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Replanted pollicization
SELECTED PAPERS
Transulnar percutaneous pinning for unstable fractures of the distal radius M. Altissimi, R P i e r d o m i n i c i
Perugia, Italy Transulnar percutaneous pinning was used in 20 unstable fractures of the distal radius. Only extra-articular fractures and intra-articular undisplaced fractures were selected for this treatment. The surgical technique included: fingertrap traction, reduction under fluoroscopic control and fracture fixation by two to four K-wires introduced through the ulna in an oblique direction into the distal radius. This technique proved very effective in mantaining reduction since the postoperative values of radial inclination in the frontal plane (22°), volar tilt in the sagittal plane (5.5°), radioulnar index (0.3 mm) and lateral translation (9 mm) were found to be almost unchanged at follow-up. According to the Gartland and Werley demerit point system, an excellent clinical result was achieved in seven patients (35%), a good result in twelve (60%) and a fair result in one patient (5'/0). There were no bad results. At follow-up, we measured 6°,/0reduction of pronation and supination, 8% reduction of extension and 10% of flexion compound to the unaffected wrist. Transulnar percutaneous pinning is a reliable technique for unstable fractures of the distal radius. It is very effective in maintaining reduction without compromising pronation and supination of the wrist.
The volar lunate dislocation M. D ' A r i e n z o , G. Falcone, A. A c a n f o r a , C. Falcone, S. P l a n n e r
Firenze, Italy The acute volar lunate dislocation is very uncommon. Although it is part of the considerable chapter of the perilunate dislocations, it should not be mistaken with them, as often appears in the literature. The correct significance of "Perilunate Dislocation" is that the lunate always stays in its anatomical site while the other carpal bones dislocate around it. When the energy of the trauma is directed through the waist of the scaphoid instead of its ligamentous attachments to the lunate, the proximal part of the scaphoid remains "in ~itu" with the lunate; in this case we use the term Trans-Scaphoid Perilunate fracture dislocation. In other cases the entire scaphoid remains in its anatomical site (ScaphoPerilunate dislocation) or even the Triquetrum with the Pisiform, the so-called Peritriquetro-Lunate dislocation. We divide the acute V.L.D. into 4 different types depending if the lunate rotates from its normal position of 90 ° (Type 1), 180° (Type 2), or 270 ° (Type 3) with respect to the transverse axis, and a Type 4 dislocation in which there is a complete rotation combined with one in the sagittal plane; this occurs when the dorsal convexity of the lunate faces the cortical volar area of the radius. After a review of the literature the aim of the present study was to define this classification method so that it could be useful in choosing the correct method of treatment. In fact in the first two types it is almost always possible to perform a closed
61 reduction in acute injuries, while in the other two types (3, 4) a surgical reduction and stabilization will be necessary. The authors report seven cases of acute V.L.D. treated from 1987 to t994. 5 were men and 2 women. The ages ranged from 29 to 53 (avg 40) and the results were reviewed at an average follow-up of 4.5 years. They were classified as excellent or good in two cases, fair in 4 cases and poor in 1. This unsatisfactory result was due to lunate necrosis. In all our cases, standard X-rays were done pre- op and postoperatively. MRI or Axial Tomography, were done at follow-up to evaluate lunate necrosis or ligament lesions with subsequent instability.
Replanted poHicization M. L a n z e t t a
Milano, Italy Objectives As the thumb is the most important digit of the hand, every attempt has to be made to replant it in case of traumatic amputation. Sometime the extent of the injury is such that replantation becomes impossible. Second stage thumb reconstruction options include potlicization, toe-to-hand transfer, lengthening procedures, on-top plasty and osteoplastic reconstruction. Whenever other digits are involved in the amputation, then one might consider a heterotopic replantation of one finger onto the non-replantable thumb stump, thus creating a one stage "replanted pollicization".
Methods Four cases of heterotopic replantation of the index finger to reconstruct a simultaneously amputated thumb are presented. The patients were all male, with an age ranging from 24 to 58 years. One patient was insulin-dependent for long standing diabetes. The thumbs were not suitable for replantation due to the type and extent of the injury. The index finger was then replanted as a free primary pollicization in emergency.
Results All cases had an uneventful postoperative period and the operations were highly successful in terms of functional recovery and outcome. In particular, all patients were able to use theheterotopicalty replanted index for both firm hand grip and fine bidigital tip pinch. All patients returned to their previous occupation. The surgical technique is outlined.
Ultrasound diagnosis of soft tissue tumours of the hand and forearm M. H 6 g l u n d , R T o r d a i
Stockholm, Sweden Objectives Evaluation of the possibility to differentiate five common groups of benign soft tissue tumours of the hand and forearm with diagnostic ultrasound.
