No abstract

Background: Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues. Methods: 851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis. Results: 31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis. Conclusions: Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.

By evaluating patients' functional requirement, and dynamic fluoroscopy examination, satisfactory outcomes can be achieved for various presentations of DRUF.

This study aims to report the 5-year survivorship of revision wrist arthroplasties and to report midterm clinical and radiological results. All patients receiving a revision wrist arthroplasty in our unit between January 1, 1997 and October 31, 2010 were identified, and clinical notes retrospectively analyzed for Quick Disabilities of the Arm, Shoulder and Hand (quickDASH), Patient Evaluation Method (PEM), Patient-Rated Wrist Evaluation (PRWE), the range of movement, and visual analog score (VAS). In cases where patient review had not occurred within the past year, they were invited for assessment, and this data was included in the analysis. Plain radiographs were analyzed for loosening of each component. The 5-year survival was plotted using Kaplan-Meier analysis. Of the 19 patients identified, 1 was lost to follow-up and therefore excluded from all analyses. Mean age at revision wrist arthroplasty was 55.8 years and the mean time from primary to revision wrist arthroplasty was 6.7 years. At revision arthroplasty, 7 patients received the Biaxial implant (DePuy, Inc., Warsaw, IN) and 11 received the Universal II implant (Integra, Inc., Plainsboro, NJ). The 5-year implant revision survivorship was 83%. Depending on the variable of interest, clinical data were available for either three, four or five patients. At final follow-up (mean: 10.4 years), mean visual analog score was 2.9, mean quickDASH 57, mean PEM 49, mean PRWE 61, and mean arc of flexion/extension was 26 degrees. Radiological data were available for 12 patients, with evidence of gross loosening present in around 60% of the carpal components and 50% of the radial components at mean 6.7 years. Revision wrist replacement implant survival is acceptable, but the majority of the surviving implants are radiologically loose. It is not clear at this time whether they are better or worse than a fusion after a failed primary wrist arthroplasty. It is reasonable to offer revision wrist arthroplasty in selective cases, but regular clinical and radiological follow-up is recommended.

Background: Superelderly patients (defined as 80 years old and older) account for 18% of all distal radius fractures in our institution and this number is increasing with the ageing population. When faced with the option of surgery, patients in this age group have concerns with regards to the long term outcomes including functional outcomes and the time to fracture union. Therefore, the aim of this study was to evaluate the functional outcomes in this specific population. Methods: Patient selection for surgery was determined by the fracture stability, the patient’s premorbid function and underlying comorbidities. Post operatively, the time to fracture union after surgical fixation, surgical complications and patients’ functional outcome scores were recorded. The method of anaesthesia and any anaesthesia-related complications were also included. Results: There were 76 superelderly patients who underwent surgical fixation of their distal radius fractures identified from our institution’s prospective database from 2009 to 2016. Overall there were good functional outcome scores. The DASH scores at 3 months and 6 months were 17 and 10 respectively. Furthermore, the mean time to fracture union in our population was 47 days (approximately 7 weeks). There were only 2 post-operative surgical complications but no anaesthesia-related complications. Conclusions: Surgical fixation of distal radius fractures in appropriately selected patients in the superelderly population yields good functional outcomes.