Aims: To study the outcome of patients treated with percutaneous intramedullary screw fixation under WALANT for unstable 5th metacarpal fractures. Methods: We used wide awake anaesthesia with 10-20 ml (1% Xylocaine and 1-2ml of 8.4% sodium bicarbonate as a buffer) infiltrated around the superficial tissues on the dorsal aspect of the 5th metacarpal including the periosteum. The reduction technique used was the Jahss manoeuver to reduce the fracture under  the guidance of a mini c-arm . All patients had a 3 mm medartis CCS (cannulated cancellous self tapping) screws which were inserted in a retrograde manner using a 5mm skin incision. The range of movement of the MCPJ was checked intra-operatively and shown to the patient to optimise their post operative rehabilitation. The patients were called for a 2 week follow up wound check, and to examine for any stiffness that may require hand therapy. Results: We used this technique in 15 patients from 2019 to 2020. All patients had a good ROM at 2 week  follow-up and the average time for them to return to their normal work was 2-4 weeks. Conclusion: This case series shows that this is a quick and reliable alternative to fix unstable metacarpal fractures especially for high demand patients who require a short period of recovery before returning to normal activities.

Introduction: Symptomatic subluxation of the Extensor Carpi Ulnaris (ECU) tendon has become increasingly recognized since its description in 1964. Forceful wrist supination, flexion, and ulnar deviation may result in rupture of the ECU tendon sheath. Case Presentation: We describe a clinical case of a 34-year-old female with chronic pain over the dorsal ulnar aspect of the wrist for two and half years. The wrist pain first started after a cross fit training, but she didn’t remember a traumatic event. The symptoms kept her from doing her job and sports activity.She had a previous MRI that suggested synovitis but didn’t document subluxation or tendon sheath rupture. She was given conservative treatment with NSAIDs, immobilization with wrist orthosis and functional therapy.We request an ultrasound that reported volar subluxation of the ECU.
She was proposed to surgery, throughout was notice rupture of the ECU sheath radial insertion. The ECU tendon osseous groove was deepened, and the sheath reattached with two anchors. Four months after surgery, the patient reported a significantly improvement of the pain and range of motion. Discussion: This case highlights the importance of appropriate imaging. Static MRI may suggest only nonspecific synovitis of the ECU sheath but does not document dynamic instability. On the other hand, dynamic ultrasound is a safe, noninvasive, and effective method to diagnose ECU tendon subluxation out of the ulnar groove during wrist supination and ulnar deviation. Surgery allowed for fast recovery and early return to activity compared to conservative treatment.

Introduction: Intraarticular distal radius fractures usually result from high energy trauma. It is more common in the functionally demanding young adults. Its management is a challenging problem. Restoration of the congruity of the articular surface is the most important prognostic factor to prevent post-traumatic arthritis. The aim of this work was to evaluate the results of using wrist arthroscopy to guide reduction and fixation of intraarticular fractures of the distal radius. Patients and method: This study included 15 patients with intraarticular distal radius fractures and treated by arthroscopic assisted reduction and fixation. Different methods were used for fixation as plates, percutaneous wires and percutaneous screws. At the end of the follow up, the clinical outcome of the patients was measured by the Mayo Wrist Score and Quick DASH score. Results: At 6 months post-operative, the mean Mayo wrist score was 84.67 ± 9.72 (70–100). Five patients (33.3%) had excellent results, six patients (40%) had good results and four patients (26.7%) had fair results. None of our patients had poor results. The mean Quick Dash score at 6 months was 6.21 ± 5.66. Conclusions: Arthroscopic guided treatment of intraarticular distal radius fractures is a valuable method for precise restoration of articular congruity, management of associated soft tissue injuries and reducing postoperative complications which will eventually improve the overall functional outcomes. Type of study: Therapeutic IV. Key-words: Distal radius fractures, intraarticular fractures, wrist arthroscopy.

Scaphoid fractures are relatively frequent, with an incidence of 30/100000persons/year, accounting for 10% of hand and 60-80% of carpal fractures. They are more frequent in males and below 30y.o.. Surgical treatment has been recommended, allowing faster return to professional/sports activity. Methods: We present a retrospective and descriptive study about patients with Scaphoid Fracture undergoing surgical treatment at our hospital from 2010-2019, with the aim of evaluating clinical outcomes. (Variables:time to surgery, VAS, QuickDASH, complications, radiographic consolidation). Statistical analysis was performed using M.Excel, with a literature review. All patients underwent osteosynthesis using a Herbert-type self-compressing cannulated screw, percutaneously. Results: The final sample is a population of 9 patients. 89%(8) were male. Most fractures(78%)occurred on the left side. The average VAS was 1(0-2) and the QuickDASH10(0-36). There were no complications. Consolidation was seen in 89% of patients. When variables were correlated, no statistically significant correlations were found. Discussion: Percutaneous surgery is indicated for aligned scaphoid fractures. When compared with open techniques, it has less surgical morbidity, faster functional recovery and better consolidation rates(90-100%). In our series, consolidation was seen in 89% of patients. Good functional status was achieved(DASH10/VAS1), with only one patient with DASH>20(36). In the remaining series, 3 patients had mild ROM limitation. These results are similar to those described by other authors. Conclusion: This series remarks that the results of percutaneous surgical treatment of scaphoid fractures have shown good results in our hospital. It is a less invasive method, well tolerated and with a low rate of complications.

