The management of gouty tophi has generally shifted from surgical excision to conservative therap... more The management of gouty tophi has generally shifted from surgical excision to conservative therapy due to surgery's traditional association with high wound complication rate. Yet there are still patients who are indicated for surgical excision of gouty tophi, including for functional or cosmetic reasons. We describe our surgical technique and clinical outcomes in patients who underwent gouty tophi excision. This technique includes near complete excision of non-infected gouty tophi with preservation of important soft tissue structures. We have performed 44 elective tophi excision surgery in ten patients with an average follow-up of 29 months. The overall patients' satisfaction rate was 90%. Only one post-operative infection was noted. No recurrence was observed. Our results suggested that this technique is a safe and effective option for a selected group of patients suffering from tophaceous gout.
G diabetes mellitus leading to peripheral neuropathy. Sural artery flap was utilized; its elevati... more G diabetes mellitus leading to peripheral neuropathy. Sural artery flap was utilized; its elevation is seen from the proximal aspect of the posterior calf area, modified by the inclusion of midline gastrocnemius muscle cuff around the sural pedicle. . Adequate coverage seen in the immediate post operative period. The pedicle was kept wide and not passed through subcutaneous tunnel. It required split thickness skin grafting for coverage. The flap developed mild distal congestion which resolved spontaneously with foot elevation without any problems.<b>Copyright information:</b>Taken from "The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature"http://www.josr-online.com/content/3/1/15Journal of Orthopaedic Surgery and Research 2008;3():15-15.Published online 18 Apr 2008PMCID:PMC2373287.
Objectives/Interrogation: Distal radius fractures are associated with a high incidence of triangl... more Objectives/Interrogation: Distal radius fractures are associated with a high incidence of trianglular fibrocartilage complex (TFCC) tears. Healing of TFCC tears is postulated after anatomical fixation. This study aims to evaluate the status of TFCC after the union of distal radius fractures [for full text, please go to the a.m. URL]
License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description that schwannomas are well encapsulated and can be completely enucleated during excision, a portion of them have fascicular involvement and could not be completely shelled out. A retrospective review for 8 patients was carried out over 10 years. 75 % of schwannoma occurred over the distal region of upper limb (at elbow or distal to it). It occurs more in the mixed nerve instead of pure sensory or motor nerve. 50% of patients had mixed nerve involvement. Fascicular involvement was very common in schwannoma (75 % of patients). Removal of the tumour with fascicles can cause functional deficit. At present, there is no method (including preoperative MRI) which can predict the occurrence of fascicular involvement; the authors therefore proposed a new system to strati...
In patients with symptomatic chronic tear of the triangular fibrocartilage complex (TFCC), recons... more In patients with symptomatic chronic tear of the triangular fibrocartilage complex (TFCC), reconstruction with a tendon graft is indicated. We propose an arthroscopic-assisted technique to reconstruct the TFCC and to stabilize the distal radioulnar joint. Patients with a chronic foveal TFCC tear of which it is deem not reparable were recruited. TFCC reconstruction was performed by making use of the TFCC remnants and a palmaris tendon graft under arthroscopic guidance. Twelve patients with an average age of 29 years old were evaluated. Three patients had concomitant ulnar shortening procedure. The average follow-up period was 29 months. All patients had stable DRUJ. Significant improvement was noted for pain score (from 4 to 1), DASH score (from 31 to 9.5), and Mayo modified wrist score (from 82 to 95). Grip strength was improved and the range of movement of the wrist was maintained. No complication nor graft re-rupture was noted. This is a viable arthroscopic technique of TFCC reconstruction in a selected group of patients who had chronic foveal TFCC tear.
Objectives/Interrogation: Adaptive carpal instability following mal-united extra-articular Colles... more Objectives/Interrogation: Adaptive carpal instability following mal-united extra-articular Colles' fracture is a well-recognized condition. Yet carpal instability non-dissociative (CIND) after intra-articular distal radius fractures or radiocarpal dislocation has not been reported. This[for full text, please go to the a.m. URL]
He heel. . After debridement, area of skin loss can be seen, optimal for flap coverage.<b>C... more He heel. . After debridement, area of skin loss can be seen, optimal for flap coverage.<b>Copyright information:</b>Taken from "The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature"http://www.josr-online.com/content/3/1/15Journal of Orthopaedic Surgery and Research 2008;3():15-15.Published online 18 Apr 2008PMCID:PMC2373287.
