Introduction: Avoiding an extensive surgical approach in multiple hand fractures treatment reduces the possibility of major local scarring that would compromise hand function. Case: A 41-years old male patient was treated for comminuted metacarpals (mtc) II-V closed fractures of the right hand, with clinically noticeable shortening of the metacarpus. To mantain normal length of the fractured mtc bones, with as more less surgical incisions, external fixation was performed. Only one mini-external fixator was available at the moment of the surgery at the clinic. The frame of Mitkovic-type external fixator was used for temporary fixation of K-wires during the surgery, first on IV, and after on III mtc bone. During such temporary fixation, followed by X-ray checks, K-wires were connected by the bone cement separately for each mtc bone. After such fixation, mtc II fracture was fixed by the external fixator frame used. Free K-wires were used for mtc V fracture. During the external fixation period, the patient could use the injuried hand for writing or holding even 4 days after surgery. The implants were fully removed at the outpatient clinic 8 weeks after surgery and the patient was successfully performed physical therapy. Conclusion: Multiple mtc fractures can be succesfully treated by closed reduction and external fixation using bone cement to conect pins if an adaptable frame, as that is in Mitkovic-type external fixator, is used to hold the fracture replacement during the cement hardening.

The article is to report flexion deformity of the ulnar digits caused by pseudo-Volkmann contracture and lesion of the forearm flexor muscles, and to discuss the characteristics, differential diagnosis, and treatment of these two symptoms and Volkmann’s contracture. We retrospectively reviewed 17 patients with flexion deformity of the fingers. There were eight males and nine females, with an average age of 18.4 years. The median duration from the onset of symptoms to the operation was 13 years (ranging from 1.5 months to 30 years). The patients were divided into three groups: flexion deformity of the ulnar digits，pseudo-Volkmann contracture, and Volkmann ischemic contracture, according to their medical history, physical examination, radiographs, and intraoperative findings. The operative effects of the three groups were evaluated. The mean follow-up period was 1.5 years (ranging from 1 year to 10 years). Eight patients with flexion deformity of the ulnar digits and three with pseudo-Volkmann contracture achieved excellent hand function. The functional outcomes of 4 patients with Volkmann contracture were excellent/good, and one with moderate Volkmann contracture and severe neuropathy and one with severe Volkmann contracture were poor. The flexion deformity of fingers caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, most patients have a good outcome and high satisfaction.

Introduction: Trigger finger is one of most frequently encountered problem in the general population which affects the daily activities. However, with effective treatment like Ultrasound guided percutaneous trigger release a precise and possible improvement in the lifestyle can be achieved and assessed. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome. Aim: To investigate the effectiveness and functional outcome of ultrasound-guided release of the first annular pulley using our novel technique and compare results with the conventional open operative technique. Material & Methods: A prospective conventional study of 50 Adult Trigger finger with QUINNELL’S Grade 2 and 3 who have not responded to conservative treatment of age from 30 to 70 years using our novel technique in our Institute from 2021-2023. The follow-up included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance using QUINNELL’S & Q-DASH scores. The data was analysed to determine the functional outcome at three months. Results: There was complete release of A1 in all of our 50 patients undergoing ultrasound guided percutaneous release using our novel technique and significant patient satisfaction. No recurrence
was observed in those patients during follow up.
Conclusions: Ultrasound guided percutaneous release of trigger finger using our novel technique with a 18 gauge a spinal needle was not only associated with excellent functional outcome and recovery but in terms of patient satisfaction and range of finger motion post-procedure also and cost effective.

Introduction: Important barriers against infection in any operation are the sterile protective drape and gowns. These can either be single-use or reusable. Recent reports have shown that disposable items are responsible for over 60% of carbon footprint in total knee replacements. Another review demonstrated a 60% reduction in carbon footprint on switching from disposable to reusable protective equipment. Furthermore, Overcash reported that reusable surgical textiles offer significant environmental benefits compared to the same disposable products. Our hand service has been utilising reusable gowns since January 2023 which is subject to rigorous quality assurance and frequent sterility checks.

