Narrow Results

We report the results of long-term follow-up after Vickers' physiolysis of the trapezoidal delta phalanx in a boy aged five year and six months with bilateral clinodactyly of the little finger. Radial deviation of the little finger was corrected from 36° to 15° on the left, and from 35° to 15° on the right at last follow-up six years and five months after surgery. The patient's parents were satisfied with the cosmetic appearance. X-ray film showed the abnormal distal epiphyses of the middle phalanges of the little fingers had disappeared.

We report a case of Linburg-Comstock syndrome, which is characterized with anomalous tendon slips connecting flexor pollicis longus (FPL) to the flexor digitorum profundus (FDP), usually at the index finger. The present patient started to be a carpenter and was suffering from his disability of flexing the thumb and the index finger independently when he handled the screws in his work. We surgically removed the tendinous connection of the FPL tendon and the index FDP tendon. After surgery, he could work as a carpenter without any difficulty. Surgical disconnection was effective treatment. Dynamic high-resolution ultrasound and three dimensions of computed tomography of the left distal forearm were helpful to confirm the diagnosis.

Introduction: Non-union of radial neck fractures is not common in adults, and surgical treatment is rarely required. This case report documents non-union of the radial neck with persistent pain around the elbow joint and tenderness over the neck of the radius, limited range of motion for 12 months. The authors performed an iliac bone graft and temporary K-wire fixation for non-union of the radial neck after an isolated radial neck fracture.

Case presentation: A 54-year-old woman slipped with her hand outstretched 12 months prior to presentation. She was diagnosed with a radial neck fracture, but her injury was eventually diagnosed as a non-union fracture, and she was transferred to our hospital. The patient had tenderness of the radial head and neck and an increasing tendency of pain in the forearm during external rotation with resistance. Flexion was a maximum of 80°, extension was limited to 20°, and internal rotation and external rotation were decreased to 60°. On plain radiographs, a clear radiolucent shadow was present between the bone fragment and radius. After the autogenous iliac bone graft, a temporary K-wire was fixed, and at eight weeks postoperatively, the bone was united. The patient is in the month 24 of postoperative follow-up and is able to perform daily activities without tenderness.

Conclusion: If elbow joint pain, tenderness, and limitation of range of motion are present in non-union of radial neck fracture, surgical treatment is necessary. If there is no injury to the ligament around the elbow or instability, the authors consider bone graft and temporary K-wire fixation as an excellent treatment option for bony union and early exercise of the joint.

The cases of two patients, a four-year-old boy and an eight-year-old boy, who had been incapable of active flexion of the little finger since birth, are presented. They were capable of active flexion of the metacarpophalangeal (MP) joint, but not of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. They were diagnosed with a defect of the flexor digitorum profundus (FDP) tendon of the little finger and underwent surgery. In both cases, the FDP tendon turned into fibrous tissue proximal to the palm and lost continuity on this side. Reconstruction was performed by making an end-to-side anastomosis of the residual proximal end of the FDP tendon to the FDP tendon of the ring finger in the palmar region. Although one patient required repeated surgery due to post-operative tendon adhesion, good outcomes were achieved, with both patients becoming capable of active flexion.

We describe here the finding of a huge perineurial cyst which eroded the sacral body. On MRI examination, a huge cyst occupied the space within the sacral spinal canal. On myelography, however, the cyst was not filled with contrast medium immediately after dye injection. Since the patient was disabled by pain, we resected the cyst microscopically. Histological examination revealed neurofibrils in the wall of the cyst. Based on these and myelographic findings, perineurial cyst was diagnosed. Surgical indications for this lesion are still controversial since most are asymptomatic. It is our opinion that if sacral cystic lesions are large enough to erode sacral bone nearly to the retroperitoneal space or sacro-iliac joint, they should be surgically resected using operative microscope.

Background and purpose: Surgery is recommended as the treatment of choice for hemorrhagic Moyamoya disease (MMD). The rationale of surgery and the choice of procedure are poorly understood. The aim of this paper is to present latest evidence, from cellular, biomechanical and population data, surgical treatment options and their effect on the outcome of hemorrhagic MMD.

Methods: We systematically reviewed the latest evidence from cellular, biomechanical and populational studies including our own meta-analysis for rationalization of management of MMD. We searched major databases from inception to latest articles available till October 2018. All major breakthroughs including basic research to randomized controlled trials (RCTs) and human case–control studies related to hemorrhagic MMD were included. Our meta-analysis was performed in accordance to the standard Cochrane.

Result: Evidence at cellular, biomechanical and RCT levels was presented. For our meta-analysis, we included eight studies, totaling at 632 patients. Our results rationalized the use of surgical methods in support of surgical management of MMD. We showed that surgery in MMD resulted in a significant lower risk of future stroke ($\mathrm{\text{RR}}=0.24$, 95% $\mathrm{\text{CI}}=0.15$–0.38). Among different surgical methods, the indirect bypass group had a lower risk for sedentary stroke risk reduction compared with the direct bypass group (RR=3.36, 95% CI=1.53–7.36). No significant differences were observed in perioperative complications between the two methods.

Conclusion: Surgery remains a mainstay for the management of MMD. We concluded that current evidence in biomechanical and our own meta-analysis is in support of surgery being an effective management of hemorrhagic MMD. We deduced insights into research for early detection, characterization and follow up of patients with MMD.

