فهرست مطالب hooman shariatzadeh

Ganglion cysts are the most common type of soft tissue tumors in the hands and wrists. When presented in rare locations, they may cause diagnostic and therapeutic challenges. In this report, we presented a case of a ganglion cyst in the thenar muscle of a 25-year-old woman, which was located adjacent to the recurrent branch of the median nerve. It was removed with surgical excision. The patient’s six-month follow-up was uneventful. This case suggests that ganglion cysts should be included in the differential diagnosis of the hand and wrist pathologies because the late diagnosis can endanger the adjacent structures, such as the recurrent branch of the median nerve.

The aim of this study was to perform a bibliometric analysis to assess the number of articles published by Iranian researchers in the field of hand and microsurgery over the last four decades.

An online search was conducted using 685 keywords in the abstract/ title sections of articles, including carpal tunnel syndrome, wrist fractures, nerve injury and repair, skin flap and graft in the hand, congenital disorders in the hand and forearm, tumor in the hand and wrist, and infection in the hand and wrist. From February 1976 to May 2021, EndNote software version 8.1 was used to search articles in PubMed and Scopus databases. Articles in which at least one of the authors was affiliated with Iran were chosen. The name of the original institution, field of study, total number of publications, type of study, collaboration rate of Iranian hand surgeons for each year, and annual sharing of Iranian articles in journals with the highest cite scores in the field of hand and microsurgery were all examined in the present study.

The total number of publications in the field of hand and microsurgery was 632 (an average of 11 papers per year). Most of the Iranian hand and microsurgery papers were from the capital city, Tehran (38.09%). There was an increasing trend in the number of publications over the years, most which were about carpal tunnel syndrome (21.5%), tendon (9.8%), and nerve (9.6%). In total, 59.6% were descriptive articles, whereas the proportion of clinical trials was relatively small (22.3%).

Iranian hand microsurgeons have continued to increase their scientific output in hand microsurgery and related fields over the last 40 years. The quality of Iranian hand microsurgeons’ scientific output, both within and outside their discipline, has greatly improved; however, they still have a long way to go before becoming a hub of science.

Scaphoid fracture is the most common wrist injury with a high rate of misdiagnosis and subsequent complications. As the morphology of the distal radius affects the load transmission through the carpal bones, radiographic wrist indices may help prevent missing occult fractures.

The current retrospective case-control study compared the distal radius radiographic indices of patients with a scaphoid fracture with a control group.

Wrist X-rays of 129 patients with scaphoid fractures (case group) and the contralateral uninjured side of 101 patients with distal radius fractures (control group) were assessed by two orthopedic surgeons. Anteroposterior and lateral radiographs were evaluated to measure the radial height (RH), radial inclination (RI), ulnar variance (UV), and volar tilt (VT).

The student t-test was used to compare the distal radius radiographic indices between the two groups. The average RI was 27.14 in the scaphoid fracture group and 24.35 in the control group (P<0.05). Mean VT, RH, and UV of the case group were, 12.32, 15.01, and - 0.73, respectively; this is while in the control group, the above measures were 10.76, 13.52, and - 0.11, respectively (P<0.05).

High values of RH, RI, and VT, and negative amount of UV are significantly correlated with scaphoid fracture after a Fall Onto an Outstretched Hand (FOOSH) injury.

Closed dislocation of thumb Interphalangeal (IP) joint is rare, due to the inherent stability of the thumb IP joint. The interposition of the volar plate, flexor pollicis longus, sesamoids, and digital nerves can treat the joint closed reduction. In this study, we report a case of three-week-old irreducible closed dislocation of thumb IP joint in a 33-year-old woman. We planned to perform open reduction surgery using a dorsal approach on the IP joint and the ulnar side opening. The volar plate was interposed in the joint. Seven months after surgery, the patient achieved 0-45 degrees of IP range of motion. No sign of degenerative joint changes on the x-ray images was observed in the final visit. This study suggests the high probability of open reduction for these injuries and recommends the use of dorsal approach, excluding the complications of volar approach.