Methods: Between April and May 2023, we retrospectively identified and collected demographic and follow up data (secondary care and community data) on n=210 consecutive patients operated on in our hand service, 38% of which were trauma patients. The average age was 58 years and the average follow up was 4 weeks. Our data reported an incidence rate of 5%(n=11) of infections, 1 of which was deep and required reoperations.

Results: The incidence of post operative infections was comparable to the data found in Wormald et al’s review. Our data captured both secondary care and community follow up data and reflect the actual SSI incident as compared to other studies who investigated only secondary care follow up.

Conclusion: Reusable gowns and drapes in hand surgery does not increase the risk of postoperative wound or metalwork related infections. We feel confident our data would encourage the use of textiles among other orthopaedic services.

Abstract: Objective: To explore the experience and curative effect of treating severe limb injury with multiple injuries; Methods: Retrospective analysis the experience of treating severe limb injury with multiple injuries in zhengzhou renji hospital. Results: Through the application of 8 techniques and the concept of Damage Control Surgery (DCS), adhering to scientific injury assessment, thorough debridement, vascular reconstruction and fracture stability, limb survival was ensured in the first stage, and functional reconstruction in the second stage, so as to achieve limb preservation and reduction of disability. Conclusion: By establishing a large limb amputation treatment center, optimizing the treatment process of multiple injuries, adopting dynamic assessment of limb saving mode, active limb saving (decisive amputation), and combining multi-discipline and multi-technology to optimize the treatment strategy, the replanting rate and treatment success rate of severe limb trauma with multiple injuries can be improved, which is worthy of promotion and application.

Introduction: This study was designed to compare the one-year outcome among the groups with different low-dosage triamcinolone acetonide injections for trigger finger. Methods: In the study period, trigger digits were initially injected with 2, 4, 8 mg triamcinolone acetonide. We checked whether they had a second injection or surgery during the following year by either patients’ revisit or telephone interview. The groups with different injections were compared according to recurrency and symptom relief period. We also assessed the six-week outcome to confirm the short-term improvement. Results: One-hundred ninety-eight digits were finally enrolled. About 60% of the injected fingers required additional treatment in each group without significant difference. The interval between the initial injection and additional treatment in the recurrent cases averaged 5 months in the 2 and 4 mg triamcinolone acetonide group, being significantly extended for short term of 1.5 months in the 8 mg group. All the groups showed a significant improvement of the patients’ clinical severity at six weeks after injection without any difference among the groups. There was no adverse event. Conclusions: Low dosage triamcinolone acetonide injection for trigger finger within 8mg yielded satisfactory results, not being inferior to those with higher dosage up to 40 mg in the comparison with previous reports. Our findings implied that increasing triamcinolone acetonide dosage might bring short-extended symptom relief, however, not reduce the recurrency. While not offering great benefit, lower dosage triamcinolone acetonide injection for trigger finger can be chosen aiming for cost-effectiveness, safety, and small injection site pain.

Flexor tendons of the hand play a key role in the already complex function of the hand. There are two flexor tendons, the deep (FDP) and superficial (FDS), for each finger from the second to the V finger and the flexor pollicis longus and brevis for the thumb (FPL and FPB). General causes of injuries are open cuts, crush injuries or avulsions. They are relatively common accounting for 33 injuries in 100.000 persons per year mainly in males between 20 to 29 years of age in zone II and the V finger being the most affected. They are generally treated surgically by primary repair mostly or by secondary repair in given cases when the primary diagnosis was missed in the first place or when dealing with injury or conditions that don’t allow to repair the tendon primarily. Most of the complications that are met after surgery are the stiffness of the joints due to adhesions formation, and rupture of the repaired tendon. In this study, we will be presenting some of the complications that we do meet in our daily practice, prevention of such complications and when and how we deal with them.

