The objective of this retrospective study is to compare the clinical and radiological results of the MIS technique and the conventional open technique for distal radius fractures.
The study includes 81 patients operated on for distal radius fractures during the year 2021. 21 patients, 8 men and 13 women, with a mean age of 57.3 years, underwent surgery using the MIS technique; 60 patients, 11 men and 49 women, with a mean age of 60.8 years, underwent conventional surgery with the Henry volar approach.
Regarding radiological parameters, the Castaing Radiological Scale showed a result of 6.7 for the MIS technique, being higher than the conventional technique, whose result was 5.85. Regarding clinical parameters, the VAS Scale offered results 1.5 for the MIS technique and 2.9 for the conventional technique. The QuickDASH Score was slightly higher for the MIS group compared to the conventional group, 13.5/100 and 19.63/100, respectively. ROM and grip strength reported similar results. Complications related to the surgical wound, nerve injury or symptoms, chronic pain or CRPS, and tendon injury were higher with the conventional technique. There was one case of non-binding in the MIS group, compared to none in the conventional group. The percentage of ablation of osteosynthesis material was similar for both groups.
The MIS technique can achieve functional results as good as the conventional technique for the treatment of the distal radius fractures, with a smaller incision, shorter surgical time, time, a higher satisfaction rating and a lower rate of complications.

Background: Persistent muscle imbalance can lead to progressive glenohumeral (GH) dysplasia in patient with Erb’s Palsy. Tendon transfers to rotator cuff improve shoulder function and lead to (GH) joint remodeling in mild and moderate (GH) dysplasia secondary to Erb’s Palsy.
Objective: in the current study we are comparing one muscle transfer, Latissimus Dorsi vs Teres Major Transfer for treatment of external rotation and abduction deficiency of the shoulder.
Patients and methods: Prospective randomized trial study from February 2014 to January 2020 on 30 patients with external rotation and abduction deficiency of the shoulder as sequelae of Erb’s palsy who underwent surgery of latissimus dorsi or teres major tendon transfer to rotator cuff at our institute. There were 15 patients in group 1 (4 boys and 11 girls), with a mean age of 2 years 8 months (range, 1.5–5 years). The mean follow-up period was 62 months (range, 38–68 months). 15 patients in group 2 (6 boys and 9 girls), with a mean age of 2 years 6 months (range, 1.5–4.8 years), The mean follow-up period was 58 months (range, 38–68 months)
Results: The results in this study show no significant difference between latissimus dorsi and Tere major tendon transfer, although there is higher incidence of development of external rotation contracture after teres major transfer.
Conclusion: Secondary shoulder reconstruction operation lattismus dorsi or teres major tendon transfer, show great improvement in shoulder abduction and external rotation.
Keywords: Teres Major, Latissimus Dorsi Transfer, Erb’s Palsy

Introduction: Reports on type V FDP tendon avulsions and their treatment are rare. Furthermore, they are not always classified in a consistent manner in literature. The purpose of our retrospective data analysis was to evaluate and present jersey finger type V injury characteristics, primary radiological findings, treatment options und subsequent patient outcomes as well as occurring complications.
Methods: We reviewed all patients treated for a fracture of the distal phalanx at an academic Level 1 trauma center over a period of 19 years. By reviewing the patients’ charts and their initial x-rays, we detected 44 patients with injuries matching the criteria for classification as jersey finger type Va and type Vb defined by Al-Quattan. All clinical records and medical images were included in the evaluation of the patients to gather data on mechanism of trauma, severity of displacement, type of treatment and subsequent outcomes in both subtypes.
Results: Accounting for 52%, falls represented the most common mechanism of trauma. Amongst 44 jersey finger type V injuries, 31 showed minor displacement and were treated conservatively with good outcome. In 13 patients, major displacement was observed. Five patients undergoing surgery showed poor outcome, except for one.
Conclusion: Jersey finger type V differs markedly from the remaining types of jersey finger injuries regarding predominant trauma mechanism. Therefore, its inclusion in this classification should be reevaluated. Established surgical methods for refixation did not show sufficient outcomes, innovative techniques may be necessary for a sufficient treatment of such injuries.

