No abstract

I.

Severely comminuted intraarticular distal radius malunion can significantly affect a patient's quality of life. To date, there is no ideal solution. We propose customized distal radius prosthesis replacement as a treatment option. A 33-year-old policeman presented with left wrist deformity and loss of motion for five months following a distal radius fracture AO (Arbeitsgemeinschaft für Osteosynthesefragen) type-C3 which had been fixed with a volar locking plate incorporate with external fixation and Kirschner wire (K-wire) augmentation for two months. He needed to rely on wrist motion for work. Therefore, we fabricated a customized distal radius prosthesis based on his contralateral normal anatomy to replace the malunion site. The patient was satisfied and able to return to work two months after the operation. Thirty months later, the range of motion had improved from fixed 40° flexion and fixed 70° pronation deformity to 73° flexion, 79° extension, 75° supination, and 85° pronation. His DASH (Disabilities of the Arm, Shoulder, and Hand) score had improved from 80 to 14.2. His pain score, as measured by the visual analog scale, improved from eight preoperatively to two. Unreconstructable intraarticular malunion of the distal radius is a challenging problem with no treatment consensus. Customized distal radius prosthesis may provide a successful treatment option. Future research should elucidate long-term outcomes.

Cubital tunnel syndrome (CuTS) is a well-recognized compressive neuropathy worldwide. With technological advancement, endoscopy is introduced to facilitate the procedure. However, there are concerns about the excessive cost that comes with special instruments. This article aims to provide the results of the cost-saving endoscopic-assisted cubital tunnel release surgical technique that uses the normally available operating instruments.A retrospective review was performed of the nine patients that were diagnosed with CuTS and underwent minimal incision endoscopic-assisted cubital tunnel release in Police General Hospital. Patients were followed up to sixth month postoperation. The modified McGowan classification was used to determine the severity of symptoms. Surgical outcomes were evaluated by the modified Bishop classification, visual analog score (VAS), and patients' satisfaction. Other factors investigated were scar pain and peri-incisional numbness and hematomas.The incisions were measured as 7-9 mm. All patients reported having a pain score of 1 on the third day. Seven of nine patients were able to return to work one day after surgery. Modified Bishop score showed five excellence, three good, and one fair after two weeks. There was no surgical-related complication found. All patients noted the excellence satisfaction of the procedure.The minimal incision endoscopic-assisted cubital tunnel release has shown favorable outcomes with the cost-saving of simple instruments. However, a large prospective trial may be needed for further study.