An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, ...An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, percutaneous or open Kirschner wire fixation similar to that in the mallet finger, or suture anchor fixation. We present a case treated by the bridging technique using two suture anchors. A 57-year-old Japanese man injured his left great toe after a fall while walking barefoot on the bed. His great toe was forced into a hyperplantarflexion position. Plain radiography and computed tomography showed a small bone fragment at the base of the dorsal distal phalanx, suggesting an avulsion fracture of the extensor hallucis longus. He was treated by bridging suture technique with two suture anchors. At first, two suture anchors were inserted to the fracture bed of the distal phalanx, and then the bone fragment and extensor hallucis longus tendon were secured with two horizontal mattress sutures. Finally, bridging sutures were performed using the remaining sutures and the sutures used for mattress suturing. He obtained bony union and symmetric range of motion of the interphalangeal joint. This technique allowed us to fix the small bone fragment rigidly and mobilize the interphalangeal joint earlier to preserve the range of motion. It would be a valuable procedure when the bone fragment is small.展开更多
Solitary bone cysts are benign bone lesions that usually occur in the humerus, calcaneus, and femur of children and adolescents. When present in adults, they are usually diagnosed as incidental findings. In this repor...Solitary bone cysts are benign bone lesions that usually occur in the humerus, calcaneus, and femur of children and adolescents. When present in adults, they are usually diagnosed as incidental findings. In this report, we present an adult case of a solitary bone cyst of the proximal humerus with concomitant refractory stiff shoulder treated with both arthroscopic capsular release and arthroscope-assisted resection of the bone cyst. A 73-year-old woman was referred with a complaint of persistent left shoulder pain and limited range of motion. Magnetic resonance imaging showed an approximately 4.5-cm long diameter cystic bone lesion from the humeral neck to the shaft. At first, arthroscopic synovectomy and pan-capsular release were performed. Next, two 1-cm skin incisions and 8-mm drill holes into the lateral wall of the cyst were created with fluoroscopic guidance. After insertion of the arthroscope through the holes, the white membranous cyst wall was resected with a shaver until bone marrow was observed. Finally, an 8-mm cannulated hydroxyapatite pin was inserted. This is a simple technique that allows direct visualization and complete resection of the cyst wall with two small incisions. Such a technique may be superior to conventional open procedures or those under image guidance.展开更多
文摘An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, percutaneous or open Kirschner wire fixation similar to that in the mallet finger, or suture anchor fixation. We present a case treated by the bridging technique using two suture anchors. A 57-year-old Japanese man injured his left great toe after a fall while walking barefoot on the bed. His great toe was forced into a hyperplantarflexion position. Plain radiography and computed tomography showed a small bone fragment at the base of the dorsal distal phalanx, suggesting an avulsion fracture of the extensor hallucis longus. He was treated by bridging suture technique with two suture anchors. At first, two suture anchors were inserted to the fracture bed of the distal phalanx, and then the bone fragment and extensor hallucis longus tendon were secured with two horizontal mattress sutures. Finally, bridging sutures were performed using the remaining sutures and the sutures used for mattress suturing. He obtained bony union and symmetric range of motion of the interphalangeal joint. This technique allowed us to fix the small bone fragment rigidly and mobilize the interphalangeal joint earlier to preserve the range of motion. It would be a valuable procedure when the bone fragment is small.
文摘Solitary bone cysts are benign bone lesions that usually occur in the humerus, calcaneus, and femur of children and adolescents. When present in adults, they are usually diagnosed as incidental findings. In this report, we present an adult case of a solitary bone cyst of the proximal humerus with concomitant refractory stiff shoulder treated with both arthroscopic capsular release and arthroscope-assisted resection of the bone cyst. A 73-year-old woman was referred with a complaint of persistent left shoulder pain and limited range of motion. Magnetic resonance imaging showed an approximately 4.5-cm long diameter cystic bone lesion from the humeral neck to the shaft. At first, arthroscopic synovectomy and pan-capsular release were performed. Next, two 1-cm skin incisions and 8-mm drill holes into the lateral wall of the cyst were created with fluoroscopic guidance. After insertion of the arthroscope through the holes, the white membranous cyst wall was resected with a shaver until bone marrow was observed. Finally, an 8-mm cannulated hydroxyapatite pin was inserted. This is a simple technique that allows direct visualization and complete resection of the cyst wall with two small incisions. Such a technique may be superior to conventional open procedures or those under image guidance.