E flow sural artery neurocutaneous flap is being rotaed through an arc 180 degrees on its pedicle... more E flow sural artery neurocutaneous flap is being rotaed through an arc 180 degrees on its pedicle. . The flap inset into the defect after rotation with excellent coverage.<b>Copyright information:</b>Taken from "The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature"http://www.josr-online.com/content/3/1/15Journal of Orthopaedic Surgery and Research 2008;3():15-15.Published online 18 Apr 2008PMCID:PMC2373287.
Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description tha... more Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description that schwannomas are well encapsulated and can be completely enucleated during excision, a portion of them have fascicular involvement and could not be completely shelled out. A retrospective review for 8 patients was carried out over 10 years. 75% of schwannoma occurred over the distal region of upper limb (at elbow or distal to it). It occurs more in the mixed nerve instead of pure sensory or motor nerve. 50% of patients had mixed nerve involvement. Fascicular involvement was very common in schwannoma (75% of patients). Removal of the tumour with fascicles can cause functional deficit. At present, there is no method (including preoperative MRI) which can predict the occurrence of fascicular involvement; the authors therefore proposed a new system to stratify patients who may benefit from interfascicular nerve grafts. In this group of patients, the authors strongly recommend that the possi...
Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endos... more Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endoscopic cubital tunnel decompression has gained popularity in recent years as this enables surgeons to achieve decompression of the ulnar nerve along its course using a small incision. This article describes the technical peals in performing endoscopic cubital tunnel decompression. In conditions which anterior transposition of the ulnar nerve is needed, subcutaneous transposition can be performed under endoscopic guidance. In addition, current literature is reviewed, and outcomes are presented. While short term results are encouraging, further prospective randomized study with longer follow-up is recommended.
Background: Reverse flow sural neurocutaneous flap has been utilized more frequently during the p... more Background: Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation. Methods: This descriptive case series was conducted at Queen Mary Hospital, Hong Kong, from 1997 to 2003. Ten patients having undergone reverse flow sural neurocutaneous flap were identified through medical records. There were six females (60%) and four males (40%), with an average age of 59.8 years. The defects occurred as a result of trauma in five patients (50%), diabetic ulcers in four (40%) and decubitus ulcer in one (10%) paraplegic patient. The defect site included non weight bearing heel in four (40%), tendo Achilles in two (20%), distal tibia in two (20%), lateral malleolus in o...
Hong Kong medical journal = Xianggang yi xue za zhi, 2007
OBJECTIVES To evaluate the application of a translated version of an established self-administere... more OBJECTIVES To evaluate the application of a translated version of an established self-administered questionnaire for carpal tunnel syndrome on Chinese patients in Hong Kong. DESIGN Evaluation of an instrument tool. SETTING Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong; Holistic Medical Centre, Aberdeen, Hong Kong. PARTICIPANTS Patients with carpal tunnel syndrome, translators. MAIN OUTCOME MEASURES The adaptation was based on forward-backward translation from English to Chinese (Hong Kong) and vice versa. Meetings with translators, investigators, and patients were organised to generate an acceptable version of the questionnaire. A pilot study was carried out on 20 patients and subsequently minor adjustments were added. Fifty patients were recruited to validate the reliability and internal consistency of the questionnaire. RESULTS The ordinality of response agreed with the original instrument. Test-retest reproducibility showed no significant difference ...
Cubital tunnel syndrome is the 2nd most common compressive nerve entrapment in the upper limb. Fo... more Cubital tunnel syndrome is the 2nd most common compressive nerve entrapment in the upper limb. For patients who remained symptomatic after conservative therapy, surgical decompression of the ulnar nerve is indicated. In selected cases e.g. ulnar nerve hypermobility, concomitant anterior transposition of the ulnar nerve may be needed to warrant a good outcome. Traditionally surgical decompression with or without anterior transposition is performed in an open method. As the endoscopic techniques have evolved, the nerve can now be decompressed and transposed endoscopically.