Methods Soft tissue tumours of the hand were preoperatively evaluated with ultrasound. Five groups of benign soft tissue tumours were included, namely: localized villonodular synovitis, haem-
Transulnar percutaneous pinning for unstable fractures of the distal radius M. Altissimi, R P i e r d o m i n i c i
Perugia, Italy Transulnar percutaneous pinning was used in 20 unstable fractures of the distal radius. Only extra-articular fractures and intra-articular undisplaced fractures were selected for this treatment. The surgical technique included: fingertrap traction, reduction under fluoroscopic control and fracture fixation by two to four K-wires introduced through the ulna in an oblique direction into the distal radius. This technique proved very effective in mantaining reduction since the postoperative values of radial inclination in the frontal plane (22°), volar tilt in the sagittal plane (5.5°), radioulnar index (0.3 mm) and lateral translation (9 mm) were found to be almost unchanged at follow-up. According to the Gartland and Werley demerit point system, an excellent clinical result was achieved in seven patients (35%), a good result in twelve (60%) and a fair result in one patient (5'/0). There were no bad results. At follow-up, we measured 6°,/0reduction of pronation and supination, 8% reduction of extension and 10% of flexion compound to the unaffected wrist. Transulnar percutaneous pinning is a reliable technique for unstable fractures of the distal radius. It is very effective in maintaining reduction without compromising pronation and supination of the wrist.
The volar lunate dislocation M. D ' A r i e n z o , G. Falcone, A. A c a n f o r a , C. Falcone, S. P l a n n e r
Firenze, Italy The acute volar lunate dislocation is very uncommon. Although it is part of the considerable chapter of the perilunate dislocations, it should not be mistaken with them, as often appears in the literature. The correct significance of "Perilunate Dislocation" is that the lunate always stays in its anatomical site while the other carpal bones dislocate around it. When the energy of the trauma is directed through the waist of the scaphoid instead of its ligamentous attachments to the lunate, the proximal part of the scaphoid remains "in ~itu" with the lunate; in this case we use the term Trans-Scaphoid Perilunate fracture dislocation. In other cases the entire scaphoid remains in its anatomical site (ScaphoPerilunate dislocation) or even the Triquetrum with the Pisiform, the so-called Peritriquetro-Lunate dislocation. We divide the acute V.L.D. into 4 different types depending if the lunate rotates from its normal position of 90 ° (Type 1), 180° (Type 2), or 270 ° (Type 3) with respect to the transverse axis, and a Type 4 dislocation in which there is a complete rotation combined with one in the sagittal plane; this occurs when the dorsal convexity of the lunate faces the cortical volar area of the radius. After a review of the literature the aim of the present study was to define this classification method so that it could be useful in choosing the correct method of treatment. In fact in the first two types it is almost always possible to perform a closed
61 reduction in acute injuries, while in the other two types (3, 4) a surgical reduction and stabilization will be necessary. The authors report seven cases of acute V.L.D. treated from 1987 to t994. 5 were men and 2 women. The ages ranged from 29 to 53 (avg 40) and the results were reviewed at an average follow-up of 4.5 years. They were classified as excellent or good in two cases, fair in 4 cases and poor in 1. This unsatisfactory result was due to lunate necrosis. In all our cases, standard X-rays were done pre- op and postoperatively. MRI or Axial Tomography, were done at follow-up to evaluate lunate necrosis or ligament lesions with subsequent instability.
Replanted poHicization M. L a n z e t t a
Milano, Italy Objectives As the thumb is the most important digit of the hand, every attempt has to be made to replant it in case of traumatic amputation. Sometime the extent of the injury is such that replantation becomes impossible. Second stage thumb reconstruction options include potlicization, toe-to-hand transfer, lengthening procedures, on-top plasty and osteoplastic reconstruction. Whenever other digits are involved in the amputation, then one might consider a heterotopic replantation of one finger onto the non-replantable thumb stump, thus creating a one stage "replanted pollicization".
Methods Four cases of heterotopic replantation of the index finger to reconstruct a simultaneously amputated thumb are presented. The patients were all male, with an age ranging from 24 to 58 years. One patient was insulin-dependent for long standing diabetes. The thumbs were not suitable for replantation due to the type and extent of the injury. The index finger was then replanted as a free primary pollicization in emergency.
Results All cases had an uneventful postoperative period and the operations were highly successful in terms of functional recovery and outcome. In particular, all patients were able to use theheterotopicalty replanted index for both firm hand grip and fine bidigital tip pinch. All patients returned to their previous occupation. The surgical technique is outlined.
Ultrasound diagnosis of soft tissue tumours of the hand and forearm M. H 6 g l u n d , R T o r d a i
Stockholm, Sweden Objectives Evaluation of the possibility to differentiate five common groups of benign soft tissue tumours of the hand and forearm with diagnostic ultrasound.
Methods Soft tissue tumours of the hand were preoperatively evaluated with ultrasound. Five groups of benign soft tissue tumours were included, namely: localized villonodular synovitis, haem-