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Radioulnar synostosis is a rare complication after a forearm or elbow injury. The severity of initial trauma, associated head injury along with timing and the type of surgical treatment have been implicated in the formation of extra bone leading to synostosis. Surgical intervention is the standard treatment and is recommended after the maturation of synostotic bone. Surgery involves resection of the extra bone with or without tissue interposition. Materials used for interposition may include synthetic materials, allografts, and vascularized and non-vascularized autologous tissue superiority of one material over the other has not been demonstrated. Reported is a case of extensive soft-tissue defect and severe type II synostosis, with a relevant review of the literature. Level of Evidence Level IV. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00395-5.

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Hemihamate arthroplasty is an established method of managing difficult Pilon fractures of the proximal interphalangeal (PIP) joint. We present our experience in 30 patients, whose injuries were further complicated by severe comminution and late presentations. Several modifications were utilized, including preoperative distraction, use of smaller size grafts and functional release of collaterals. The average follow-up period was 28 months (range 18 to 28). Postoperatively, the average range of flexion at the PIP joint improved from 30° (range 20° to 45°) preoperatively to 104° (90° to 110°) at the final follow-up. The average extension lag was 6° (0° to 20°). Five patients required secondary procedures and no patient had a recurrent dorsal dislocation. We propose these modifications in the use of hemihamate arthroplasty for the management of difficult PIP joint fractures.Level of evidence: IV.

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PURPOSE: The abductor digiti minimi (ADM) and flexor digiti minimi (FDM) muscles have a similar vascular and nerve supply. The purpose of this study was to assess the feasibility of transferring the FDM instead of ADM for thumb opposition. METHODS: Thirty cadaver hands were dissected under loupe magnification to assess the presence of the ADM and FDM muscles as well as their blood and nerve supply. The length of these muscles and their location in relation to the radial aspect of the thumb metacarpophalangeal joint were assessed. RESULTS: The ADM muscle was present in all cadavers whereas the FDM muscle was absent in 33% of hands. When the dimensions were suitable (53%), the more radially located FDM muscle reached the thumb metacarpophalangeal joint more easily. CONCLUSIONS: Although the dissections revealed considerable variability in FDM anatomy, when present, it can have positional advantage over the ADM for opponensplasty. CLINICAL RELEVANCE: In some cases with radial longitudinal deficiency, preservation of ADM function is essential. In these children, the FDM can potentially be explored and transferred if it is found to be suitable.

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Amputation of multiple fingers of both hands is a rare and serious injury. We report a case of a 41-year-old male patient who presented to Khoula Hospital, Muscat, Oman, in 2015 with the amputation of nine fingers due to a workplace injury. With two teams working in tandem, all the amputated fingers were re-attached. A total of seven fingers survived and the patient regained reasonable functionality of his hands. To the best of the authors' knowledge, this is the first case of several finger amputations in Oman.

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BACKGROUND: Presenting and demonstrating a surgical procedure in the current era is difficult without good intraoperative pictures and videos. A long, complex, multi-staged surgery is better illustrated by detailed intraoperative images at various stages. Although desirable, it may be difficult due to various reasons. MATERIAL AND METHODS: A simple method of preparing illustrations with pictures/diagrams created on PowerPoint and clay models to recreate the missing links in clinical photographs has been proposed. RESULTS: It is a simple technique with a moderate learning curve. Once familiar with technique, one can effectively use the technique to convey the details in much more clear manner. CONCLUSION: It is a simple and effective way of communicating through digital images, and gives the audience a 3 dimensional idea about the concept.

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Giant Cell Tumors commonly occur at the ends of long bones. However in rare cases, they can occur in the bones of the hands and feet. Tumors in these locations occur in younger patients; in addition, these tumors are more commonly multifocal and are associated with a higher risk for local recurrence than tumors at the ends of long bones. Since lesions in the small bones may be multifocal, a patient with a giant cell tumor of the small bones should undergo a skeletal survey to exclude similar lesions elsewhere. Primary surgical treatment ranges from curettage or excision with or without bone grafting to amputation. The success of surgical treatment depends on the completeness with which the tumor was removed. We are presenting a case report of a 34 year old female, who presented with a swelling in the right hand, following trauma. X-ray of the hand showed an osteolytic expansile lesion at the base of the 1(st) metacarpal bone. The lesion was initially curetted and then treated by local resection with bone grafting. Histological examination revealed a typical benign giant cell tumor composed of closely packed stromal cells with a variable admixture of giant cells. Follow up at the end of one year did not reveal any recurrence of the tumor.