It is the goal of medicine discovery to help patients. It is therefore important to analyze studies published by Iranians in PubMed related to shoulder and elbow problems.

We conducted a bibliometric search to determine the number of papers published by Iranian scholars in PubMed related to shoulder and elbow.

A search in PubMed database was conducted using 129 keywords such as shoulder, cubitus, bankart, rotator cuff, olecranon, etc. Articles with at least one author from Iran published from 1995 to 2021 were selected. The selected papers were studied in terms of the institution name, study subject, total number of papers, study design, contribution rate of Iranian orthopedic surgeons each year, annual number of papers published by Iranians in five journals with the greatest impact factor, and in journals with an impact factor.

There were 463 eligible articles in the field of shoulder and elbow (17 per year); 89 (18%) were clinical trials, and 375 (82%) were retrospective studies. Fracture dislocations were the most common study subject (17%), 11 % related to shoulder and 6 % related to elbow. Among shoulder related articles, the most common study subjects were fracture dislocation (24%), brachial plexus (14%), rotator cuff (12%), and tumor (6%). In elbow related articles, the most common study subjects were fracture dislocations, tennis elbow, and cubital tunnel syndrome (23%, 21%, and 16%, respectively). 

Although the number of articles published by Iranians in the field of shoulder and elbow in PubMed has increased significantly in recent years, there is still a long way for Iran to become a science exporting country.

There is no clear consensus on the best treatment option for scaphoid fractures. 

In this study, we aim to evaluate the short-term clinical and radiologic outcomes in patients with acute isolated scaphoid fractures treated with surgical or nonsurgical methods.

In a retrospective study, 31 patients with acute isolated scaphoid fracture (Mean±SD age: ‎28.9±9.9 ‎years) treated with open reduction and internal fixation (n=15) or cast immobilization (n=16) methods were included. The fractures were classified according to Herbert & Fishers’ classification system. Clinical outcome measures were the wrist range of motion, pinch strength, and grip strength. Radiographic outcome measures were the lunocapitate angle, scapholunate angle, and ulnar variance. The outcome were compared between the involved and uninvolved hands and between surgical or nonsurgical groups.

The majority of fractures were type B2 (n=14). In a Mean±SD follow-up of 15.1±3.2‎‏ months, the mean extension, flexion, pinch, and grip strength of the involved hand averaged 81.3%, 80.7%, 90%, and 87% of the uninvolved hand. Accordingly, clinical outcomes were significantly lower in the involved hand. The scapholunate angle was significantly higher in the involved hand (P=0.002). Clinical and radiographic outcomes were not significantly different between the surgical and nonsurgical groups. Radiographic malalignment was detected in 25 scaphoids. No significant correlation was found between the clinical and radiographic outcomes.

After scaphoid fracture union, the decrease in wrist range of motion (extension, flexion) and grip/pinch strength has no correlation with radiographic results.

Carpal malalignment following the treatment of scaphoid nonunion increases the risk of Dorsal Intercalated Segment Instability (DISI) and progressive radiocarpal arthrosis. 

In this study, we aimed to investigate the outcome of interpositional bone grafting without preplanning to correct carpal malalignment in treating scaphoid nonunion. 

In a retrospective study, 96 patients who underwent surgery to treat scaphoid nonunion (interpositional bone grafting without correction of carpal malalignment) were included. Indices of carpal malalignment, including the lunocapitate and scapholunate angles, were assessed before and one year after the surgery. A lunocapitate angle of more than15º and a scapholunate angle of more than 60º were considered a sign of DISI.

The study population included 93 men (96.9%) and three women (3.1%) with a Mean±SD age of 26.1±3.1 years. The mean±SD time from fracture to nonunion surgery was 8.6±4.2 months. The Mean±SD lunocapitate angle was 15.2±13.1º before and 14.4±11º one year after the surgery (P=0.48). The Mean±SD scapholunate angle was 63.9±15.2º before and 64.5±14.6º after the surgery (P=0.69). DISI was present in 67 patients (69.8%) before and 66 (68.8%) after the surgery. This difference was not statistically significant, too (P=0.89).

