Download Congenital Flexion Deformity of the Long, Ring, and Little Fingers

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Congenital
Kirschner wire. Collateral ligaments were also reconstructed.
Results: Age at operation was 1.5 years on average. The proximal phalanx of the fourth toe was used in 51 and that of the
third toe in 3. Seven toes were trimmed because the skin pocket
was tight. Silastic expander was used for tissue expansion
before toe phalanx transfer in 4 cases. Five cases required revision surgery for partial necrosis of the skin pocket. Five children (7 toes) were lost before 5-year follow-up, and hence
excluded for evaluation. Six children underwent bone lengthening procedure between 5- and 10-year follow-up period, and
10 children did not reach 10 years after surgery. They, too,
were excluded for the evaluation at 10-year follow-up. At
5-year follow-up, the physis was closed in 30%, growth rate
was 0.8 mm/year, and %length was 87%. At 10-year followup, closure rate increased to 85%, growth rate decreased to 0.5
mm/year, and %length was 69%. Conclusion: Free nonvascularized toe phalanx transfer is a versatile procedure for reconstruction of the congenital finger deficit. Growth ability
remains at least 5 years in most of the cases but it decreases
when they reached 10-year follow-up period.
Evaluation of Postoperative
Radiocapitellar Joint Alignment in
Congenital Radioulnar Synostosis Patients
Kazuki Kuniyoshil, Tomoyo Akasakal,
Takane Suzuki2, Yusuke Matsuural,
Rei Abel, Keisuke Uenol, Hitoshi Kiuchil,
Aya Kanadukal, Naoya Hirosawal,
Maki Iwasel, and Atsuro Yamazakil
1
Department of Orthopedic Surgery, Graduate school of Medicine,
Chiba University, Japan
2
Department of Environmental Medicine, Graduate school of Medicine,
Chiba University, Japan
Hypothesis: No study has evaluated radiocapitellar joint
alignment or proximal radioulnar joint alignment postoperatively in congenital radioulnar synostosis patients. The aim of
this study was to clarify the postoperative clinical results and
radiocapitellar joint alignment. Methods: Eight forearms in
7 patients (6 males and 1 female with a mean age of 8.8
years) with congenital radioulnar synostosis, who underwent
surgery with a minimum of a year and a mean of 2.1 years of
follow-up, were evaluated. The surgery consisted of division
of the synostosis and interposition with a pedicled vascularized adipofascial flap between the radius and the ulna. A corrective radial osteotomy was performed in 3 patients at the
radial neck, which had a great angular deformity, and in 1
patient at the mid-diaphysis, which had a great bowing deformity. Radiocapitellar joint alignment was evaluated in a lateral view radiograph and classified into 3 types as anterior,
intermediate, or posterior, defined by whether the radial neck
and head axis were above, within, or below the capitellum.
This alignment was evaluated preoperatively and at final
follow-up. The active range of prono-supination was also
evaluated as a clinical outcome. There was no patient who
had recurrence of bony union at the divided synostosis.
Results: Preoperatively, there were 5 forearms of the anterior
type, 1 intermediate type, and 2 of the posterior type. At final
follow-up, there were 2 forearms of the anterior type and 6 of
the posterior type. Four forearms were changed into a posterior type. At the final follow-up, the active range was 37.5 ±
8° in pronation and 20 ± 10° in supination in the anterior
type, and was 41 ± 23° in pronation and 26 ± l8° in supination
in the posterior type. There was no significant difference in
pronation or supination between types. It was more difficult
to improve supination than pronation in each type. Summary
points: In this case series, it was difficult to reconstruct the
proper radiocapitellar alignment. To better improve the range,
especially of supination, reconstruction of the radiocapitellar
joint or the proximal radioulnar joint with a more accurate
corrective radial osteotomy or sigmoid notch plasty should
be considered.
Congenital Flexion Deformity of the
Long, Ring, and Little Fingers With an
Aberrant Origin of the Flexor Digitorum
Profundus: Differential Diagnosis With
the Volkmann’s Contracture
Ge Xiong1
1
Beijing Jishuitan Hospital, China
Objective: To report a series of cases of congenital flexion
deformity of the long, ring, and little fingers with an aberrant
origin of the flexor digitorum profundus and to compare this
disease with the Volkmann’s contracture. Materials and
Methods: Five cases of congenital flexion deformity of the
long, ring, and little fingers with an aberrant origin of the
flexor digitorum profundus were reported. Two of them were
children. All the patients were misdiagnosed as the
Volkmann’s contracture in the local clinics. Radiographs and
3-D computed tomography (3-D CT) of the involved forearm
were performed. There were no neural disorders in any case.
Results: The 3-D CT showed there was a bone prominence
on the proximal part of the ulna. During the operation, we
could find an aberrant origin of the flexor digitorum profundus of 3 to 5 fingers was attached to the bone prominence.
Resection of the aberrant origin could achieve a thorough
release in children cases but further muscle sliding procedure
was needed in adult cases. Conclusion: Congenital flexion
deformity of the long, ring, and little fingers with an aberrant
origin of the flexor digitorum profundus is a potentially
ignored disease. Finding the bone prominence on the proximal part of the ulna is helpful for the early diagnosis.
Resection of the aberrant origin with muscle sliding procedure can get good result.