scapholunate dissociation and restores scapholunate joint stability. 4-DCT demonstrated the anato... more scapholunate dissociation and restores scapholunate joint stability. 4-DCT demonstrated the anatomical impact of scapholunate interosseous and dorsal extrinsic ligaments sectioning on carpal stability during radioulnar deviation and more importantly, the positive impact of the SLICL in restoring CT kinematic parameters to normal and thus, scapholunate joint stability and normal carpal anatomy. This represents additional evidence of the effectiveness of the SLICL in correcting dissociation and supports the use of 4-DCT for the postoperative evaluation of patients with persistent symptoms and where radiographic evaluation may be non-contributory. Contrary to conventional radiographs, 4-DCT is not influenced by superimposition phenomenon and measurement errors related to the wrist position. This technique can quantify distances between carpal bones during motion with more precision and a better intraand interobserver reproducibility than radiographs. Further clinical studies with a kin...
Wrist and hand injuries are very common in sports trauma, particularly in many contact and ball s... more Wrist and hand injuries are very common in sports trauma, particularly in many contact and ball sports. However, they are often missed or treated as simple sprains. A high index of suspicion is needed when symptoms and signs persist, particularly, if the athlete continues to compete with a painful wrist or swollen finger, which can lead to further injury of the secondary stabilizers and articular surfaces. Unfortunately, these late presentations are a much greater challenge to manage. It is too late to simply reduce the joint or the fracture, so a salvage procedure such as a fusion may be required. This chapter presents and discusses different scenarios of wrist and hand injury in sports practice, clinical and radiological evaluation, as well as therapeutic approaches.
Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine
Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompress... more Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompression is indicated for patients who failed conservative therapy. Decompression in situ has shown to achieve comparable outcomes as decompression with anterior transposition in idiopathic cubital tunnel syndrome. Endoscopic cubital tunnel decompression has gained popularity in recent years, as surgeons can attain decompression of the ulnar nerve along its course using a small incision. Results from randomised controlled studies and systematic reviews, comparing endoscopic with open decompression in situ, are promising. Cases in which anterior transposition of the ulnar nerve is needed, an endoscopic technique can still be used by creating an additional volar portal, for the mobilisation of ulnar nerve. Early short-term results are encouraging. Further adequately powered, prospective, preferably double-blinded, randomised study are needed.
The management of gouty tophi has generally shifted from surgical excision to conservative therap... more The management of gouty tophi has generally shifted from surgical excision to conservative therapy due to surgery's traditional association with high wound complication rate. Yet there are still patients who are indicated for surgical excision of gouty tophi, including for functional or cosmetic reasons. We describe our surgical technique and clinical outcomes in patients who underwent gouty tophi excision. This technique includes near complete excision of non-infected gouty tophi with preservation of important soft tissue structures. We have performed 44 elective tophi excision surgery in ten patients with an average follow-up of 29 months. The overall patients' satisfaction rate was 90%. Only one post-operative infection was noted. No recurrence was observed. Our results suggested that this technique is a safe and effective option for a selected group of patients suffering from tophaceous gout.
G diabetes mellitus leading to peripheral neuropathy. Sural artery flap was utilized; its elevati... more G diabetes mellitus leading to peripheral neuropathy. Sural artery flap was utilized; its elevation is seen from the proximal aspect of the posterior calf area, modified by the inclusion of midline gastrocnemius muscle cuff around the sural pedicle. . Adequate coverage seen in the immediate post operative period. The pedicle was kept wide and not passed through subcutaneous tunnel. It required split thickness skin grafting for coverage. The flap developed mild distal congestion which resolved spontaneously with foot elevation without any problems.<b>Copyright information:</b>Taken from "The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature"http://www.josr-online.com/content/3/1/15Journal of Orthopaedic Surgery and Research 2008;3():15-15.Published online 18 Apr 2008PMCID:PMC2373287.
Objectives/Interrogation: Distal radius fractures are associated with a high incidence of triangl... more Objectives/Interrogation: Distal radius fractures are associated with a high incidence of trianglular fibrocartilage complex (TFCC) tears. Healing of TFCC tears is postulated after anatomical fixation. This study aims to evaluate the status of TFCC after the union of distal radius fractures [for full text, please go to the a.m. URL]
License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description that schwannomas are well encapsulated and can be completely enucleated during excision, a portion of them have fascicular involvement and could not be completely shelled out. A retrospective review for 8 patients was carried out over 10 years. 75 % of schwannoma occurred over the distal region of upper limb (at elbow or distal to it). It occurs more in the mixed nerve instead of pure sensory or motor nerve. 50% of patients had mixed nerve involvement. Fascicular involvement was very common in schwannoma (75 % of patients). Removal of the tumour with fascicles can cause functional deficit. At present, there is no method (including preoperative MRI) which can predict the occurrence of fascicular involvement; the authors therefore proposed a new system to strati...
