• Journal of the Korean Orthopaedic Association
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• v.54 no.5
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• pp.447-451
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• 2019

This case report describes the unusual occurrence of a flexor digitorum profundus avulsion secondary to an enchondroma of the distal phalanx of the middle finger. The enchondroma was treated by simple curettage with an autogenous bone graft harvested from the olecranon. The avulsed bone fragment was reattached to the distal phalanx using the pull-out suture technique. Bony union and full function of the digit were achieved.

• The Journal of the Korean bone and joint tumor society
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• v.18 no.2
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• pp.109-112
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• 2012

A turret exostosis was known a smooth, dome-shaped extracortical collection of subperiosteal bone beneath the extensor apparatus. In most cases, turret exostosis involve middle and distal phalanges compared with involving metacarpal cases have been rarely reported in the literature.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.138-141
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• 2004

Osteochomdromas, which are uncommon in the hand, are encountered most frequently with hereditary multiple exostosis. They can occur away from the epiphyseal plate region at the distal end of the proximal and middle phalanges. But little has been written about exostosis that occur at the distal end of the distal phalnges. We report one case of hereditary multiple exostosis that arose at the distal end of the distal phalnges. Complete excision was done and the patient was disease-free of 4 years follow-up.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.117-120
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• 2011

Avulsion rupture of the flexor digitorum profundus tendon at the distal phalanx is a rare injury. It usually occurs during extension of the DIP joint, while the flexor digitorum profundus tendon is contracted, or when strong extension force is applied, to the distal phalanx. We experienced a patient, combat policeman who had avulsion rupture of flexor digitorum profundus tendon at the distal phalanx after 2 days of combat exercise. Here, we would like to report unusual case of rare tendon injury with studies from other papers.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.480-484
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• 2006

Purpose: A lot of surgical techniques were tried to correct extension lag of distal interphalangeal joint. Spiral oblique retinacular ligament reconstruction is the one of correction techniques. Methods: From January 2004 to January 2005, a total of 13 extension lag of distal interphalangeal joint corrections were performed using spiral oblique retinacular ligament reconstruction for 11 patients. After dorsal incision exposing from base of distal phalanx to proximal phalanx, the new ligament(half of lateral band or graft tendon) lies distally at the dorsum of the distal phalanx and passes volarly and proximally along the side of the middle phalanx and anterior and obliquely across the front of the proximal interphalangeal joint to the opposite side of the digit at the proximal phalanx. Results: 5 of 6 mallet finger deformities and 7 swan neck deformities were corrected, which were both extension lag of distal interphalangeal joint and hyperextension of proximal interphalangeal joint. Conclusion: As a result, spiral oblique retinacular ligament reconstruction is an effective and recommendable method for correction of mallet finger deformity and swan neck deformity.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.409-412
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• 2007

Purpose: Percutaneous Kirschner wire fixation is common method for hand fracture. It is simple but has risk of ascending infection through the pin and bony injury by multiple drilling. Ascending infection through pin tract is mostly superficial and can be treated with antibiotics and aseptic dressing. This is a case review of subacute osteomyelitis on phalangeal bones after Kirschner wire fixation with literature review. Methods: A 40-years-old man with distal phalangeal fracture on right second finger is presented. He went to a local clinic and had percutaneous Kirschner wire fixation under local anesthesia. He was transferred to our hospital for ulcerative wound on DIP joint at 4 weeks after operation. Radiography showed osteolytic change around medulla of middle and distal phalanges, leading to diagnosis of a subacute osteomyelitis. We treated it with amputation at the level of shaft of middle phalanx. Results: The postoperative course was uneventful. We thought several possible reasons for osteomyelitis in our case. First, it could resulted from ascending infection through the wire. Second, it could be resulted from a bony burn by repeated drilling. And bony necrosis could be a consequence of arterial insufficiency caused by 2 pin insertion. Conclusion: We suggest that a precise pinning based on accurate anatomical understanding is required for a percutaneous Kirschner wire fixation. The frequency of drilling should be minimized. Careful observation and patient education for pin site care are essential.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.18-25
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• 2011

