Arthroscopic bone grafting in scaphoid fracture nonunion: Is it a universal solution?

Since 1997, arthroscopic bone grafting has offered hand surgeons a solution to the riddle of scaphoid fracture nonunion. The intended merit of an arthroscopic approach for scaphoid fracture nonunion management lies in its minimal invasiveness, which preserves the tenuous vascularity of the scaphoid, poses minimal disturbance to carpal ligaments, and allows comprehensive evaluation in diagnostic uncertainty. What does the evidence tell us about its outcomes and limitations compared to open techniques? Level III evidence suggests that arthroscopic bone graft yields similar union rates and potentially earlier time to union compared to open bone graft, at an average union rate of 96 % and union time of 13.

Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024).

 Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes.

Imaging of dorsal wrist pain.

Pain on the dorsal side of the wrist is a common clinical presentation, comparable to pain experienced on the ulnar and radial aspects of the wrist. The dorsal wrist region has distinct anatomical features and is associated with a wide spectrum of pathologies, including conditions affecting the bones, cartilage, ligaments, and tendons. Accurate diagnosis often depends on imaging techniques such as radiographs and ultrasound, with a growing trend towards the use of magnetic resonance imaging (MRI) for more detailed assessment of complex cases.

Clinical and Radiological Outcome of Osteoscopic-Assisted Treatment of Enchondroma in Hand with Artificial Bone Substitute or Bone Graft: A 7-Year Case Series and Literature Review.

This study aims to look at the intermediate-term clinical, functional and radiological outcomes of patients with enchondroma in hand treated with osteoscopic-assisted curettage and artificial bone substitute or bone graft. The addition of osteoscopy allows direct visualisation of the bone cavity during and after curettage of tumour tissue without the need of creating a large opening in the bone cortex. This could lead to better clearance of tumour tissue and lower risk of iatrogenic fracture.

Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome.

Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR).

Materials And Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.

Hand Surgery in Hong Kong.

Hand surgery in Hong Kong was borne out of necessity. It has been changing with the social, economic, and political situations. The spectrum of hand surgeries evolves with time, from infection-related hand surgeries to microsurgical or non-microsurgical operations on the huge volume of industrial hand injuries, to a wider variety of reconstructions on rheumatological, congenital upper limbs, traumatic, neurological diseases, etc, to minimally invasive surgeries on hand, wrist, and elbow.

Neurovascular Island Flap for Pulp and Nail Augmentation in Thumb Duplication Reconstruction: A Surgical Method With Long-Term Follow-Up.

Purpose: Pulp and nail atrophy and asymmetry are commonly seen in thumb duplication. In hypoplasia of both digits, conventional reconstruction or Bilhaut-Cloquet procedure and its modifications may not be possible or may lead to a poor cosmetic outcome. The purpose of the study was to review a reconstruction technique with a neurovascular island flap developed to improve the aesthetic and functional results of treatment.

MRI of the Carpal Tunnel 3 and 12 Months After Endoscopic Carpal Tunnel Release.

The purpose of this study was to study changes in the median nerve, retinaculum, and carpal tunnel on MRI after successful endoscopic carpal tunnel release (ECTR). In this prospective study, 35 wrists in 32 patients (five men, 27 women; mean age, 56.7 ± 6.

Necrotizing fasciitis induced by in patients without marine contact in Hong Kong.

Necrotizing fasciitis caused by Vibrio species is a life-threatening soft tissue infection with rapid progression and high mortality. The classic history of Vibrio species-induced necrotizing fasciitis is the infection of wounds by direct invasion or contact with contaminated seawater or raw seafood, especially in immunocompromised patients. We present two cases of necrotizing fasciitis in the upper limb without any wounds or seawater contact and with good past medical history.

MR imaging of the traumatic triangular fibrocartilaginous complex tear.

Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ). However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification.

Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment.

The assessment and management of Kienböck Disease (KD) has always been a conundrum. The Lichtman classification has traditionally been used to guide treatment based on imaging. Arthroscopy provides a direct visualization of the articular surface, allows probing of the surfaces, and enables minimally invasive techniques to be performed.

Arthroscopic-Assisted Combined Dorsal and Volar Scapholunate Ligament Reconstruction with Tendon Graft for Chronic SL Instability.

Background Both the dorsal and the volar portion of the scapholunate interosseous ligament (SLIL) are major stabilizers of the scapholunate (SL) joint. Most reconstruction methods to restore SL stability do not address the volar constraints and frequently fail to reduce the SL gapping. Wrist arthroscopy allows a complete evaluation of the SL interval, accompanying ligament status, and associated SL advanced collapse (SLAC) wrist changes.

Irreducible volar subluxation of the proximal interphalangeal joint due to radial collateral ligament interposition: case report and review of literature.

Irreducible volar subluxation should be considered when assessing a patient with flexion deformity of the proximal interphalangeal finger joint (PIPJ). Primary assessment requires careful examination of the collateral ligaments and extensor tendon. Preoperative imaging such as ultrasound and MRI can help identify the interposed structures and plan the subsequent operation.

Malignant schwannoma of the radial nerve with unusual presentation: a case report.

Malignant schwannoma (MPNST) is a rare tumor. Many of these cases occur in patients with neurofibromatosis type I (NF-1) and they usually present as a mass lesion which rapidly increase in size with or without neurological symptoms. Here we present an unusual case of MPNST along the radial nerve in which the patient has no underlying neurofibromatosis type I.

A baby with symmetrical hand injuries and rhabdomyolysis following nonfatal electrocution by an unusual mechanism.

Childhood electrical injuries are rare in the city of Hong Kong. We report the case of a 21-month boy with severe electrical injuries of both hands and explored underlying mechanism for the incident. Meticulous orthopedic repair and reconstruction ensures satisfactory cosmetic and functional outcomes.

Wrist Arthroscopy under Portal Site Local Anesthesia (PSLA) without Tourniquet.

Unlabelled: Purpose wrist arthroscopy is typically performed under general or regional anesthesia with the aid of a tourniquet to maintain a bloodless field. We have been using portal site local anesthesia (PSLA) for wrist arthroscopy without a tourniquet since 1998. The aim of the study was to assess the efficacy, safety, and complications of PSLA and whether this can be recommended for routine wrist arthroscopy.

Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability.

Purpose: To report the 10-years' experience of a novel arthroscopic assisted anatomical TFCC reconstruction in treatment of chronic DRUJ instability resulting from irreparable TFCC injuries.

Materials And Methods: 15 patients (7 males, 8 females) with mean age of 37 (17-49) suffering from irreparable TFCC injuries received arthroscopic assisted reconstruction using palmaris longus graft. Three skin incisions were made with creation of one radial and one ulna tunnel for passage of graft following the path of dorsal and palmar radio-ulnar ligaments under fluoroscopic and arthroscopic guidance.

Do we need to repair the nerves when replanting distal finger amputations?

Distal replantation is an excellent model to study the results of nerve repair. We aim to demonstrate differences in aesthetic, sensory, and functional outcomes in fingertip replantation, with and without nerve repair. We recruited 28 fingers in 28 patients, who had successful distal replantation in 5 years.