Correction of carpal malalignment should be preoperatively planned to treat scaphoid nonunion to reduce the risk of postoperative DISI and subsequent radiocarpal arthrosis.

Schwannomas are the most common nerve sheath tumors which are usually solitary enucleated lesions. Multipleschwannomas are a rare circumstance which may occur with or without other manifestations of neurofibromatosis.In this study, we report the case of a 45-year-old man presenting with pain and swelling in the thigh and popliteal spacewithout any manifestation of neurofibromatosis or neurologic problems. Surgery was performed and revealed fourseparated tumors in the sciatic nerve which was characteristic of schwannoma and confirmed by pathologic findings.Although multiple schwannomas are frequently associated with neurofibromatosis, the current case demonstrateda patient with multiple schwannomas without any manifestation o f neurofibromatosis.Level of evidence: IV

It is essential to have a suitable instrument for the accurate assessments of pain and disability outcomes during interventions; such tools also help to guide hand surgery and rehabilitation programs in distal radius or scaphoid fracture. This study aimed to evaluate the psychometric features of the Patient-rated Wrist Evaluation (PRWE) questionnaire in Iranians with a history of scaphoid and distal radius fractures.

One hundred and fifty subjects with a history of scaphoid and distal radius fractures were recruited from hospital-based outpatient hand clinics and completed the PRWE, 2 and 7 days after the occurrence of fracture. Additionally, the Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH), the percentage of Wrist Range of Motion (%ROM), Visual Analog Scale Pain/Disability (VAS-P, VAS-D), Short-form Health Survey (SF-36) questionnaires, and pinch and grip strength (%) were conducted in the study participants. Cronbach’s alpha (α) coefficient and Intraclass Correlation Coefficient (ICC) were used to evaluate the internal consistency and test-retest reliability of the scale, respectively. Pearson or Spearman correlation coefficient was calculated for assessing the test’s construct validity.

No floor or ceiling effect was found. A very high test-retest reliability was obtained for the PRWE’s total score and subscores (ICC≥0.92). Cronbach’s α coefficient was obtained as ≥0.78 for the PRWE and its subscales. The PRWE total score presented a weak to strong (0.24-0.74) correlation with the average values of %ROM, %power grip, %pinch strength, VAS-P, VAS-D, SF-36, and Quick-DASH. The standard error of the measurement of PRWE total score equaled 3.93; its smallest real difference was 10.86. 

The PRWE presented acceptable validity and excellent reliability for measuring disability and pain in individuals with the scaphoid and distal radius fractures in Iran.

Open reduction and internal fixation is the standard surgical treatment of calcaneal fractures. However, it is associated with a high rate of wound problems. 

In this study, we evaluated the clinical and radiologic outcomes, as well as the wound complication rates of sinus tarsi minimally-invasive approach in the treatment of intra-articular calcaneus fracture.

In a retrospective study, 62 patients who were referred with an intra-articular calcaneus fracture and treated with a minimally-invasive sinus tarsi approach were included. The radiographic evaluations included the assessment of Bohler and Gissane angles before and after the surgery, as well as the height and length of the calcaneus. The clinical outcome was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire.

The Mean±SD age of the patients was 41.8±12.7 years. The Mean±SD follow-up of the patients was 21.3±10 ‎months. After 6  months, in  43 patients (69.3%) both Bohler’s and Gissane’s angles were significantly improved after the surgery (P=0.003 and P<0.001, respectively). The calcaneus height was significantly improved after the surgery (P=0.009), as well. The Mean±SD AOFAS score of the patients was found 79.6±7. Wound infection was seen in only 1 case (1.6%). Delayed wound healing occurred in 4 cases (6.4%). No other wound complication such as dehiscence and skin necrosis was recorded.

Minimally-invasive sinus tarsi approach is an efficacious procedure for the treatment of intra-articular calcaneus fracture with a minimized rate of wound complications.