Stab incision and blunt dissection before wire placement is believed to decrease the risk of injury during percutaneous pinning of distal radius fractures. However, only a few studies have compared stab incision and dissection to direct wire placement. 10 cadavers (20 upper limbs) were divided into two groups of five each. Five 2.0mm Kirschner (K)-wires were inserted into the distal radius under fluoroscopic control in a standard fashion to simulate percutaneous pinning of distal radius fractures. In group 1, the K-wires were inserted directly, whereas, in group 2, the wires were inserted after making a stab incision and blunt dissection. Each limb was then dissected to measure the distance of the K-wires from the branches of the superficial radial nerve (SRN), the cephalic vein, and the first dorsal compartment and to determine the structures injured by the K-wires. Out of the 100 K-wires placed, 18 wires were in close contact with or pierced an underlying structure. These included 11 wires injuring tendons, 6 wires injuring branches of the SRN, and one wire injuring the cephalic vein. Direct wire placement (group 1) resulted in injury to 8 structures (44.4%) while stab incision and blunt dissection prior to wire placement (group 2) resulted in injury to 10 structures (55.5%). This difference was not statistically significant. Percutaneous pinning of distal radius fractures has a high risk of injury to the extensor tendons and branches of the SRN. This risk is not reduced by making a stab incision and blunt dissection before K-wire placement.

Objective:To explore the feasibility and clinical effect of anterolateral chimeric perforating flap in the first phase of emergency repair of complex tissue defects of upper limbs.Methods: From January 2010 to March 2022, Twenty-two patients underwent upper extremity Emergency repair of using chimeric ALT perforator flaps, which consists of a skin component on its isolated perforator and a portion of the fascia and muscle flaps on the same pedicle from the descending branch of the lateral circumflex femoral artery (LCFA). The area of the soft tissue defects ranged from 43×35 cm to 19×9 cm, containing extensive, irregular, ring-like soft tissue defects or degloving injuries. Results: The mean dimension of skin flap was 19×8 cm to 11×2 cm. The mean dimension of fascia flap was 9×8cm to ×7×2 cm. The mean dimension of muscle flap was 11×6×1.5 cm to 7×5×1 cm. No total flap loss occurred. One patient presented with venous thrombosis, and re-anastomosis and vein grafting were performed. Two cases exhibiting partial skin graft loss at the site at which the fascia flap was inset were treated via secondary skin grafts. During a follow-up period of 18 monthse-30 months, patients were satisfied with the functional and aesthetic outcome. No serious donor-site complications occurred. Conclusions: Chimeric anterolateral thigh perforator flap can be one of the best choice for reconstruction of complex soft-tissue defects in the upper extremities.

Introduction: Central sensitization (CS) is nervous system condition associated with onset and maintenance of chronic pain. This study reports the association between hand osteoarthritis (HOA) and CS in the general population. [Subjects and Methods] Total of 771 general population (351 men and 420 women, age 65.9 ± 11.3 years) were included. Three hand surgeons diagnosed the presence of HOA. The Quick DASH (qDASH) for upper extremity dysfunction and the Central Sensitization Inventory (CSI) for CS were used as self-administered questionnaires. Prevalence rates by gender and age group for HOA, and prevalence rates or statistical indices by gender and age for hand pain and qDASH were calculated. Multiple logistic regression models were used to examine the association between hand pain and the total number of HOA joints and CSI scores. Results: HOA was present in 64.2% of men and 67.9% of women. 6.3% of men and 8.3% of women had hand pain, which was discrepant from the prevalence of HOA. The mean qDASH was 5.4±9.7 for men and 7.0±9.9 for women, with significantly higher disability scores in women. Multivariate analysis revealed that factors significantly associated with qDASH were shoulder joint pain, arm pain, hand pain, and CSI scores. On the other hand, factors associated with hand pain were found to be the total number of HOA joints and CSI scores. Discussion: The association with CS has been identified for HOA. This finding is important from clinical and preventive medicine perspectives.

