylprednisolone. In groups P and I, hepatic CYP3A levels were measured by midazolam clearance before treatment (baseline) and before methylprednisolone injection. All animals were sacrificed 3 weeks after methylprednisolone injection and both femurs were harvested and examined histologically for osteonecrosis. Midazolam clearance was significantly increased and decreased, compared with baseline in groups P and I respectively (p < 0.0005, p < 0.002). The incidence of osteonecrosis in group P (33%) was significantly lower than in group I (100%) and group C (83%; p < 0.001 for both). The percentage necrotic area to whole bone marrow area on cross sections in group P (8.2 AE 5.9%) was significantly lower than in group I (69.8 AE 20.8%) and group C (51.5 AE 30.7%; p < 0.005 for both). Hepatic CYP3A activity inversely correlated with the incidence of osteonecrosis and extent of the necrotic area caused by the same dose of corticosteroids, suggesting possible prevention of the steroid-induced osteonecrosis by reducing steroid dose in poor corticosteroid metabolizers. ß

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Patients with pediatric trigger thumb present with fixed contracture of the interphalangeal joint (IPJ) or snapping of the thumb. We applied a hand-based dynamic splint using coils at the IPJ. The aim of this study was to report the clinical outcomes of splint therapy versus observation. One hundred twenty-nine thumbs (112 patients and 57 boys) were examined retrospectively. At initial presentation, parents selected the treatment after explanation of pathology and consents were obtained. Treatment was concluded when full extension or resolution of the involved IPJ was achieved; alternatively, surgical treatment was offered for patients who failed to improve. Improvement in extension loss to 0º and hyperextension was defined as resolution of the IPJ. Surgery was not selected as a first-line treatment strategy in any of the cases in this study. The rate of resolution was 59% at 31 months of follow-up in the splint group (99 thumbs) and 43% at 30 months in observation group (30 thumbs); there was no significant difference between the groups (P = 0.15). Twenty-one thumbs showed locking of the IPJ in the extended position during splint therapy, but all recovered with a 71% rate of resolution. The splint group showed a higher rate of resolution than the observation group; however, there was no significant difference between therapies. Our study showed that 55% of patients with pediatric trigger thumb showed resolution following conservative treatment for an average of 30 months until surgery could be performed under local anesthesia. Splint therapy and observation are viable treatment options prior to surgery.

Intra-articular osteoid osteoma (OO) of the elbow is rare. We report a 26-year-old man who presented with pain, swelling, and limited elbow range of motion. Plain computed tomography (CT) showed a radiolucent round lesion at the distal humerus and reactive bone in the olecranon fossa. Conservative treatment with salicylate failed under the suspicion of OO. During elbow arthroscopy, a red solitary lesion was noted after resection of the white reactive bone in the olecranon fossa and was excised en bloc using a bony chisel. Histological examination showed OO. The patient’s symptoms resolved the day after surgery. The patient remained asymptomatic 2 years postoperatively. This case report shows the successful clinical results of an arthroscopic procedure for intra-articular OO based on two primary goals: precise location of the lesion indicated by reactive bone on preoperative CT and histological verification using bony chisel.