Nishimura, Ken

Background: This study aimed to determine whether trapezium morphology, specifically trapezial inclination, is a risk factor for the failure of primary conservative or minimally invasive treatment for acute traumatic thumb carpometacarpal (CMC) joint dislocations in the relatively early period. We hypothesized that an elevated trapezial inclination would be associated with a higher rate of treatment failure. Methods: We retrospectively reviewed patients treated for acute thumb CMC joint dislocations between 1976 and 2025 with closed reduction and subsequent immobilization or percutaneous pinning. Patients were classified into “failure” (recurrent dislocation or subsequent symptomatic subluxation) or “non-failure” groups. Trapezial inclination, measured on oblique hand radiographs, was compared between the groups using the Mann-Whitney U test. Results: Fourteen patients met the inclusion criteria (7 failure, 7 non-failure). While demographics were not significantly different, the failure group demonstrated a significantly higher mean trapezial inclination (19.1° vs 8.7°; P = .0012). This significant difference persisted in a subgroup analysis that excluded associated Gedda type 3 Bennett fracture ( P = .0318) Conclusions: Elevated trapezial inclination may predict the failure of primary conservative or minimally invasive treatment in the relatively early period for acute thumb CMC joint dislocation. Our findings suggest that patients with this steep trapezium may be poor candidates for conservative or minimally invasive management and should be considered for primary definitive surgery.

Chronic wounds remain a major unmet clinical challenge, often failing to progress to normal healing due to persistent inflammation, impaired angiogenesis, and cellular senescence. Exosomes have recently been investigated as promising acellular therapeutics capable of restoring intercellular communication and promoting tissue regeneration. Among these, the Purified Exosome Product (PEP) represents a next-generation, platelet-derived exosome formulation manufactured under Good Manufacturing Practice (GMP) conditions with high purity, stability, and reproducibility. This review summarizes the current advances in exosome-based chronic wound therapeutics and PEP delivery systems and their translational potentials. Incorporation of PEP into bioengineered carriers such as fibrin sealant, collagen scaffolds, and hyaluronic acid (HA) hydrogels enables localized and sustained exosome release, significantly prolonging therapeutic effects and improving regenerative outcomes. Fibrin-based PEP delivery achieved complete wound closure and functional skin regeneration in animal models, while collagen and HA-based systems showed promising results for injectable and dermatologic applications. Beyond its intrinsic healing effects, PEP may also serve as a nanocarrier for other drugs, offering a future direction in chronic wound management.

Background: In this study, we aimed to perform noninvasive acoustic quantification of digital arterial Doppler sounds and to determine the possibility of evaluating digital arterial circulation using the results of acoustic assessment. Methods: In this prospective study, we recorded the Doppler sounds of the radial and ulnar digital arteries of all digits of 25 volunteers (male, n = 10; female, n = 15) included in the study, converted these recordings into digital files, and analyzed them using a fast Fourier transform analyzer. We recorded the Doppler sound of each digital artery by means of (1) contralateral digital artery compression, (2) ipsilateral digital artery compression, and (3) no compression as a control. The analyzed parameters comprised the equivalent sound level (Leq), sound pressure difference between the maximum and minimum sound pressures (delta sound pressure), and frequency. In addition, the Doppler sounds of the contralateral and compression groups were acoustically compared with those of the control group by 2 examiners. Results: The contralateral compression group demonstrated a statistically lower Leq and greater delta sound pressure. In particular, the delta sound pressure had a higher sensitivity and specificity. The ipsilateral compression group had a significantly lower Leq and frequency. The Doppler sounds of the contralateral compression group resembled a staccato rhythm. The agreement rate of the kappa coefficients was high. Conclusions: The patency of the digital artery is presumably high if the Doppler sound changes to a staccato rhythm upon compression of the contralateral digital artery.

Case: A 4-year-old girl patient presented with complete amputation of the second toe close to the distal interphalangeal joint. Replantation was performed using a novel midlateral approach. The procedure used the dorsal subcutaneous vein on the foot as a graft for the artery. Four months postoperatively, the toe healed without any complication. The patient reported pain-free physical exercise without limitations in daily activity. Conclusion: This report demonstrates that this approach has the potential to provide a safe and viable alternative for treating toe amputations and offers advantages such as simplified artery identification, straightforward anastomosis, and improved vein graft harvesting.