Background: Scapholunate advanced collapse (SLAC) is a pattern of degenerative wrist arthritis that develops as a result of scapholunate dissociation with progressive instability, deformity and finally arthritis. In stage II SLAC wrists the most established treatments are proximal row carpectomy or four-corner fusion. Motion-sparing techniques allow to obtain good pain relief while preserving some of the wrist range of motion. Case Presentation: We present three clinical cases of SLAC stage II wrist. Patient 1 was a 54 year-old male, patient 2 a 72 year-old-male and patient 3 a 66 year-old female. They were submitted to an arthroscopic scaphoid chondroplasty and interpositional arthroplasty of the radiocarpal joint and percutaneous scapho-capito-triquetral fixation. We did an arthroscopic scaphoid chondroplasty and a mini-open radial styloidectomy. In patient 1 and 2 we harvested the flexor carpi radialis tendon and applied it with an anchor in the scaphoid fossa. In patient 3 we used a tendon allograft and applied it with an anchor in the scaphoid fossa. Afterwards, in all 3 patients, we did an arthroschopic dorsal scapholunate capsulodesis and percutaneously used two Kirschner wires to temporarily fixate the scapho-capito-triquetral joints. Clinical Outcomes: At 5 years follow-up, all patients are extremely satisfied with the results. They all improved their grip strength and pain visual analog scale from 8 to 1. Discussion: Motion-sparing procedures have been designed to relieve pain while maintaining some wrist range of motion and we think they should be the first choice when dealing with SLAC.

Background: The first carpometacarpal (CMC) is a common site of degenerative arthritis. A variety of surgical techniques was described to treat it. There is some evidence in the current literature reporting the high success of arthroscopic hemitrapezectomy without interposition material. Objectives: To determine the outcome of arthroscopic hemitrapeziectomy without interposition in patients with symptomatic basilar thumb arthritis. Methods: Arthroscopic treatments for basilar thumb arthritis performed at our institution between 2017 and 2019 were reviewed. Inclusion criteria included an arthroscopic hemitrapezectomy without interposition and a minimum of 12-month follow-up. Radiographic evaluation was performed according to Eaton-Litller classification. It was evaluated the pain in the pre-operative and pos-operative period (visual analog scale – VAS), the QuickDASH, pinch and grip strength, range of motion and the arthroplasty space (measured radiographically). Results: A total of nine patients were reviewed (3 men and 6 women). Radiographically, 5 patients presented with Eaton stage II and 4 with stage III. At 12 months of follow up, every patient reported significant decrease of pain (7.2 to 2.1 - VAS). Median QuickDASH was 19.3. Total ROM of the thumb axis decreased by 17%, but all patients were capable to oppose to the fifth finger. Pinch and grip strength remained unchanged. A metacarpal subsidence of 1.6 mm was noted. Conclusion: Our analysis demonstrates that arthroscopic hemitrapezectomy without interposition of the first carpometacarpal arthritis is a safe and effective technique for moderate basilar thumb arthritis (Eaton-Littler II a III). The procedure provides a high patient satisfaction and a functional pain-free thumb.

Introduction: Kienbock’s disease (KD) is defined by avascular necrosis of the lunate and it is most common in males between 20-40 years old. Objectives: The aim of this work is to evaluate the treatment options for KD according to Lichtman classification. Methods: We reviewed 17 patients with KD surgically treated between 2000 and 2017. The Lichtman classification was used to characterize the cases reported: 9 type II, 6 type III and 2 type IV cases. 11 patients were treated with radial shortening osteotomy, 3 with proximal carpectomy, 2 with total wrist arthroplasty and radio-carpal arthrodesis. Results: The average follow-up was 78 months. There was an increase of 67% in wrist range of motion, the mean DASH score was 14,94 and the hand grip strength was 74% comparing to the contralateral. At the end of the follow-up, 12 patients had no pain, 3 had mild pain and 2 had moderate pain. As complication there was a septic arthroplasty loosening that we posteriorly have done a radio carpal arthrodesis. Discussion: Radial shortening osteotomy should be done in Lichtamn type II and III cases, with good results on functional outcome. Lichtman type III and IV have the worst prognosis. Conclusions: KD is rare, however we should have a high index of suspicion in order to make a early diagnosis and improve the prognosis. Radial shortening osteotomy is an effective procedure to make on Lichtman II and III cases. Proximal carpectomy, wrist arthroplasty and radio-carpal arthrodesis should be saved to the most serious cases.