Management of chronic collateral ligament injury of the Metacarpophalangeal (MCP) joint, either its Ulnar Collateral Ligament (UCL) or Radial Collateral Ligament (RCL), is challenging. 

In this study, we report the outcome of ligament reconstruction procedure in the treatment of such injuries. 

In a retrospective study, the outcomes of static reconstruction surgery of the symptomatic chronic collateral ligament injury of the thumb MCP joint (five RCL and three UCL) were evaluated. We used palmaris longus tendon in four surgeries and flexor carpi radialis tendon in the remaining. The outcome measures included the thumb range of motion, the disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire, pinch and grip strength, visual analog scale, and Kapandji opposition score.

Eight patients (6 males and 2 females) with the mean±SD age of 32±7.1 years were included in this study. The Mean±SD duration from the injury to surgery was 66.7±99.5 weeks. The Mean±SD follow-up of the patients was 4.88±1.35 years. The mean pinch and grip strength of the involved hand averaged 98.9% and 100% of the other hand, respectively. Postoperative pain was only noticed in two patients. The Mean±SD postoperative Kapandji opposition score was 9.4±0.7 (range: 8-10). The Mean±SD QuickDASH score was 12.9±1.9 (range: 11-17). The thumb range of motion was similar to the contralateral hand in all but one patient. All the operated joints were stable. A case of mild degenerative joint disease was the only observed postoperative complication.

Static reconstruction of chronic collateral ligament injury of the thumb MCP joint provides acceptable results, regardless of the time interval between the injury and surgery.

Lunate morphology has been associated with several wrist pathologies. In this study, we aimed to find how lunate morphology (absence or presence of hamate facet) affects the severity of Kienböck disease.

Evaluation of the relationship between lunate morphology and kienbocks disease. 

A total of 106 patients with stage IIIA or IIIB of Kienböck disease at initial presentation were included in this study. Modified Litchman classification system and standardized lateral radiographs were used for staging the Kienböck disease. Lunate morphology was investigated on plain radiograph and computed tomography scan or magnetic resonance imaging and was classified into type I (absence of hamate facet) and type II (presence of hamate facet).

The mean±SD age of the patients was 33.5±9.2 years. Kienböck disease stage IIIA and IIIB were identified in 68 (64.2%) and 38 (35.8%), respectively. Hamate facet was present in 65 (61.3%) patients and absent 41 (38.7%) patients. A significant association was found between lunate morphology and stage of disease so that the number of patients with lunate type I was significantly more in stage IIIB and number of patients with lunate type II was significantly more in stage IIIA (p<0.001).

Lunate morphology is associated with the severity of Kienböck disease in patients initially presented with stage IIIA or IIIB. These associations could be implicated to prevent disease progression as well as to optimize the outcome of treatment.

The optimal treatment of radial head component in the terrible triad injuries of the elbow is challenging. In this study, we compared the functional outcome and complication rates of radial head resection with radial head fixation in a terrible triad setting.

Comparison of radial head resection with radial head fixation in terrible triad. 

In the present retrospective study, the outcome of terrible triad injury in 41 patients, in whom the radial head component was managed with either radial head resection (n=28) or open reduction and internal fixation (n=13), was compared. The subjective assessments of the outcome included visual analog scale (VAS) for pain, ‎the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and ‎hand (DASH) score. The objective assessment of outcome included the evaluation of elbow range of motion (ROM) and elbow stability.

The mean±SD age of the patients was 39.2±10.2 years. The demographic characteristics of the patients of the two study groups were not statistically different. The mean supination/pronation arc of motion was not significantly different between the two ‏study groups (P=0.11). The mean flexion/extension arc of motion was significantly more in the fixation group (P=0.001). The mean MEPS and DASH scores were not ‏significantly different between the study groups (P=0.22 and P=0.49, respectively). The mean ‏VAS was significantly more in the fixation group (P=0.04). All the elbows were stable at the last follow-up. The postoperative complications (arthrosis and heterotopic ossification) were considerably more in the resection group.

