:Purpose : The surgical techniques widely used in Japan for idiopathic carpal tunnel syndrome (CTS) are the Okutsu method of endoscopic carpal tunnel release (ECTR) and palmar incision for open carpal tunnel release (OCTR). However, no prospective randomized controlled trials (RCTs) have compared treatment outcomes between these two procedures. This RCT compared shortterm outcomes between ECTR and OCTR for CTS.Materials and Methods : Subjects were 101 hands (79 patients) treated in the department. ECTR was performed on 51 hands (40 patients), and OCTR was performed on 50 hands (39 patients). For assessment items, the following patient -based outcomes were evaluated : 1) changes in subjective symptoms ; and 2) impairment in activities of daily living. The following items were also evaluated by physicians : 3) abductor pollicis brevis -distal latency (APB -DL) ; 4) sensation ; and 5) muscle strength. All these assessments were made in postoperative weeks 4 and 12.Results : Recovery of muscle strength at postoperative week 4 was significantly better with ECTR (p<0.05), but no significant differences were identified between groups in any of the other items. The ECTR group showed transient postoperative exacerbation of subjective symptoms in two hands (4%) and of APB -DL in three hands (6%). Comparison of hands with improved and exacerbated postoperative APB -DL in the ECTR group revealed significantly greater preoperative electrophysiological severity in exacerbated hands (p<0.05). The cause of postoperative exacerbation with ECTR was considered to be transient nerve dysfunction resulting from the unique aspects of the ECTR procedure.Conclusions : Compared with OCTR, ECTR offers superior recovery of muscle strength in the early postoperative period. At the same time, ECTR may carry a risk of transient nerve dysfunction in the early postoperative period. Caution must therefore be exercised when using ECTR for patients with severe electrophysiological findings.

Long-term follow-up of humerus reconstruction by FVFHG showed no deterioration in upper limb function despite the risk of fibular head resorption. FVFHG of the proximal humerus is a reconstruction technique that can provide good long-term upper limb function.

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Summary:A pedicled latissimus dorsi (LD) myocutaneous flap is a reliable reconstructive method for elbow flexion, though there are no reports regarding its application to a terminal nerve level injury of the brachial plexus. A 29-year-old man presented with dysfunction of elbow flexion, wrist extension, and finger extension. Physical examination and electromyography showed that the palsy was caused by an injury at the terminal nerve level of the brachial plexus without dysfunction of the axillary nerve. Bipolar transfer of LD for reconstruction of elbow flexion and subsequent tendon transfer for wrist and finger extension were performed. The final British Medical Research Council grade was 4 for elbow flexion, and active range of motion was 0/135. An injury at the terminal nerve level of the brachial plexus should be listed in the differential diagnosis of elbow flexion dysfunction even if shoulder function is intact, and a suitable reconstructive method for this atypical type of palsy could be bipolar transfer of a LD flap.

Background : Treatment strategies for bone defects include free bone grafting, distraction osteogenesis, and vascularized bone grafting. Because bone defect morphology is often irregular, selecting treatment strategies may be difficult. With the Masquelet technique, a fracture site is bridged and fixed with a locking plate after treating deep infection with antibiotic -containing cement, and a free cancellous bone -graft is concomitantly placed into the defects. This procedure avoids excessive bone resection. Methods : We studied 6 patients who underwent surgical treatment for deep infection occurring after extremity trauma (2004 through In all patients, bone defects were filled with antibiotic -containing cement beads after infected site debridement. If bacterial culture of infected sites during curettage was positive, surgery was repeated to refill bone defects with antibiotic -containing cement beads. After confirmation of negative bacterial culture, osteosynthesis was performed, in which bone defects were bridged and fixed with locking plates. Concomitantly, crushed cancellous bone grafts harvested from the autogenous ilium was placed in the bone defects. Results : Time from bone grafting and plate fixation to bone union was at least 3 and at most 6 months, 4 months on average. Infection relapsed in one patient with methicillin -resistant Staphylococcus aureus, necessitating vascularized fibular grafting which achieved bone union. No patients showed implant loosening or breakage or infection relapse after the last surgery during follow -up. Conclusion : The advantage of cancellous bone grafting include applicability to relatively large bone defects, simple surgical procedure, bone graft adjustability to bone defect morphology, rapid bone graft revascularization resulting in high resistance to infection, and excellent osteogenesis.