Childhood acute flaccid myelitis, including the first confirmed cases of enterovirus D68 myelitis, in Singapore and Southeast Asia.

Aim: We report the epidemiology, treatment and outcomes of acute flaccid myelitis (AFM), including the first two cases of enterovirus (EV) D68 myelitis, in Singapore.

Methods: Retrospective observational study from a paediatric hospital in Singapore, from January 2012 to December 2022. Clinical, laboratory, neuroimaging and outcome data were analysed.

A Biomechanical Comparison of Different Knots Tied on Fibrewire Suture.

Background: Synthetic sutures such as Fiberwire used in flexor tendon repairs have high tensile strength. Proper application allows early mobilisation, decreasing morbidity from repair rupture and adhesions while preserving range of motion. Suture stiffness can cause poorer knot holding, contributing to gapping, peritendinous adhesions or rupture.

A biomechanical comparison of 3 loop suture materials in a 6-strand flexor tendon repair technique.

Purpose: The braided polyblend (FiberWire) suture is recognized for its superiority in tensile strength in flexor tendon repair. The purpose of this study was to compare the biomechanical performance of 3 loop-suture materials used in a locking 6-strand flexor tendon repair configuration: braided polyblend (FiberLoop 4-0), cable nylon (Supramid Extra II 4-0), and braided polyester (Tendo-Loop 4-0). We hypothesized that, using this technique, the braided polyblend suture would give superior tensile strength compared with the other 2 suture materials.

Spontaneous partial posterior interosseous nerve palsy not caused by an adjacent ganglion.

We report a case of spontaneous partial posterior interosseous nerve palsy where the ganglion adjacent to the nerve was not the main cause of the compression. Instead, a thick fascial band deep to the distal edge of the supinator was found responsible. This case illustrates the importance of completing the nerve exploration to fit with the clinical picture.

Approach to debridement in necrotizing fasciitis.

Aggressive debridement is a cornerstone intervention in necrotizing fasciitis. Our approach consists of 4 steps: (1) confirming the diagnosis and isolate the causative organism; (2) defining the extent of fasciitis; (3) surgical excision; and (4) post-excision wound care. The extent of the infection is defined by probing the wound bluntly.

Free digital artery flap: an ideal flap for large finger defects in situations where local flaps are precluded.

The heterodigital arterialized flap is increasingly accepted as a flap of choice for reconstruction of large finger wounds. However, in situations where the adjacent fingers sustained concomitant injuries, the use of this flap as a local flap is precluded. This paper describes our experience with the free digital artery flap as an evolution of the heterodigital arterialized flap.

Elbow ganglion arising from medial epicondyle pseudarthrosis.

We present a patient with an asymptomatic painless medial elbow swelling of one year's duration, which was diagnosed as a ganglion originating from a non-united avulsion fracture of the medial epicondyle with a pseudarthrosis. Medial elbow ganglia are unusual lesions typically arising from the medial aspect of the ulnohumeral joint capsule, often in combination with symptoms of cubital tunnel syndrome. To our knowledge, a ganglion arising from a pseudarthrosis has not been reported in the literature, and should be considered in the differential diagnoses of lesions encountered over the site of fracture non-union in proximity to a joint.

The spiral flap for fingertip resurfacing: short-term and long-term results.

Purpose: We describe a homodigital neurovascular island flap for reconstructing large pulp defects of the fingertips and review the short-term and long-term appearance and function of the reconstructed fingertips.

Methods: The spiral flap is a homodigital neurovascular island flap with a unique spiral advancement and transposition design that allows pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. Thirty-two fingertips were resurfaced using this flap.

Complex carpal dissociation with open, complete, and divergent trapezium, capitate, and hamate dislocation: a case report.

We report a patient with a unique complex carpal dissociation involving complete and divergent dislocation of the hamate, capitate, and trapezium with total ligamentous disruption of the distal carpal row and midcarpal joint, associated with a transverse shaft fracture of the fifth metacarpal. The mechanism of injury was a sustained torsional force resulting in a simultaneous distraction and bidirectional dorsopalmar (ulnar)-palmodorsal (radial) crushing force at the carpus.

Factors affecting the prognosis of pyogenic flexor tenosynovitis.

Background: Pyogenic flexor tenosynovitis is a closed space infection involving the digital flexor tendon sheaths of the upper extremity that can cause considerable morbidity. The purpose of the present report is to describe the various risk factors leading to poor outcomes and to recommend a clinical classification system for this condition.

Methods: We studied seventy-five patients with pyogenic flexor tenosynovitis over a six-year period.