Purpose: In the process of replantation of the amputated fingertips, the primary concern was given to survival of the amputees, while the functional aspect of digits after the surgery has been easily neglected. Although an internal fixation with a K-wire is often a part of replantation of the amputated fingertips, little consideration had been given to the study of relationship between distal interphalangeal joint fixation and post operative range of motion. A comparative study in relation to post operative range of motion was done on two different groups, one group with K-wire insertion and the other group without a K-wire insertion at the distal interphalangeal joint. Materials and Methods: The study was done on the cases of a single digit amputation conducted at our institute (the age in the range of 10 to 60) in about four-year of time span from March of 2005 to March of 2009. The cases with a thumb replantation, osteomyelitis or articular surface injury have been excluded from this study. The cases of both head and shaft fracture, except the insertion site of tendon, of distal phalanx of internal fixation with a single K-wire were reviewed for this study. A group of 24 cases without distal interphalangeal joint fixation in comparison to a group of 22 cases with distal interphalangeal joint fixation was reviewed to assess the postoperative range of motion at distal interphalangeal joint on the 6th week after the surgery. And, on the 30th month after the surgery, a group of 10 cases without distal interphalangeal joint fixation in comparison to a group of 10 cases with joint fixation was reviewed. A K-wire was removed in about 5 weeks after the fracture was reunited under the radiographic image, immediately followed by a physical therapy. Result: The active range of motion for a group without interphalangeal joint fixation was measured $49.0^{\circ}$ on average, while $28.6^{\circ}$ was measured for a group with interphalengeal fixation on the 6th week after the surgery. On the 30th month after the surgery, the active range of motion was measured $52.0^{\circ}$ and $55.0^{\circ}$ on average for a group without and with interphalangeal fixation respectively. Conclusion: In the process of replantation of the amputated fingertips, short-term(on the 6th week) improvement of postoperative active motion of range can be expected in the cases without distal interphalangeal fixation in comparison to the cases of interphalangeal joint fixation with a K-wire. However, there seems to be no difference on motion of range in a long-term (on the 30th month) follow up period.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.239-247
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• 2018

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford's criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a significant relationship between gap or step-off and extension lag. Using Crawford's evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.248-253
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• 2018

Purpose: The purpose of this study was to evaluate the clinical results of anatomic reduction of bony mallet finger using modified-intrafocal pinning technique. Methods: From March 2014 to October 2017, 18 patients with bony mallet finger were treated with modified-intrafocal pinning technique. Kirschner-wire was used to directly reduction the bony fragment, and extension block pinning and distal interphalangeal joint fixation were additionally performed to minimize the loss of reduction. Postoperative pain, range of motion, and radiological evaluation were performed. Duration of bone healing, functional recovery and complication rate were evaluated and Crawford's criteria was used to determine functional outcome after surgery. Results: Bone union was achieved in all cases after a postoperative mean of 6 weeks (5-7 weeks). An average of $2.8^{\circ}$ ($0^{\circ}-10^{\circ}$) extension loss occurred in all patients. All patients showed satisfactory joint congruency and reformation of the joint surface, the mean flexion angle of the distal interphalangeal joint at the final follow-up was $72.2^{\circ}$ ($70^{\circ}-75^{\circ}$). According to Crawford's classification, 12 patients (66.7%) were excellent and 6 patients (33.3%) were good. Conclusion: Modified-intrafocal pinning technique is a method of obtaining anatomical bone healing by directly reduction and fixation of the bony fragment. Combined with other conventional percutaneous pinning procedures, it is expected that good results can be obtained if applied to appropriate indications.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.107-112
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• 2004

Purpose: We described our experience with subungual exostosis in the foot for which we used different surgical technique according as location and size of lesion and revealed excellent results. Materials and Methods: We experienced 12 cases of subungual exostosis that were treated surgically and followed them more than one year between October 1995 and July 2003. There were nine females and three males. The average age of patients at surgery was 13.4 years. Duration of symptoms was 20.3 months on average. The lesion involved the hallux in nine cases; eight dorsomedial and one dorsolateral aspect of distal phalangeal bone. It involved the second, the third, and the fifth toe in one each; all central aspect of dorsum of distal phalanx. We used surgical technique that involves approaching the exostosis under the nail to preserve nail coverage for lesion in the hallux. The nails were extracted totally but preserved nail bed as much as possible in other toes. Results were based on appearance of the regenerated nail and presence of recurrence. Excellent results were those in which the nail appeared nearly normal and there was no clinical or radiographic evidence of recurrence. Good results were associated with a minor nail deformity such as ridging, and no evidence of recurrence. Fair results had obvious nail deformity or a minimal asymptomatic recurrence that was discernable only on radiograph. Poor results were associated with a clinically evident symptomatic recurrence. Results: When the lesion involved hallux, there were six excellent and two good results, and one poor result. All cases that involved other toes revealed good results. Conclusion: We suggest that different surgical technique might be applied according as location and size of the lesion to achieve satisfactory results for subungual exostosis in the foot.