Introduction: Fractures of the metacarpal neck are treated depending upon the angulation and displacement; which is in the sagittal plane, usually palmar wards with apex dorsal. The fixation is done by various methods, but implants are oriented in the coronal plane. Mechanically, this seems paradoxical and inefficient. I have been using a different method to overcome this deficiency. Method: 15 patients of angulated or displaced fractures of necks of metacarpal were treated by closed reduction and internal fixation with k wires. After manual reduction, a stabilizing wire was passed para-axially from the head into the shaft in an oblique direction. A second k wire was manually introduced from the palmar aspect into the fracture site. The angulation was levered dorsally back into position, and the wire was drilled into the shaft proximally. This is similar to the intrafocal method of Kapandji, but oriented in the sagittal plane, matching the plane of displacement. After confirming reduction, the hand was protected with a splint and cast. After union, the cast, splint and wires were removed; and movements begun. Results: There were no complications relating to the wires and immobilization when assessed after 4 months. Patients had a good grip, with restoration of the arch of metacarpal heads and good cosmesis. Conclusion: An intrafocal wire introduced from the palmar side helps reduce and maintain a palmar angulated fracture of the metacarpal neck, as both the displacement and correction device are in the same sagittal plane.

Objective: Skin flap repair, a frequently utilized microsurgical intervention for wound coverage and functional reconstruction in clinical settings, encounters a prevalent and inadequately understood complication—distal necrosis of skin flaps. Comprising traditional Chinese medicinal leech and Dilong, Hirudo-Dilong Extract (HDE) exhibits hemostatic properties, fostering meridian circulation. This investigation seeks to elucidate the precise molecular mechanisms and pivotal targets governing pyroptosis via the TLR4/NF-kB/NLRP3 signaling pathway.

Methods: An adapted McFarlane rat model in skin flaps was instituted. Seventy-two male Sprague-Dawley rats were randomly assigned to a control group (receiving equivalent saline) or experimental groups with low-dose (0.5 ml/kg/d), medium-dose (1.5 ml/kg/d) and high-dose (3ml/kg/d) Hirudo-Dilong Extract through continuous intraperitoneal administration for seven days. On the seventh postoperative day, skin flap survival area was gauged. Lead oxide/gelatin angiography appraised neovascularization. Furthermore, a HUVEC line established an ischemia-reperfusion model, with control, low, medium and high-dose groups (1 ul/kg/d, 5 ul/kg/d, 10 ul/kg/d). Immunofluorescence and western blotting ascertained TLR4, NF-κB, NLRP3, VEGF, IL-1β, L-6 and TNF-α expression in tissues and cells.

Results: Compared to the control group, the experimental group exhibited a significantly expanded skin flap survival area and neovascularization, with inter-group disparities among three groups (p < 0.05). In both animal and cell experiments, VEGF expression upregulated in the experimental group, while the expression of TNF-α, IL-6, IL-1β, TLR4, NF-κB and NLRP3 were downregulated (p < 0.05).

Conclusion: Hirudo-Dilong Extract enhances the survival of ischemic skin flaps by suppressing cell pyroptosis mediated through the TLR4-NF-κB-NLRP3 pathway.

Wrist arthrodesis is operative procedure of fusion between radial end carpal bones. Thanks to that we make a strong construction which give a satisfactory range of motion of hand and fingers, preserve grip strength of them and achieve a pain relief.
Our target is research of functional results after wrist arthrodesis which was used in different groups of patients and with different types of devices.
We analyzed patients, operatively treated, in last four years in our department. We performed 20 total wrist fusion with deferent preoperative conditions
Functional results were evaluated with MAYO wrist and DASH score.
All patients had achieved pain relief, with great improved of grip strength of that on the contralateral side. They also improved overall quality of life and work capacity.
Key words: total wrist fusion, arthrodesis, arthrosis, spasticity

Not many studies have investigated which wrist joints most frequently have osteoarthritis. Scapholunate advanced collapse is considered the most frequent pattern. The aim of the study was to describe the patterns and prevalence of advanced osteoarthritis of the wrist. Bilateral wrist radiographs of 1,327 patients over 40 years old were screened. In 368 wrists of 228 patients end-stage osteoarthritis was present. Twenty-seven different patterns were found. The most common pattern was isolated osteoarthritis of the scaphotrapeziotrapezoidal joint (217 wrists)(59%), followed by isolated osteoarthritis of the radioscaphoid joint (45 wrists)(12%). In 251 (68%) wrists advanced osteoarthritis was only present in the midcarpal joint and in 115 (31%) wrists in the radiocarpal joint or combined in the mid- and radiocarpal joints. It can be concluded that advanced osteoarthritis may be more frequently present in the midcarpal joint than previously assumed.