Triphasic Bone Scintigraphy Is Not Useful in Diagnosis and May Delay Surgical Treatment of CRPS of the Hand.

Triphasic bone scintigraphy (TPBS) is often used to diagnose complex regional pain syndrome (CRPS). The primary aim of this study is to determine if the diagnosis of CRPS in patients with a positive TPBS (TPBS +ve) is accurate. A secondary aim is to determine if there was delay in treatment of patients who underwent TPBS compared to those who did not have a TPBS.

Minimally Invasive Procedure for Correcting Extra-Articular Malunions of Metacarpals and Phalanges.

Purpose: Extra-articular malunions of metacarpals and phalanges may cause palmar pain, finger scissoring, and splaying, and interfere with function. Current treatment involves open osteotomy and fixation with plates and screws. We present a minimally invasive method using cannulated headless screws for correction of malunions and examine the outcomes in a series of patients.

Effectiveness of an Arthroscopic Technique to Correct Supination Losses of 90° or More.

Purpose: To present a new arthroscopic method for treating supination losses.

Methods: Six patients (15-71 y) were eligible for this study. All had a history of trauma to the wrist more than 6 months previously.

The lateral para-olecranon approach for total elbow arthroplasty.

Purpose: To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches.

Methods: A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12-105 mo).

Vascularized graft from the metatarsal base for reconstructing major osteochondral distal radius defects.

Purpose: To present our experience of reconstructing distal radius articular defects with a vascularized osteochondral graft from the metatarsal base and to present the mid-term outcomes.

Methods: Seven patients (average age, 36 y; range, 26-55 y) who had reconstruction of major defects of the articular surface of the radius are presented. In 5, the lunate facet and sigmoid notch were reconstructed; in 1, an isolated defect on the surface of the lunate facet was reconstructed; and in 1, the scaphoid facet was reconstructed.

Selecting the diameter of a radial head implant: an assessment of local landmarks.

Introduction: Little information exists on radial head implant diameter sizing methods. When the native head is absent due to extensive comminution or previous excision, the lesser sigmoid notch may be a useful landmark for sizing. We evaluated the reliability of native radial head measurements, and the lesser sigmoid notch, as landmarks for radial head implant diameter sizing.

Reconstruction of the ulnar head with a vascularized second metatarsal head: case report.

A case of a young patient with avascular necrosis of the ulnar head following a severely displaced ulnar head fracture is presented. Treatment included debridement of the entire ulnar head, leaving the ulnar styloid, sigmoid notch, triangular fibrocartilage, and both distal radioulnar ligaments intact. The head of the ulna was reconstructed by transferring a vascularized second metatarsal head.

Sigmoid notch reconstruction and limited carpal arthrodesis for a severely comminuted distal radius malunion: case report.

We present the case of a young patient with a severely comminuted, malunited, intra-articular distal radius fracture and complete disruption of the sigmoid notch. We reconstructed the malunited distal radioulnar joint by osteotomy and repositioning the displaced sigmoid notch fragments through a combined dorsal and volar approach. At the same time, we carried out a radioscapholunate arthrodesis with distal scaphoid excision.

An all-inside technique for arthroscopic suturing of the volar scapholunate ligament.

Repair of the volar scapholunate ligament has not been performed arthroscopically. We present an all-inside technique that presents closure of the anterior scapholunate interval. A Tuohy needle and a resorbable suture are all that is required.

Rheumatoid arthritis of the elbow.

Rheumatoid arthritis (RA) is the most common form of inflammatory arthropathy. RA is considered a disease of synovial joints, although it can cause various extra-articular manifestations. The synovium appears to be the primary target; however, investigations are ongoing to determine the exact etiology and pathoanatomy.

Arthroscopically guided osteotomy for management of intra-articular distal radius malunions.

Purpose: A malunion with a step-off of 1 mm or more after an intra-articular distal radius fracture may cause pain and arthritic changes at midterm follow-up. We present our technique for treating intra-articular distal radius malunions by carrying out an osteotomy from inside the joint outward under arthroscopic guidance using the dry arthroscopy technique, with emphasis on the clinical and radiologic outcomes.

Methods: We performed surgery on 11 patients for intra-articular malunion of the distal radius 1 to 5 months after the injury.

Late salvage of the ischemic finger after crush injury using flow-through flaps: case report.

The progressive evolution and late salvage of a posttraumatic digit with poor vascularization has not been discussed in the literature. We report the cases of 3 patients whose fingers were rescued at referral 5 to 16 days after the traumatic event by restoring the arterial inflow by means of flow-through free flaps. All 3 fingers were compromised vascularly with patchy necrosis and absence of Doppler signal distal to the injury.

Super-thinned iliac flap for major defects on the elbow and wrist flexion creases.

Four free iliac flaps were used to treat or prevent flexion contracture at the elbow or wrist flexion crease. Flap size ranged from 13 x 6 cm to 18 x 8 cm. Two flaps were used for primary coverage, and the other 2 flaps were used to treat established flexion contractures.

Ischemic toe encountered during harvesting: report of 6 cases.

Local vessel disease causing lack of arterial inflow at the time of toe harvesting represents a surgical emergency. In a personal experience of 194 toe transfers to the hand, 6 cases (in 4 patients) were found to have diseased vessels at the first web to the point that acute ischemia of the toe occurred when the tourniquet was released at the lower limb. We report our experience in these 6 cases.

Dehydroepiandrosterone sulfate and high-density lipoprotein-cholesterol levels in overweight children.

Objective: The association of childhood overweight with cardiovascular risk factors seems to change by sex and age, which may indicate that hormonal status could be the cause of this different association. In this study, we analyzed the relationship of dehydroepiandrosterone sulfate (DHEA-S) with the alterations associated with overweight by analyzing the influence of this hormone in the differences found in biochemical variables between normal-weight and overweight prepubertal children. RESEARCH METHODS AND DESIGN: The study included 684 6- to 8-year-old children (350 boys and 334 girls) categorized by the presence or absence of overweight, according to the age- and sex-specific cut-off points proposed for children.

A technique to improve foot appearance after trimmed toe or hallux harvesting.

We describe a technique to improve the appearance of the donor site after hallux harvesting. The surgery has been used in 6 consecutive patients having a trimmed-toe-type transfer. Instead of the classic stump closure advised by Wei, the following steps were performed on the donor site: (1) removal en bloc of the second metatarsal and transposition of the second toe on top of the proximal phalanx of the hallux, (2) interposition of a tibial (medial) glabrous flap from the tibial aspect of the hallux onto the tibial side of the second toe to increase its size, and (3) eponichial flap to increase the nail show on the second toe.

The tibial second toe vascularized neurocutaneous free flap for major digital nerve defects.

Purpose: Most digital nerve defects can be reconstructed by means of nonvascularized nerve grafts or artificial tubes, for example. When the bed is poor, the defect is long, or there is a concomitant soft-tissue loss; however, a vascularized nerve graft may be a better option. Our purpose is to introduce a method of 1-stage reconstruction of complex neurocutaneous defects in the fingers and to report the results and clinical effectiveness at a minimum 1-year follow-up period.

Dry arthroscopy of the wrist: surgical technique.

Purpose: To present a method to perform arthroscopic exploration and instrumentation without infusing any fluid.

Methods: The hand is suspended from a bow, with traction on all fingers. Portals are developed as in the classic (wet) wrist arthroscopic procedure except that no water is infused to distend the joint and create the optic cavity.