Purpose: To evaluate the results of arthroscopic bone grafting and fixation scaphoid fracture non-union with humpback deformity. Methods: This was a prospective single-center study of twenty patients (20 men) presented with non-united fracture scaphoid with humpback deformity in a period from January 2020 to January 2022. Subjective and objective outcome measures were evaluated pre-operatively and at final follow-up using modified Mayo wrist score with visual analog scale (VAS) for pain. Results: The average follow-up period was 18.75 months. The surgery was performed between 9 to 26 months from injury. Fixation was performed using Kirchner wires in all cases. The mean range of flexion-extension arc increased from 122.1º (± 3.86º) pre-operatively to 128.35º (± 9.39º) (P= 0.0145). The peak grip strength increased from 77.82% (± 3.35%) from the normal side pre-operatively to 90.63% (± 6.77%) (P= 0.004). The modified Mayo score at final follow up improved from 56.25 (± 7.41) to 76.75 (± 9.9) (P=0.002) and VAS score decreased from 8.3 (± 0.97) to 2.15 (± 2.27) (P=0017). Seventeen of the twenty non-unions (85%) achieved radiographic union at a mean of 8.7 weeks. Conclusions: Results of arthroscopic bone grafting and fixation of scaphoid non-union with humpback deformity are promising. The use of Kirshner wires is sufficient and effective method of fixation that keeps the graft in position and maintain the corrected scaphoid length till achieving union. Type of study/level of evidence: Therapeutic IV. Keywords: Arthroscopy, scaphoid, non-union, bone graft

Background: Flap necrosis is a common issue encountered in clinical flap transplantation surgery. Here, we assessed the effects of saxagliptin, a dipeptidyl peptidase-4 inhibitor, on flap survival and explored the underlying mechanisms. Methods: 36 rats were established dorsal McFarlane flap model and randomly divided into a high-dose saxagliptin (HS) group (saxagliptin, 30 mg/kg/day, n = 12), low-dose saxagliptin (LS) group (saxagliptin, 10 mg/kg/day, n = 12), and control group (n = 12). On day 7, flap survival was examined by eye in six rats from each group, along with determination of blood perfusion by laser Doppler flowmetry and angiogenesis by angiography. The remaining rats were sacrificed for flap tissue harvesting. The status of the flap tissue was examined histopathologically by staining with hematoxylin and eosin (H&E). Oxidative stress was evaluated by determination of superoxide dismutase (SOD) activity and malonaldehyde (MDA) content. The expression of gasdermin D (GSDMD), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), NOD-like receptor pyrin domain containing 3 (NLRP3), interleukin (IL)-6, IL-18, Toll-like receptor 4 (TLR4), IL-1β, caspase-1 and nuclear factor-κB (NF-κB) were detected by Immunohistochemical analysis. Results: The experimental group exhibited a larger area of flap survival, with more blood perfusion and neovascularization and better histopathological status, than the control group. The degree of oxidative stress and the levels of NF-κB, TLR4, proinflammatory cytokines, and pyroptosis-associated protein were decreased in the experimental group, while the VEGF level was augmented in a saxagliptin dose-dependent manner. Conclusion: Saxagliptin promotes random skin flap survival.

Objective: To investigate the feasibility and clinical effect of lateral femoral circumflex artery chimeric transplant combined with in-situ prefabricated avulsed palm skin in the treatment of severe palm injury.Methods: 12 patients with severe palm injury caused by various reasons were repaired primarily in the emergency department. For the avulsed palm skin prefabricated with muscle flap, the back of the hand was covered with skin flap; the blood vessels of the skin flap were bridged between the radial artery or the ulnar artery and the finger artery in order to recover the blood supply of their fingers, and then the survival, color, texture and postoperative function for the avulsed palm skin were observed. Results ：One patient failed in the operation and the other eleven patients successfully saved their palms. The follow-up of 4 months - 6 years showed the fabricated avulsed palm skin was soft, thick and tough in its texture and their feeling gradually recovered in 3-6 months. 37 fingers were replanted through Flow-through, in which 4 fingers were thumbs, and 26 fingers (2 thumbs) survived; bone healing time was about 4 months; the feeling of 7 patients reached s4, the feeling of 3 patients reached s3, and the feeling of 1 patient reached s1. Conclusion：Lateral femoral circumflex artery chimeric transplant combined with in-situ prefabricated avulsed palm skin and/or Flow-through technique is a reliable and effective method for the repair of severe palm injury and has a better effect in functional recovery.

