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.

Assessment of Progressive Hand and Wrist Deformities in the Rheumatoid Patient.

This article focuses on hand and wrist deformities arising from rheumatoid arthritis. The pathogenesis is synovitis and pannus formation, leading to direct tissue invasion and mass effect resulting in stretching and attenuation of ligaments. The typical deformity of a rheumatoid wrist is a dorsal subluxation of the ulna head (or more aptly, volar translation of the radius given that the ulna is fixed in position), with volar subluxation, ulnar translocation and supination of the carpus, eventually leading to carpal collapse.

Development and Validation of a Low-Cost Drilling Model.

Simulation models enable learners to have repeated practise at their own time, to master the psycho-motor and sensory acuity aspects of surgery and build their confidence in the procedure. The study aims to develop and evaluate the feasibility of a low-cost drilling model to train surgeons in the drilling task. The model targets three aspects of drilling - (1) Reduce plunge depth, (2) Ability to differentiate between bone and medullary canal and (3) Increase accuracy drilling in various angles.

Salvage of failed proximal interphalangeal arthroplasty with vascularised toe joint transfer: Report of two cases.

Failed implants of the proximal interphalangeal joint may result in bone and soft tissue deficits and joint instability with limited reliable options for reconstruction besides an arthrodesis procedure. The purpose of this report is to illustrate the use of vascularized second toe joint for salvage of failed, multi-operated proximal interphalangeal joint in two active patients. Pre-existing scars are used to define the approach and choice of donor site.

Novices can assess microsurgery performance, and this is enhanced using the Manual Suture Parameters for Training and Assessment (M-SParTA) scoring system.

This study explores how novices could effectively evaluate the quality of microsurgical suturing. That would be enhanced with using a novel Manual Suture Parameters for Training and Assessment (M-SParTA), which supported novices with guidance on the objective parameters, in order to increased the accuracy of scoring ability. We also propose the following initial framework to train novices in microsuturing using a standardised task: 1) Exposure; 2) Assessment; 3) Hands-on and self-assessment.

Collapse after Carpal Bone Tunneling. An Underreported Complication?

Purpose: To report the complication of carpal bone tunnel collapse in scapholunate reconstruction.

Methods: The authors present six cases of carpal collapse or bone necrosis after bone tunneling for ligamentous reconstruction, three in the scaphoid bone and three in the lunate.

Results: All six cases were secondary to ligament reconstruction for chronic scapholunate dissociations, none of which had preoperative structural scaphoid or lunate deformities.

The epidemiology and distribution of hand fractures in Singapore.

Introduction: The aim of this study was to elucidate the epidemiology and distribution of hand fractures in Singapore.

Methods: A total of 701 hand fractures in 596 patients aged 21 years and above from a single centre were reviewed from 2010 to 2011. Details regarding the patient demographics, occupation, mechanism of injury, associated injuries and treatment were obtained.

Chicken Feet: A Model for Practising Locoregional Flaps of the Hand.

The aim of this study was to determine the feasibility of the chicken foot model for surgical trainees interested in practising the designing, harvesting and inset of locoregional flaps of the hand. A descriptive study was performed to demonstrate the technical aspects of harvesting four locoregional flaps in a chicken foot model: fingertip volar V-Y advancement flap, four-flap and five-flap Z-plasty, cross-finger flap and first dorsal metacarpal artery (FDMA) flap. The study was performed in a surgical training laboratory on non-live chicken feet.

Surgical Anatomy and Exercises Using the Chicken Thigh Sciatic Nerve for Microsurgery Training.

 Vessel repair in a chicken thigh is commonly used in microsurgery training model. The sciatic nerve is closely associated with the vessels and has been used for training nerve coaptation, which has different technical considerations from vessel anastomosis. We describe in detail the relevant surgical anatomy and training exercises that can be used with this model.

Radioscaphoid Impingement after Volar Plate Fixation and Bone Grafting of a Non-United Scaphoid Fracture.

Volar plate fixation (VPF) of scaphoid fractures has received increased attention over the past decade. The purported benefits over headless screw fixation are increased rigidity, better purchase of small fragments, the ability to prevent extrusion of bone graft, and to act as a buttress against excessive scaphoid flexion. We report a case of symptomatic radioscaphoid impingement presenting two years after successful VPF for a non-united scaphoid fracture.

3D-printed Poly-Lactic Co-Glycolic Acid (PLGA) scaffolds in non-critical bone defects impede bone regeneration in rabbit tibia bone.

Background: An increasing number of bone graft materials are commercially available and vary in their composition, mechanism of action, costs, and indications.

Objective: A commercially available PLGA scaffold produced using 3D printing technology has been used to promote the preservation of the alveolar socket after tooth extraction. We examined its influence on bone regeneration in long bones of New Zealand White rabbits.

A Comparison of Casting Versus Splinting for Nonoperative Treatment of Pediatric Phalangeal Neck Fractures.

Background: Phalangeal neck fractures account for 13% of pediatric finger fractures. Al Qattan type I (undisplaced) fractures are treated nonoperatively. There is increasing evidence that Type 2 (displaced) fractures achieve remarkable fracture remodeling with nonoperative treatment and patients frequently make a full functional recovery.

Outcomes of Phalangeal Neck Fractures in a Pediatric Population.

Purpose: Displaced pediatric phalangeal neck fractures are regarded as unstable, and hence, surgical fixation is traditionally recommended. In our experience, some patients with displaced fractures treated nonsurgically healed with a good clinical outcome and no further displacement. We studied the outcome of displaced phalangeal neck fractures treated nonsurgically with attention to the change in fracture displacement over time and hypothesized that displaced phalangeal neck fractures can be treated nonsurgically with maintenance of acceptable radiological parameters.

VY Advancement, Thenar Flap, and Cross-finger Flaps.

The VY advancement, thenar flaps, and cross-finger flaps are workhorse flaps used in reconstruction of fingertip defects. They are reliable and simple to raise without need for microvascular dissection. In addition, they usually provide good results in terms of sensibility and range of motion.

Maximal advancement of homodigital neurovascular island flaps.

We investigated the maximal advancement of the homodigital neurovascular island flap with the digit in full extension and its correlation to the digital length. In 32 adult cadaveric digits, flaps measuring 1 × 1 cm were sequentially elevated to different dissection points. Dissection of the flap to the proximal interphalangeal joint crease, palmo-digital crease, division of adjacent digital artery and the superficial arch resulted in flap advancement of 8, 12, 15 and 18 mm, respectively.

Treatment of Carpal Instability and Distal Radioulnar Joint Instability.

Carpal instability and distal radioulnar joint instability represent an important set of conditions responsible for pain and disability in the wrist. Either condition can occur as a result of ligamentous failure or loss of articular congruity from fractures or a combination of both. Instability itself is a clinical diagnosis supported by relevant imaging modalities.