In patients with symptomatic chronic tear of the triangular fibrocartilage complex (TFCC), recons... more In patients with symptomatic chronic tear of the triangular fibrocartilage complex (TFCC), reconstruction with a tendon graft is indicated. We propose an arthroscopic-assisted technique to reconstruct the TFCC and to stabilize the distal radioulnar joint. Patients with a chronic foveal TFCC tear of which it is deem not reparable were recruited. TFCC reconstruction was performed by making use of the TFCC remnants and a palmaris tendon graft under arthroscopic guidance. Twelve patients with an average age of 29 years old were evaluated. Three patients had concomitant ulnar shortening procedure. The average follow-up period was 29 months. All patients had stable DRUJ. Significant improvement was noted for pain score (from 4 to 1), DASH score (from 31 to 9.5), and Mayo modified wrist score (from 82 to 95). Grip strength was improved and the range of movement of the wrist was maintained. No complication nor graft re-rupture was noted. This is a viable arthroscopic technique of TFCC reconstruction in a selected group of patients who had chronic foveal TFCC tear.
Objectives/Interrogation: Adaptive carpal instability following mal-united extra-articular Colles... more Objectives/Interrogation: Adaptive carpal instability following mal-united extra-articular Colles' fracture is a well-recognized condition. Yet carpal instability non-dissociative (CIND) after intra-articular distal radius fractures or radiocarpal dislocation has not been reported. This[for full text, please go to the a.m. URL]
He heel. . After debridement, area of skin loss can be seen, optimal for flap coverage.<b>C... more He heel. . After debridement, area of skin loss can be seen, optimal for flap coverage.<b>Copyright information:</b>Taken from "The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature"http://www.josr-online.com/content/3/1/15Journal of Orthopaedic Surgery and Research 2008;3():15-15.Published online 18 Apr 2008PMCID:PMC2373287.
E flow sural artery neurocutaneous flap is being rotaed through an arc 180 degrees on its pedicle... more E flow sural artery neurocutaneous flap is being rotaed through an arc 180 degrees on its pedicle. . The flap inset into the defect after rotation with excellent coverage.<b>Copyright information:</b>Taken from "The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature"http://www.josr-online.com/content/3/1/15Journal of Orthopaedic Surgery and Research 2008;3():15-15.Published online 18 Apr 2008PMCID:PMC2373287.
Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description tha... more Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description that schwannomas are well encapsulated and can be completely enucleated during excision, a portion of them have fascicular involvement and could not be completely shelled out. A retrospective review for 8 patients was carried out over 10 years. 75% of schwannoma occurred over the distal region of upper limb (at elbow or distal to it). It occurs more in the mixed nerve instead of pure sensory or motor nerve. 50% of patients had mixed nerve involvement. Fascicular involvement was very common in schwannoma (75% of patients). Removal of the tumour with fascicles can cause functional deficit. At present, there is no method (including preoperative MRI) which can predict the occurrence of fascicular involvement; the authors therefore proposed a new system to stratify patients who may benefit from interfascicular nerve grafts. In this group of patients, the authors strongly recommend that the possi...
Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endos... more Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endoscopic cubital tunnel decompression has gained popularity in recent years as this enables surgeons to achieve decompression of the ulnar nerve along its course using a small incision. This article describes the technical peals in performing endoscopic cubital tunnel decompression. In conditions which anterior transposition of the ulnar nerve is needed, subcutaneous transposition can be performed under endoscopic guidance. In addition, current literature is reviewed, and outcomes are presented. While short term results are encouraging, further prospective randomized study with longer follow-up is recommended.