Experience of application three-dimensional preoperative planning in corrective osteotomy of diastal radius malunion
Turbin K.O.1, Akulaev A.A.1, Povalii A.A.1
1 Saint Petersburg state University, Clinic of high medical technology n. a. N.I. Pirogov, 2nd Department of traumatology and orthopedics.
The use of three-dimensional technologies can allow то study more particular the three-dimensional configuration of distal radius malunion.
Purpose of the study: To report on the clinical results of a study of the use of three-dimensional preoperative planning of distal radius corrective osteotomy in cases of malunion.
Methods: From February 2018 to October 2022, we studied clinical cases of 48 patients (48 upper limbs) with post-traumatic deformity of the radius. In group A, we performed a complex of three-dimensional planning with the creation of an individual guide template. Group B was the control. One surgeon operated the patients on. For the 12th month were evaluated DASH, SF-16, volar tilt, radial inclination, radial height.
Results:
Statistically significant differences in intraoperative radiation exposure (p-level= 0,03) and duration of surgery procedure (p-level= 0,01), DASH and SF-16 physical component questionnaires (p-level < 0,01), radial inclination (p-level = 0,03), radial height (p-level= 0,02) were found improvement in the group with three-dimensional planning. in favor of the group with three-dimensional planning.
Conclusion: We suppose that the technology has points of development and may be useful in the treatment of distal radius malunion. It requires further study methodology. The advantage of the method is the best reproducible surgical procedure.
Key words: distal radius malunion, 3d planning, corrective osteotomy

Introduction: This study aimed to differentiate between the attachment sites of the volar plate and the flexor digitorum profundus (FDP) tendon in lateral radiographs. Furthermore, their relation to a volar spur (VS) was assessed.
Methods: We dissected the attachments of the volar plate and the FDP tendon in 200 cadaveric distal phalanges. The margins of the attachments were marked with cannulas for subsequent radiological analyzation. The location of a not yet described VS at the base of the distal phalanx was assessed concerning potential correlation to the FDP tendon attachment. Any correlations were assessed with the Pearson correlation coefficient.
Results: The analyzed distal phalanges were 16.8 ± 1.5 mm long and 5.6 ± 0.7 mm deep. The VS was identifiable in all specimens and was located 3.5 ± 0.6 mm from the articular line. The distances from the articular line to the VS and to the proximal margin of the FDP tendon showed strong correlation (0.560, p < 0.001). The proximal margin of the FDP tendon attachment was located at 47.4% ± 10.6% of the distance between the articular line and the VS.
Conclusion: The VS at the volar base of the distal phalanx facilitates the identification of the FDP tendon attachment and its differentiation from the volar plate attachment. This may be essential in the characterization of bony volar plate avulsion in the distal phalanx. Furthermore, the VS may serve as radiological reference of the centroid of the FDP tendon attachment facilitating correct repair placement in FDP tendon avulsions.

Introduction: Scaphoid excision and fusing the remaining four carpal bones (capitate, lunate, triquetrum and hamate) is the standard treatment for scaphoid non union with radio-scaphoid joint arthritis i.e. SNAC wrist. This procedure requires extensive dorsal dissection of the wrist, decortication of four carpal bones, bone grafting and hardware bulk for fixation of the fusion mass. Long term follow up of these patients revealed a close correlation between the clinical outcome and the success or failure of healing of fusion at the capito-lunate joint as it is the cardinal load bearing joint in the wrist after scaphoid excision. Fusing capito-lunate joint alone without bone grafting was suggested as a simpler procedure compared to four corner fusion. Methods: 33 patients having scaphoid non union and radioscaphoid arthritis (SNAC) were treated surgically. Average total wrist movement was 50º with 15º average dorsi-flexion and 25º average palmar flexion. Grip strength had a mean of 40%. Through dorsal approach and after removal of non-united scaphoid, the joint between the lunate and the capitate was decorticated. A Herbert screws was inserted antegardely across capito-lunate joint. Results:
All patients reported no pain. Total wrist movement was 80º with 30º dorsi-flexion and 40º palmar flexion. Grip strength had a mean of 80%. Healing of fusion site was confirmed radiologically within 8 weeks. Mayo modified wrist score improved from 37 points to 75. Luno - capitate fusion is a simple procedure with less hardware and no bone grafting. It is gaining more popularity over classic four corner fusion technique.