Objective To explore the clinical efficacy of the treatment for scaphoid waist fracture assisted by wrist arthroscopy.Methods From January2015 to December 2017,12 cases of fresh scaphoid waist fracture were treated with closed reduction and percutaneous Herbert screw fixation assisted by wrist arthroscopy.The healing of fracture was observed by regular X-ray after operation.Results All the patients were follow-up for 6 to 12 months,with an average of 10 months.All the fractures healed,with an average healing time of 8.4 weeks.The wrist function was evaluated by modified Mayo wrist score.The results were rated as excellent in 8 cases and good in 4 cases.Conclusion Percutaneous internal fixation with Herbert screw assisted by wrist arthroscopy for fresh scaphoid waist fracture can achieve satisfactory clinical results.

Objective: To report outcomes of repair of flexor pollicis longus (FPL) tendon in 23 thumbs followed by early active thumb motion. Materials and Methods: We used a 6-strand repair with very loose epitenon suture for lacerated FPL tendons in 23 thumbs. These patients were treated between January 2014 and May 2015. All patients were repaired primarily in the day of injury or within the first week after injury. The FPL was exposed through a Bruner’s incision, and the tendon was repaired with either a 6-strand M-Tang repair (17 thumbs) using 4-0 looped suture and a 6-strand repair method made of 3 groups of modified Kessler repair (6 thumbs) using 4-0 Ethilon suture. After surgery, the thumbs were immobilized for 3 to 4 days, and active motion was initiated after that. The patient was encouraged to move the thumb interphalangeal joint to about ½ of the total motion range in the first 1 to 3 weeks after repair. Then the patient proceeded to full range of active motion around the end of week 3. Results: All patients were followed for 6 to 19 months with the mean follow-up of 14 months. The functional recovery at the final follow-up was graded according to Strickland criteria. Fourteen thumbs were rated excellent, 4 good, and 3 fair. No thumbs were rated poor. No rupture of the FPL was recorded. The overall excellent and good rate was 86%, and the rate of fair results was 14%. Conclusions: We found that a 6-strand core suture repair is sufficient for early active motion of the repaired FPL tendon. With early active motion, the recovery of the FPL function is usually excellent and good. We found there is no risk of repair rupture with a 6-strand core suture repair. We only used very loosely added 2 or 3 stitches of epitenon suture. We found that adding complex epitenon suture is unnecessary with a strong 6-strand repair for the FPL tendon.

Objectives: We report our experience in using a perforator island flap based on the middle dorsal branch of the proper palmar digital artery for repairing fingertip defect and analyze the clinical outcomes in 25 patients. Methods: Between January 2014 and July 2015, we repaired soft tissue defects of 25 fingers, including 10 index, 4 middle, 5 ring, and 6 little fingers, using this pedicle perforator flap. The middle dorsal branch of the proper palmar digital artery was dissected out and was used as the pedicle with fascia tissue of about 5 mm preserved surrounding the pedicle to ensure venous return. The donor located on the dorsal aspect of the proximal phalanx. The defects in the fingertip were pulp defects on the volar or lateral sides, mostly involving the bone or with bone exposure. Donor site was covered with full-thickness skin graft. The flap survival rate and hand function recovery were analyzed. Results: All flaps survived completely. The patients were followed up for 6 to 18 months. The blood circulation, thickness, skin texture, and the color of the transferred flap match those of normal fingertip. The static 2-point discrimination of the flap ranged from 8 to 11 mm. Minor or mild extension contracture of the distal interphalangeal (DIP) joint was noted in most cases, but no severe scar contracture of the DIP and proximal interphalangeal (PIP) joints. Conclusions: We found that the perforator island flap based on the middle dorsal branch of the proper palmar digital artery is an additional good option of distal finger soft tissue repair. The merit of this flap is no sacrifice of the proper digital artery and close proximity of the donor to the fingertip. The vascular supplies to this flap are reliable for a pedicle perforator flap transfer based on our experience.