Background: Reverse flow sural neurocutaneous flap has been utilized more frequently during the p... more Background: Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation. Methods: This descriptive case series was conducted at Queen Mary Hospital, Hong Kong, from 1997 to 2003. Ten patients having undergone reverse flow sural neurocutaneous flap were identified through medical records. There were six females (60%) and four males (40%), with an average age of 59.8 years. The defects occurred as a result of trauma in five patients (50%), diabetic ulcers in four (40%) and decubitus ulcer in one (10%) paraplegic patient. The defect site included non weight bearing heel in four (40%), tendo Achilles in two (20%), distal tibia in two (20%), lateral malleolus in o...
Hong Kong medical journal = Xianggang yi xue za zhi, 2007
OBJECTIVES To evaluate the application of a translated version of an established self-administere... more OBJECTIVES To evaluate the application of a translated version of an established self-administered questionnaire for carpal tunnel syndrome on Chinese patients in Hong Kong. DESIGN Evaluation of an instrument tool. SETTING Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong; Holistic Medical Centre, Aberdeen, Hong Kong. PARTICIPANTS Patients with carpal tunnel syndrome, translators. MAIN OUTCOME MEASURES The adaptation was based on forward-backward translation from English to Chinese (Hong Kong) and vice versa. Meetings with translators, investigators, and patients were organised to generate an acceptable version of the questionnaire. A pilot study was carried out on 20 patients and subsequently minor adjustments were added. Fifty patients were recruited to validate the reliability and internal consistency of the questionnaire. RESULTS The ordinality of response agreed with the original instrument. Test-retest reproducibility showed no significant difference ...
Cubital tunnel syndrome is the 2nd most common compressive nerve entrapment in the upper limb. Fo... more Cubital tunnel syndrome is the 2nd most common compressive nerve entrapment in the upper limb. For patients who remained symptomatic after conservative therapy, surgical decompression of the ulnar nerve is indicated. In selected cases e.g. ulnar nerve hypermobility, concomitant anterior transposition of the ulnar nerve may be needed to warrant a good outcome. Traditionally surgical decompression with or without anterior transposition is performed in an open method. As the endoscopic techniques have evolved, the nerve can now be decompressed and transposed endoscopically.
scapholunate dissociation and restores scapholunate joint stability. 4-DCT demonstrated the anato... more scapholunate dissociation and restores scapholunate joint stability. 4-DCT demonstrated the anatomical impact of scapholunate interosseous and dorsal extrinsic ligaments sectioning on carpal stability during radioulnar deviation and more importantly, the positive impact of the SLICL in restoring CT kinematic parameters to normal and thus, scapholunate joint stability and normal carpal anatomy. This represents additional evidence of the effectiveness of the SLICL in correcting dissociation and supports the use of 4-DCT for the postoperative evaluation of patients with persistent symptoms and where radiographic evaluation may be non-contributory. Contrary to conventional radiographs, 4-DCT is not influenced by superimposition phenomenon and measurement errors related to the wrist position. This technique can quantify distances between carpal bones during motion with more precision and a better intraand interobserver reproducibility than radiographs. Further clinical studies with a kin...
Wrist and hand injuries are very common in sports trauma, particularly in many contact and ball s... more Wrist and hand injuries are very common in sports trauma, particularly in many contact and ball sports. However, they are often missed or treated as simple sprains. A high index of suspicion is needed when symptoms and signs persist, particularly, if the athlete continues to compete with a painful wrist or swollen finger, which can lead to further injury of the secondary stabilizers and articular surfaces. Unfortunately, these late presentations are a much greater challenge to manage. It is too late to simply reduce the joint or the fracture, so a salvage procedure such as a fusion may be required. This chapter presents and discusses different scenarios of wrist and hand injury in sports practice, clinical and radiological evaluation, as well as therapeutic approaches.
Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine
Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompress... more Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompression is indicated for patients who failed conservative therapy. Decompression in situ has shown to achieve comparable outcomes as decompression with anterior transposition in idiopathic cubital tunnel syndrome. Endoscopic cubital tunnel decompression has gained popularity in recent years, as surgeons can attain decompression of the ulnar nerve along its course using a small incision. Results from randomised controlled studies and systematic reviews, comparing endoscopic with open decompression in situ, are promising. Cases in which anterior transposition of the ulnar nerve is needed, an endoscopic technique can still be used by creating an additional volar portal, for the mobilisation of ulnar nerve. Early short-term results are encouraging. Further adequately powered, prospective, preferably double-blinded, randomised study are needed.
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Papers by Margaret Fok