Background:Even in patients with an open capitellar physis, nonsurgical treatment for advanced-stage osteochondritis dissecans (OCD) of the capitellum often yields poor outcomes. However, surgical methods for such patients are controversial. At our institution, we have consistently performed closed-wedge osteotomy of the distal humerus to treat advanced-stage OCD of the capitellum, regardless of the OCD grade or condition of the capitellar physis.Purpose:To clarify the clinical and radiological results and determine the influence of the capitellar physis on closed-wedge osteotomy for advanced-stage OCD of the capitellum in young patients.Study Design:Case series; Level of evidence, 4.Methods:A total of 32 patients with OCD of the humeral capitellum were treated surgically with closed-wedge osteotomy. Of these, 17 patients with more than 2-year follow-up were available for an evaluation. The mean patient age was 11.8 years (range, 11-12 years), and the mean follow-up period was 70.1 months (range, 25-184 months). The clinical assessment included range of motion, elbow pain, and the Japanese Orthopaedic Association (JOA) and Timmerman-Andrews scores. The radiological assessment at the final examination included cross-bridging of the physis, size and fishtail deformity of the distal part of the humerus, size of the radial head, healing of the OCD lesion, and osteoarthritis.Results:The mean range of motion and JOA and Timmerman-Andrews scores improved significantly after surgery; 13 patients were completely pain free. In 11 patients with an open capitellar physis, metaphyseal-epiphyseal, cross-bridging was observed in 1 patient. A fishtail deformity of the distal part of the humerus was not observed. Healing of the OCD lesion was defined as excellent in 9 patients, good in 3, fair in 3, and poor in 2. In 3 of the 5 patients in whom healing was described as fair or poor, there was a lesion of the lateral widespread type with osteoarthritis before surgery. Moderate osteoarthritic changes were evident in 2 patients.Conclusion:Closed-wedge osteotomy for the treatment of advanced-stage OCD of the capitellum in young patients can provide satisfactory clinical and radiological results. However, fair and poor outcomes were found in lateral widespread–type cases with osteoarthritis before surgery. We believe that patients in whom osteoarthritic changes have not yet appeared are eligible for closed-wedge osteotomy.

For reconstructing an injured fingertip, a reverse pedicle digital island flap can restore excellent function and appearance. However, postoperative flap congestion may lead to flap necrosis. We tested a method for dissecting the vascular pedicle to prevent congestion and to provide more reliable results. Between August 2002 and December 2010, we reconstructed 14 fingertips in 13 patients (average age, 43 years; range, 24 to 68 years; 9 men). Through a small zigzag incision, the digital artery and a 4-mm-wide subcutaneous venous network were elevated in retrograde fashion to facilitate venous drainage. All flaps healed completely without severe congestion or necrosis. Slight flexion contractures remained in the PIP (mean, 12°) and DIP (mean, 14°) joints. Our procedure is simpler and more reliable than other techniques, such as adding a narrow skin bridge to the pedicle or a venous anastomosis to prevent venous congestion, and it assures the survival of the flap.

We evaluated the injuries, survival rats, and secondary surgeries of patients who had undergone finger replantation or revascularization between October 2005 and July 2010. The 70 digits came from 43 patients (average age, 46 years; range, 19 to 78 years; 37 men). Overall replantation survival rate was 94%; 93% (27/29) for complete amputations and 95% (39/41) for near-amputations. In all, 39 digits from 21 patients required 48 secondary surgeries; skin grafts, tenolysis, joint fusion, bone graft, osteotomy, and web plasty. The more proximal or more severe the injuries, the higher the need of secondary surgeries. The most common surgery soon after replantation was skin coverage; the most common after two months was tendon surgery. Primary repair must be adequate to restore the function and appearance of amputated digits; however, the possible need for secondary surgeries must be kept in mind to avoid restricting the options for secondary procedures.

We report a trigger finger of the right index finger in a 28-year-old man with acromegaly, in which condition growth hormone increases extracellular volume by stimulating sodium reabsorption in the distal nephron. The increase in extracellular fluid can cause oedematous swelling of the flexor synovium in the digital sheath.

Fractures of the proximal end of the radius in children are uncommon. A case of fracture through the articular surface of the radial head (Salter-Harris type IV) in a 12-year-old boy is presented. Our paper recommends bone peg fixation in the treatment of Salter-Harris (S-H) type III or IV injuries in nearly skeletally mature.