Although comparable at function, the present study favors the radial head fixation whenever possible to avoid the postoperative complications of radial head reaction.

Kienbock's disease is an enigmatic entity that causes wrist pain and disability in young adults. This study aimed to assess clinical and radiological outcomes radial shortening as its most common treatment.

In a retrospective research, the data of medical records of 100 patients with Kienbock's disease were studied. They included 66 men and 34 women with mean age of 28.9 ± 7.6 years, who treated using radial shortening surgery. The wrist indexes and Disabilities of the Arm, Shoulder, and Hand Score (Quick DASH) were calculated and analyzed.

60% of the patients were ulnar minus, 26% neutral, and 14% ulnar plus. Mean Quick DASH score was 11.34 ± 6.30 in patients in the Lichtman stages I and II, and 23.05 ± 10.40 in the Lichtman stage III. Delayed union after 5 months occurred in 3%, screw back out in 1%, and superficial infection in 1%. Mean duration of union was 16 weeks. Ulnar variance was the same amongst different Lichtman stages. At follow up, 29% had none, 39% mild, 23% moderate, 8% severe, and 1% extreme pain. Ulnar variance changed from -0.9 to +0.1. Bilateral involvement was noted in 4% and dominant arm involvement in 45%. In 26% of patients, radius was shortened less than 1 millimeter. No radiological progression or improvement occurred during follow up.

 After radial shortening surgery in Kienbock's disease, clinical improvement was commonly expected, even if the radius was not shortened to reach to neutral ulnar variance. This improvement was more obvious in patients in in the Lichtman stages I and II.</div>

The appropriate monitoring of union following the treatment of scaphoid nonunion is essential. However, there is no consensus regarding the optimal imaging modality for this evaluation. 

Here, we compared the reliability of plain radiographs with computed tomography (CT) scanning in determining the union of scaphoid following the scaphoid nonunion.

In this retrospective study, 25 patients, who underwent the surgical treatment of scaphoid nonunion and had both plain radiographs and CT images, were included. The surgical procedure included open reduction, illiac crest bone graft, and K-wire fixation. Two different observers assessed the healing of scaphoid nonunion by both imaging modalities and graded as healed or non-healed.

The mean±SD age of the patients was 29.1±6.8 years. The mean±SD time interval from the operation to imaging was 6.5±2.5 months. Based on the plain radiographs, all patients achieved the scaphoid union. However, in the CT evaluation, 23(92%) patients showed the scaphoid union. Accordingly, CT images and plain radiographs agreed in 23 cases and disagreed in two cases. This difference was not statistically significant (P=0.5).

In a subset of patients, who underwent the operation for the treatment of scaphoid nonunion, plain radiographs might falsely confirm a scaphoid union. In these patients, a complementary CT evaluation might be helpful in the accurate assessment of scaphoid healing.

Recent evidence supports the superiority of surgery over conservative treatment in the management of medial humeral epicondylar fractures (MHEF) with the displacement of more than 2 mm, regardless of other indications for surgical intervention. We evaluate this strategy in a cohort of pediatric MHEF with more than 2 mm displacement. A total of 10 pediatric patients with MHEF and more than 2 mm displacement were included in the study. Relative and absolute indications for surgical intervention were present in five and one patient, respectively. No surgical indication was present in the other four cases. Elbow dislocation had occurred in three cases. All the patients were treated with open reduction and internal fixation (ORIF). The outcome measures included: Radiographic union, elbow range of motion, and Mayo elbow performance score (MEPS). At the final follow-up session, the mean flexion was 129° ± 6.1°. Flexion contracture and hyperextension were seen in three (30%) and one (10%) patient, respectively. The mean supination and pronation were 81° ± 3.2° and 80.5° ± 1.6°, respectively. MEPS was 100 (excellent) in nine patients and 55 (poor) in one patient. Radiographic union was observed in all the patients. In one patient, ulnar nerve neurolysis was performed 23 months after the initial surgery due to severe tenderness around the medial epicondyle. ORIF management of MHEF is an easy procedure with a low complication rate and satisfactory outcomes. Thus, we suggest the surgical approach for all pediatric patients with MHEF and displacement of > 2 mm, regardless of the presence of other indications for surgery.