This study investigated the effect of two surgical treatment schemes on complex proximal humeral fractures. We included 60 patients with complex proximal humeral fractures admitted to the People’s Hospital of Zhongjiang County, China, from May 2016 to May 2017. The patients were randomly divided into group A (30 cases; intramedullary nail fixation) or group B (30 cases; plate internal fixation) to compare the therapeutic effects. We used Neer’s scoring system to calculate an acceptability ratio and assess pain six weeks after surgery. The acceptability ratio was 80.0% in group A and 93.3% in group B, and the ratio did not differ between the groups ($P>0.05$). In groups A and B, 56.7% and 50% of patients were without pain, respectively; this rate did not differ between the groups ($P>0.05$). Our results indicate that both methods are suitable for treating complex proximal humeral fractures. However, in practice, surgeons should select the most appropriate treatment method based on the actual fracture to ensure the best postoperative outcome with the least amount of pain.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.

Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.

Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.

Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.

Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.

A 7-month-old, intact, male French bulldog presented for paraplegia for two days, and persistent fever and diarrhea for seven days. Complete blood count and biochemical profiles were within normal limits. Radiography and computed tomography (CT) revealed destructive endplate lesions between T11 and T12. Surgery of intervertebral disc (IVD) curettage was performed because the dog was beginning to lose deep pain perception. Staphylococcus epidermis was isolated from blood culture and specimens of the IVD. After surgery, intravenous and oral antibiotics were continued for three weeks. The dog regained ambulatory status one month after surgery. Diagnosis of discospondylitis of T11 and T12 was confirmed according to CT and positive bacteria culture. To our knowledge, this case is the youngest dog confirmed with discospondylitis managed successfully, and the first case report of discospondylitis in a French bulldog. Aggressive surgical treatment is highly recommended in young dogs with rapidly progressive neurologic deficits from discospondylitis.

A mallet finger is a common injury that results from a sudden flexion force on an extended distal phalanx or rarely, from hyperextension of the distal interphalangeal joint. Mallet finger can be purely tendinous or bony when associated with an avulsion fracture. The management of this injury is largely conservative with the use of a splint, although surgery may be indicated for select patients. There is little consensus on the indications for surgery or the suitable surgical technique. The aim of this review article is to provide a pragmatic and evidence-based approach to mallet finger that will guide the treating surgeon in providing best care for their patient.

Background: To review the cases of dangling-type thumb polydactyly treated with suture ligation vs surgical excision.

Methods: Cases of dangling-type thumb polydactyly treated in 2 different hospitals from 1994 to 2014 were recruited. Group 1 includes cases treated with suture ligation in hospital 1; Group 2 includes cases treated with surgical excision in hospital 2. The demographics data, early clinical outcomes and early complications were retrieved from clinical notes. All cases were contacted for a final assessment.

Results: There were 23 cases recruited in group 1 and 26 cases recruited in group 2. The mean age at the time of procedure was 15.9 days (group 1) vs. 14 months (group 2). The infection rate was comparable in both groups (4.35% vs. 3.85%). 12 cases in group 1 and 14 cases in group 2 completed a final assessment. Residual tissue is common in group 1 (58.5%) and 4 cases (33.3%) required revision surgery. No case in group 2 had residual tissue and none require revision surgery. There was no painful neuroma in both groups and all patients achieved normal thumb and hand functions. The parental satisfaction score was 7.8 (group 1) and 8.8 (group 2) with no statistical difference (p = 0.061).

Conclusions: Suture ligation and surgical excision are safe and effective treatment options for dangling-type thumb polydactyly. Both methods received comparable parental satisfaction. However, residual tissue is common after suture ligation while this problem is not observed after surgical excision.

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain.

Level of Evidence: Level V (Therapeutic)

Background: Ovarian endometriomas have been shown to have a negative effect on fertility. There is a dilemma on the timing for surgery either before or after the fertility treatment. By delaying surgical treatment for infertile patients with endometriomas, medical treatment has become an important choice for these patients. The objectives of this review were to compare the efficacy of medical treatment on endometrioma size and endometriosis-associated pelvic pain (EAPP).

Methods: We performed a systematic review and meta-analysis examining women who have endometrioma and underwent medical therapy for endometrioma size reduction. The primary outcome measure was endometrioma size reduction. Secondary outcome measures EAPP.

Results: We included 14 studies for the meta-analysis. We performed a systematic review and meta-analysis examining women with endometrioma who underwent medical therapy for endometrioma size reduction. The primary outcome measure was endometrioma size reduction. Secondary outcome measure is EAPP. The majority of the studies were non-randomized controlled trials (RCTs; 9/14), and five were RCTs. Women who received medical treatment have a significant endometrioma size reduction in diameter compared to women not receiving any medical treatment or placebo (MD −9.66mm; 95% CI [−13.85, −5.46], three studies, 467 women, $I^2=96$%) and a reduction in visual analog scale (VAS) for EAPP (MD −2.64; 95% CI [−3.31, −1.97], two studies, 338 women, $I^2=0$%). Women who received dienogest (DNG) treatment have a significant endometrioma size reduction in diameter (MD −4.61mm; 95% CI [−9.08, −0.15], three studies, 220 women, $I^2=96$%). Compared to women receiving other medical treatments, women receiving DNG treatment had more VAS reduction of EAPP (MD −0.46; 95% CI [−0.62, −0.31], four studies, 451 women, $I^2=85$%).

Conclusions: The use of medical therapy is associated with endometrioma size reduction and a reduction in endometriosis-related pain when compared with no medical treatment given. With the availability of various medical options, surgery can thus be avoided to minimize the risk of damage to the ovarian reserves.