Scaphoid fracture is the most common fracture in carpal bones. Although the reported union rate of conservatively-treated fractures is more than 90%, there is a controversy over the most appropriate treatment. In recent years, many reports have compared the clinical outcomes of conservatively-treated scaphoid fractures with the results of operatively treated ones using randomized controlled trials and meta-analyses. However, there is no consensus regarding the optimal treatment. In this paper, based on literature review, we provide an overview of the management of the acute scaphoid fractures particularly focusing on the issues related to conservative treatment.

The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

Background: Perineural adhesion is a potential complication of manipulating peripheral nerves. Using a model of median nerve manipulation in the carpal tunnel, perineural adhesion preventive effects of an alginate gel formulation were examined. Methods: After exposing carpal tunnels of Japanese white rabbits and dissecting the median nerve, the gliding floor was excised as much as possible and the transverse carpal ligament was repaired to induce a perineural tissue reaction. Prior to wound closure, 0.5 ml of alginate gel formulation was administered into the right carpal tunnel (formulation group) and 0.5 ml of physiological saline was administered into the left carpal tunnel (control group). At 1, 2, 3, and 6 weeks after treatment, electrophysiological evaluation of thenar distal latency, macroscopic evaluation with adhesion score, and pathological evaluation of carpal tunnel cross sections were performed (N = 4–5 at each time point). Results: Although distal latency tended to be low in the formulation group, there was no significant difference between the groups according to electrophysiological evaluation. Macroscopic evaluation revealed that the adhesion score was always lower in the formulation group than in the control group; over the course of treatment, it remained unchanged in the formulation group, but peaked at 3 weeks after treatment in the control group. In pathological evaluation, neural perfusion peaked at 2–3 weeks after treatment in both groups; neural perfusion tended to be lower in the formulation group than in the control group. Conclusions: Results suggested that the peak tissue response associated with nerve dissection occurred 2–3 weeks after treatment and that the repair process started subsequently. The alginate gel formulation modified the surrounding environment of the nerve and promoted repair by acting as a physical barrier against perineural fibrosis. The preventive effect of alginate gel on perineural adhesion may improve treatment outcomes of constrictive neuropathy.

The purpose of this research was to examine the effects of stockinets processed with deodorizing and antibacterial agents. The subjects were injured patients who received plaster cast immobilization. The following were performed: 1) sensory evaluation using an odor intensity measurement method, 2) measurement of residual odor concentrations of ammonia, acetic acid, and hydrogen sulfide, and 3) measurement of bacteriostatic activity values. Odor was significantly reduced in the processed stockinets (2.27 ± 0.93) compared to the unprocessed stockinets (2.92 ± 1.03). The odor concentrations were reduced and significant differences were observed in ammonia and hydrogen sulfide concentrations, but not for acetic acid. The bacteriostatic activity was 4.23 ± 0.70 for processed stockinets and a criterion of 2.2 or greater was satisfied. These findings demonstrated the deodorizing and antibacterial effects of the processed stockinets.