Introduction: A mallet finger is the result of a fracture of the dorsal base or from a purely tendinous disruption of the distal interphalangeal joint (DIP). Objectives: The aim of this work is to evaluate the outcomes of using the Ishiguro’s technique in displaced mallet finger fracture. Methods: We reviewed 7 patients with a mallet fracture (involving more than one-third of the articular surface) treated by Ishiguro Technique between May 2019 and August 2020. Patients where fracture reduction was not proper after application of stack finger splint, comminuted or open fractures and fractures older than 6 weeks were excluded from study. Results and Discussion: The mean follow-up was 3 months. After removing the k-wires all patients had distal interphalangeal joint complete extension but only maximum 45º degrees of flexion. All patients had complete ROM at 8 weeks. No complication were registered. Treatment remains somewhat controversial. Some recommend nonoperative treatment for all mallet fingers fractures with full-time extension splinting for 6 to 8 weeks. Others recommend closed reduction with internal fixation for displaced fractures with subluxation. Ishiguro’s technique is easier than open surgery and closed manipulation reduces the possibility of the fragment becoming comminuted. It has a short learning curve. Disadvantages include articular cartilage damage leading to secondary osteoarthritis. Conclusions: In our experience, mallet finger fracture involving more than one- third of the articular surface should be operated and Ishiguro technique seems to be a simple, safe and effective procedure.

Introduction: Degenerate changes in distal interphalangeal joint (DIPJ) can cause deformity, pain, and functional impairment. Arthrodesis of DIPJ is a good operative procedure to address these issues. Compression and rigid fixation are thought to have a positive influence on the bony union. Headless compressive screw (HCS) is gaining popularity as an accepted method for DIPJ fusion. Surgery can be performed via open or percutaneous technique. Method: Patient-reported outcome (PROM) was collected using the DASH score and satisfaction rate was collected using a binary questionnaire. Results: 16 digits of 11(n) patients had undergone DIPJ fusion using percutaneous fixation technique between 1st January 2014 – 31st December 2019. Mean age was 61 years (52 – 76 years). M: F (1:10). Mean follow-up was 51 months (41 – 69 months). Mean pre-op DASH score was 52.87 (18.30 – 80, SD 18.93). Mean post-op DASH score was 36.90 (1.7 – 72.5, SD 23.10) with a p-value of 0.0004 (95% CI 21.31 – 52.35). 81.81 % (n=9) were satisfied with outcome of the surgery. 18.20 % (n=2) reported they would not prefer to undergo surgery again due to associated postoperative pain and not much improvement in appearance. Conclusion: we conclude percutaneous fixation method has an advantage of no dorsal scar or associated numbness and has a considerable shorter operative time however, careful patient selection and detail counselling is necessary so that a patient is fully aware of the postoperative recovery and realistic expectations.

Introduction: Dupuytren’s contracture is a common hand disease among older Europeans. There are few epidemiological studies of Dupuytren’s contracture in Asians. This study investigated the prevalence and quality of life related to Dupuytren’s contracture among the residents in Japan. Methods: This study included 771 individuals (351 males and 420 females aged 40-93 years). Dupuytren’s contracture was diagnosed by qualified hand surgeons based on physical examinations. The severity of the disease was assessed by Meyerding’s classification. In addition, all participants had completed Quick DASH (qDASH). The relationship between the prevalence of disease and qDASH value were examined statistically. Results: Dupuytren’s contracture was found in 52 (6.7%), 43/349 men (12.3%) and 9/418 women (2.2%). The prevalence of disease increased with age. The Meyerding’s classification in the group revealed that 35/52 grade 0 (67.3%), 8/52 grade 1 (15.4%), and 9/52 grade 2 (17.3%). No significant difference was found in Dupuytren’s contracture group between the score of qDASH and the grading of Myeyerding’s classification. Conclusion: This cross-sectional study revealed the prevalence of Dupuytren’s contracture in 6.7% Japanese. Most of them (over 65%) were asymptomatic and the disease did not contribute to upper limb dysfunction.

Predictors, including age, gender, type of surgery, and electrophysiological assessment of the outcome after carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) are controversial. Few studies have referred to postoperative prognostic factors of the outcomes after CTR. The aim of this study was to determine whether numbness and pain after 1 month of CTR were the early postoperative predictors of clinical outcomes at 6 months after surgery. Numbness and pain were evaluated using the visual analog scale (VAS) preoperatively and at 1 month after surgery. PROMs including the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH), Hand20, and Boston carpal tunnel questionnaire (BCTQ), were recorded for each patient at 6 months after surgery. BCTQ consisted of symptom severity scale (SSS) and functional status scale (FSS). Multivariable linear regression analysis was performed to investigate the association between the VAS scores and PROMs. We retrospectively identified 93 patients who underwent open carpal tunnel release (OCTR) or endoscopic carpal tunnel release. The mean age of the patients was 67.5 years and 67 patients (72.0%) were female. 60 patients were treated by OCTR (65.0%). Numbness and pain evaluated by VAS at 1 month after surgery had significant correlations with QDASH, Hand20, SSS, and FSS at 6 months after surgery. Numbness and pain at 1 month after CTR were significant postoperative prognostic factors for the outcome at 6 months after surgery. We found that better clinical outcomes would be achieved in patients having less numbness and pain in the early postoperative period.