Elbow stiffness is a debilitating condition with different etiologies including trauma, head injury, and burns, which seriously interferes with the patient’s daily activities. Here, we aimed to report the outcome of elbow release surgery in patients with elbow stiffness caused by different etiologies. In a retrospective study, the outcome of surgery was evaluated in 18 patients with elbow stiffness. The indication for surgery was the functional loss of elbow range of motion that failed at least six months of conservative management. Elbow range of motion was evaluated before and after the surgery. Mayo elbow performance score (MEPS) was used to assess elbow function at the final follow-up session. The mean follow-up period of the patients was 4.5 ± 2.6 years, ranging from 2 to 10 years. The etiology of stiffness was trauma in 11 cases, central nervous system injury in six patients, and burns in one patient. The mean pre-operative supination, pronation, and flexion arc improved by 15.3°, 20.9°, and 62.2° at the final follow-up evaluation, respectively (P = 0.028, P = 0.008, and P < 0.001, respectively). The mean MEPS of the patients was 85 ± 9.1, ranging from 65 to 95. According to the MEPS scores, the functional outcome was excellent in 8 (44.4%) patients, good in 7 (38.9%) patients, and fair in 3 (16.7%) patients. The release of stiff elbow could be regarded as an effective treatment that provides an acceptable gain in the range of motion and considerable improvement of elbow function.

Bizarre parosteal osteochondromatous proliferation (BPOP), also known as the Nora’s lesion, is a part of the spectrum of reactive lesions with a difficult diagnosis. To date, only limited number of Nora’s lesions have been reported in the literature. Here, we report a case of Nora’s lesion and discuss the differential diagnosis of the case. A 34-year-old male that was referred to the hand clinic of our center with a painful lump at the dorsoulnar aspect of the first metacarpal bone of his left hand. The diagnosis of BPOP was suspected using its clinical and radiographic characteristics. Subsequently, excisional biopsy was performed and the extracted lesion was sent to the pathology for definitive diagnosis. The histopathologic evaluation confirmed the diagnosis of BPOP. One year follow-up of the patient showed no radiographic or clinical sign of recurrence. BPOP can be confused with malignant lesions such as parosteal osteosarcoma and chondrosarcoma. Thus care should be taken to combine the radiographic and pathologic information in the correct diagnosis of this lesion, especially when the BPOP presents with atypical features.

Treatment of Monteggia fracture-dislocations can become quite complicated when the diagnosis is delayed. We report the outcome of open reduction and ulnar osteotomy with annular ligament repair or reconstruction in pediatric patients with neglected Monteggia fracture-dislocation. In a retrospective study, pediatric patients with neglected Monteggia fracture-dislocation who underwent open reduction and ulnar osteotomy with annular ligament repair or reconstruction were included. The radiologic evaluations included the assessment of the union of the osteotomy site and elbow joint degenerative changes or peri-articular ossifications. The clinical evaluation of outcomes included the range of motion (ROM) and the Kim elbow performance score (KEPS). A total number of seven patients with pediatric Monteggia fracture-dislocations and the mean age of 6.6 ± 2.7 years were evaluated. The mean delayed time from injury to surgery was 53.3 ± 31.4 days. The mean follow-up of the patients was 30.8 ± 25.5 months. The mean flexion arc, supination, and pronation were 137.9‎°, 72.1‎°, and 65.7°, respectively. Flexion contracture was present in two cases only. The mean KEPS of the patients was 96.4 ± 6.3. Accordingly, the outcome was excellent in six (85.7%) patients and good in one (14.3%). One ulnar nonunion and one heterotopic ossification were recorded as post-operative complications. No case of subluxation, dislocation, or degenerative joint disease was seen in our series. Radial head reduction and ulnar osteotomy with annular ligament reconstruction result in acceptable radiologic and clinical outcomes in the management of neglected pediatric Monteggia fracture-dislocation.

