Objective To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips. Methods Between August 2019 and October 2021, a total of 15 fingertips defects were repaired with neurovascular staghorn flap. There were 8 males and 7 females with an average age of 44 years (range, 28-65 years). The causes of injury included 8 cases of machine crush injury, 4 cases of heavy object crush injury, and 3 cases of cutting injury. There were 1 case of thumb, 5 cases of index finger, 6 cases of middle finger, 2 cases of ring finger, and 1 case of little finger. There were 12 cases in emergency, and 3 cases with finger tip necrosis after trauma suture. Bone and tendon exposed in all cases. The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm, and the range of skin flap was 2.0 cm×1.5 cm to 2.5 cm×2.0 cm. The donor site was sutured directly. Results All flaps survived without infection or necrosis, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10 months. At last follow-up, the appearance of the flap was satisfactory, the wear resistance was good, the color was similar to the skin of the finger pulp, and there was no swelling; the two-point discrimination of the flap was 3-5 mm. One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension, which had little effect on the function; the other patients had no obvious scar contracture, good flexion and extension of the fingers, and no dysfunction. The finger function was evaluated according to the total range of motion (TAM) system of the Hand Surgery Society of Chinese Medical Association, and excellent results were obtained in 13 cases and good results in 2 cases. Conclusion The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect. The flap has a good fit with the wound without wasting skin. The appearance and function of the finger are satisfactory after operation.
Objective To explore the effectiveness of arthroscopic-assisted closed reduction and internal fixation with absorbable screws in the treatment of Hawkins type Ⅱ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data of 31 patients with closed Hawkins type Ⅱ talar neck fractures between October 2021 and July 2023, all of whom were treated with arthroscopic-assisted closed reduction and internal fixation with absorbable screws. There were 18 males and 13 females with an average age of 35.9 years (range, 17-61 years). Causes of injury included sports injuries in 26 cases and impact injuries in 5 cases. The time from fracture to operation was 3-5 days (mean, 3.7 days). During follow-up, ankle pain and function were assessed using the visual analogue scale (VAS) score and the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AHS), while radiological examinations were used to evaluate the quality of fracture reduction and healing. ResultsAll operations were successfully completed, and all incisions healed by first intention. All patients were followed up 12-16 months (mean, 13.0 months). One patient experienced persistent pain, limping, and joint dysfunction postoperatively, which returned to normal after symptomatic treatment. At 3 months after operation and last follow-up, the VAS scores were 2.7±0.9 and 1.3±0.8, respectively; the AOFAS-AHS were 74.5±4.7 and 90.9±3.6, respectively. There were significant differences in VAS score and AOFAS-AHS between different time points (P<0.05). At last follow-up, all fractures healed, and the internal fixation was secure. No complication such as talar necrosis, subtalar joint stiffness, wound infection, or screw irritation occurred during follow-up. Conclusion Arthroscopic-assisted closed reduction and internal fixation with absorbable screws for Hawkins type Ⅱ talar neck fractures has the advantages of minimal trauma, precise screw placement, few complications, and avoiding secondary screw removal, with satisfactory effectiveness.