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INTRODUCTION: Bone dust is often used as a control when testing the potential of a new reconstructive graft material. Under microscopic examination, it would be expected to see the fully differentiated cellular components of bone, but instead only fusiform shapes characteristic of fibroblasts are mainly seen. This study aimed to compare the osteogenic potential of cells obtained from calvarial bone dust, bone fragments, and periosteum using 3 assays: collagen, calcium, and alkaline phosphatase. MATERIALS AND METHODS: Bone dust was harvested from the calvaria of 5 euthanized rabbits by drilling burr holes. Small pieces of intact, nondrilled bone, and periosteum were also obtained to serve as controls. The cells obtained from the bone dust, bone fragments, and periosteum were cultured for 5 weeks and then assayed for collagen (type 1), calcium, and alkaline phosphatase. RESULTS: Staining for calcium revealed that the greatest calcium deposition was achieved with periosteum, followed by bone dust and then bone fragments. Staining for alkaline phosphatase was similar for bone dust and periosteum, followed by bone fragments. Collagen assay demonstrated the presence of collagen in similar concentrations in all 3 preparations. CONCLUSIONS: Bone dust has most of the necessary components for osteogenesis, including the presence of osteoprogenitor cells that have the ability to lay down collagen type 1 and deposit calcium and can differentiate to form bone. Further studies that can accurately quantify the percentage of surviving osteoblasts in various bone components are needed.

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UNLABELLED: Polymethylmethacrylate (PMMA) is still the most frequently used alloplastic material for calvarial reconstruction, especially when dealing with large bony defects. It is strong, provides good protection to the underlying cerebral structures, and is stable and minimally reactive. One of the disadvantages of this material is its tendency to become loose over time because of its poor adherence to bone. Onlay miniscrews in improving PMMA's adhesion to bone have been previously proposed. A series of experiments were conducted to evaluate whether placement of screw anchors will significantly improve the adhesion force between the polymer and bony surface. METHODS: Four fresh-frozen cadaver heads were used for this experiment. The PMMA preparation and setup time strictly followed manufacturer guidelines. Two experimental groups were created: (1) PMMA was placed on the subperiosteal bony surface with increasing surface areas (areas: 1-20 cm2), and (2) a standard area of 16 cm2 PMMA was placed on the bony surface with an increasing number of titanium miniscrews (number of screws: 0-5). The force required to separate the material from the underlying bone was assessed using a digital pull force gauge (Imada DPS-44) through vertical traction. The experiments were undertaken in triplicate; the results were statistically analyzed using Student t test. RESULTS: Experiment 1: increasing forces were required as the surface area of PMMA application increased (1.2-42.3 N). The most consistent measurements with a low SD were obtained on the 16-cm2 implant, which was chosen for experiment 2. A 16-cm2 area would allow for the placement of up to 5 screws without technical difficulty. Experiment 2: higher forces were needed to detach the material, with increasing screw placement (1, 79; 2, 132.5; 3, 194.2; and 4 and 5, >196.1 N). In 73 of 75 experiments, the screws remained attached to the PMMA after separation. When the PMMA alone on a 16-cm2 surface area was compared with the placement of one or more screws, the force of adhesion significantly increased for all groups (P < 0.01). There was a 2.6x increase in this force with 1 screw, 4.4x with 2, 6.4x with 3, and 6.5x with 4 or more screws. Three or more miniscrews provided sufficient stabilization to anchor an implant firmly in place while resisting large traction forces. CONCLUSION: Although greater surface areas of PMMA will increase the adhesion force between the polymer and bone, a clinically and statistically significant increase in this force may only be achieved with the use of miniscrews.

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Neural tumors composed of Pacinian corpuscles are rare and have only occasionally been reported in the literature. All such lesions, which have been reported to date, have been benign. One such lesion described here presented as a painful lesion on the right hand in a 17-year-old Omani female. There was history of trap door injury 7 years back involving the wrist, thumb and index finger. The patient gradually developed multiple bosselated nodules near the first web space with gradually increasing pain. This case is being reported for the first time in the Sultanate of Oman. We herein report this case due to its rarity.