Several procedures have been described for the management of post-traumatic disorders of the distal radioulnar joint (DRUJ). Amongst them, Sauve-Kapandji (SK) procedure has shown promising results; yet, it is not infallible. Here, we evaluated the radiologic and clinical outcomes of the SK procedure in eight patients with post-traumatic disorders of DRJU.

In a retrospective study, patients with post-traumatic derangement of the DRUJ that underwent the SK procedure were included. The radiologic outcomes were evaluated using the assessment of union, ulnar variation, and radial deviation. The forearm range of motion and Mayo Modified Wrist Score (MMWS) were used for the clinical evaluation of the outcomes. The grip strength of the injured hand was compared with the grip strength of contralateral hand.

The mean extension, flexion, supination, and pronation of the patients were 67.5°, 65°, 77.5°, and 78.1°, respectively. The mean ulnar and radial deviations were 20.6° and 17.5°, respectively. The mean grip strength was 45.6 ± 14.1 Ib for the injured hand and 75.4 ± 30 Ib for the non-injured hand (P = 0.012). The mean MMWS was 83.8 ± 5.2. Based on the MMWS, the functional outcome was categorized as excellent in two patients, good in five patients, and fair in one patient. At the last follow-up, radiologic union was observed in all the patients but one. No other complications were recorded.

The SK procedure could result in acceptable radiologic and functional outcomes for the management of post-traumatic DRUJ problems. However, it might compromise some indices of the forearm such as grip strength

Congenital radial club hand (RCH), as a rare congenital deformity of the upper extremity, is characterized by a wide spectrum of malformations including radial deviation. Centralization surgery is the standard treatment for severe cases that have been associated with a high rate of recurrence. This study reports the long-term results and recurrence rate of radial deviation following the centralization surgery of RCH.
The medical records of 13 congenital RCH patients (16 hands), who underwent centralization surgery, were reviewed retrospectively. Hand-forearm angle (HFA), hand-forearm position (HFP), and ulnar bow (UB) were used to assess forearm angles.
The mean age of the patients was 19.4±8.9 months, and their mean follow-up was 62.1±39.9 months. The mean HFA correction was 29.4°±23.9°, the mean HFA recurrence was 13.3°±13.7°, the mean correction of HFP was 13.4±7.3 mm, and the mean recurrence of HFP was 1.4±2.8 mm. The mean UB showed 7.6°±12.5° correction immediately after surgery and a further 3.6°±7.3° at the last follow-up (overall 11.2°±17.6°). A number of 12 out of 13 parents were completely satisfied with the results.
According to our results, an acceptable long-term result is expected after the centralization surgery of RCH. However, the risk of the recurrent radial deviation is high and needs to be optimized in future investigations.

Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Although isolated posterior Hoffa fractures of medial femoral condyle have been rarely reported, no reports are available regarding the anterior fracture of this type. Here, we report a large isolated anterior osteoarticular fracture of the medial femoral condyle.
A 16 - year - old girl with a traumatic open joint injury of the right knee caused by a car - to - pedestrian accident was referred to our emergency department for further evaluation. A physical examination of the knee revealed effusion and limited knee range of motion. While no obvious fracture was detectable on plain radiographs of the knee, a large anterior osteoarticular fracture of the medial femoral condyle was observed in computed tomography (CT), which was detached from the medial condyle. The fracture was managed with open reduction and internal fixation. Eight weeks after the surgery, the patient retrieved the full knee motions and the complete union of the fracture was observed. No complication was reported by the patient at a follow-up period of 12 months.
In cases with knee tenderness and/or effusion and normal plain radiographs, whenever there is a discrepancy between plain radiographs and clinical symptoms of the patient, a further evaluation of the knee with a CT scan and/or MRI is necessary to avoid missing a Hoffa fracture, which could be successfully treated if timely diagnosed.

While there is consensus about the treatment of acutely presented displaced lateral condyle fracture (LCF) of distal humerus in children by open reduction and internal fixation, treatment for lately presented LCF remained challenging due to contradictory results of treatments and paucity of studies in this field.
The aim of this study was to report the clinical and radiological results of open reduction and internal fixation for the treatment of lately presented LCF of distal humerus in children.
Prospectively we studied the clinical and radiographical results of open reduction and internal fixation of 8 patients from 12 cases. These cases had a delayed presentation of more than 3 weeks from injury among those who were referred to our center from 2011 to 2017. We evaluated the range of motion, alterations in carrying angle, presence of prominent deformity, presence of arthritic or neurological symptoms, and finally nonunion or avascular necrosis of the lateral condyle. For assessment of the treatment results we used the Hardacre criteria.
A total of 8 patients, including 7 males and 1 female with mean age of 5.2 years (2.5 - 8) bearing time delay from injury to the surgery of 32.4 days (22 - 48), underwent surgical treatment. The mean follow up was 21 months (8 - 54). The main reason for referring to the clinic consisted of palpable mass followed by decreased range of motion. All patients achieved satisfactory union. Of the patients, 2 suffered from complications; 1 patient experienced avascular necrosis of the lateral condyle and the other was complicated by carrying angle abnormality. According to the Hardacre criteria, 6 patients achieved excellent results and 2 patients, with mentioned major complications, obtained fair results.
Open reduction and internal fixation of lately presented lateral condyle fracture of distal humerus can result in excellent functional and radiological results in most of the patients.

Although carpal tunnel release (CTR) is accepted in severe cases of carpal tunnel syndrome (CTS), it is not clear if CTR overweighs the local steroid injection (LSI) in the treatment of patients with mild symptoms.
Here, we compared the efficacy of LSI with CTR on improving signs and symptoms of mild to moderate CTS.
In a randomized clinical trial, we used the Boston carpal tunnel questionnaire (BCTQ) to evaluate the change of functional status scale (FSS) and symptom severity scale (SSS), in addition to the patients’ satisfaction, over a follow - up period of 6 months.
In total, 68 patients (33 in the LSI and 35 in the CTR group), with the mean age of 45.8 ± 8.1 years and mean BMI of 30.5 ± 6.1 kg/m2 were included. The baseline clinic - demographic characteristics of the patients were not significantly different between the 2 study groups. Both treatments significantly improved the FSS (p = 0.002 for LSI and p = 0.001 for CTR) and SSS (p = 0.001 for both groups). However, no significant difference was observed between FSS (p = 0.36) and SSS (p = 0.29) of the 2 groups. Although the patients’ satisfaction was also not significantly different between the 2 groups, the number of completely satisfied patients was more in the LSI group.
Considering no significant difference between the outcome and satisfaction rate of patients treated with LSI or CTR, it can be concluded that both treatments are efficacious in the treatment of mild to moderate CTS, at least for a period of 6 months. However, the durability of treatments needs further evaluation.

Context: Ulnar variance (UV) is attributed to the natural history of several wrist disorders. Thus, its reliable measurement is of considerable clinical importance. Several factors are proposed to affect the UV measures; the current study aimed at discussing these factors to further clarify their role in the evaluation of UV.
Evidence Acquisition: The evidence of the current review was derived from literature published in English in PubMed to identify papers discussing the factors affecting UV measurement. The title and abstract of the articles published prior to October 2017 were checked. After the exclusion of non-relevant studies, 16 articles were found eligible for investigation.
Based on the available evidence, the perpendicular technique is the most reliable method of UV assessment. Magnetic resonance imaging (MRI) is also reported as the best imaging method for UV measurement. Moreover, the most increase in UV is expected when the position changes from relaxed supination to pronation and grip status. It seems that aging affects UV, at least until maturity, with a shift toward less ulnar minus position. In addition, ulnar plus wrist position seems to be more frequent in females. Repetitive minor wrist trauma can also change wrist radiologic parameters, especially ulnar variance.
Among several potential factors affecting the UV, the role of some factors such as positioning, imaging, and measurement technique are well defined, while the role of some others such as age and gender needs further clarifications in future investigations.