Microtrauma at the humeral medial epicondyle: Quantifying lacunar lesions to reconstruct activity patterns in past populations.

Partial auricular avulsion following a monkey attack in an infant with associated cranial injury

Microsurgical dorsal root entry zone (DREZ) lesioning is an established treatment for refractory pain following brachial plexus avulsion. However, lesion depth and trajectory are critical technical variables that may influence safety and outcomes. We report our single-center experience using intraoperative ultrasound for systematic post-lesion confirmation during cervical DREZ lesioning. Between January 2016 and March 2025, 23 consecutive patients with complete or partial brachial plexus avulsion and severe neuropathic pain (VAS ≥6) refractory to optimized pharmacological therapy underwent cervical DREZ lesioning with ultrasound-based post-lesion confirmation. Serial microcoagulations were performed along the posterolateral sulcus to a depth of approximately 3 mm with medial angulation of 25°-45°, under multimodal neuromonitoring. Ultrasound was used after each lesion to confirm depth and medial-lateral trajectory. Pain intensity was assessed using the visual analog scale (VAS) at baseline and during serial follow-up. Mean preoperative VAS was 9.6. At a median follow-up of 36 months (range: 6-108), 13 patients (57%) achieved excellent pain relief (VAS ≤3), 6 (26%) had good relief (VAS: 4-6), and 4 (17%) had poor outcomes (VAS ≥7). One patient (4%) developed a transient motor deficit lasting three months, 2 (9%) required revision for laminotomy reconstruction subsidence, and 1 patient (4%) died from postoperative pulmonary embolism. Intraoperative ultrasound for post-lesion confirmation during cervical DREZ lesioning is feasible and may enhance depth and trajectory verification. Durable pain relief was achieved in the majority of the patients. Further studies are needed to define its incremental benefit.

Return to Sport After Ulnar Collateral Ligament Repair and Reconstruction.

Background:Partial articular supraspinatus tendon avulsion (PASTA) lesions are a common cause of shoulder pain and dysfunction. Transtendinous repair is a surgical technique used to restore tendon integrity while preserving intact tendon and minimizing iatrogenic tendon damage.Indications:This technique is indicated in patients with symptomatic, partial-thickness rotator cuff tears who have failed conservative management.Technique Description:The PASTA transtendinous technique repair is performed in the beach-chair position. The articular-sided tear is visualized, debrided, and 2 suture anchors are placed percutaneously through the tendon into the rotator cuff footprint. The sutures are passed in a boxed mattress configuration, and knot-tying is performed arthroscopically on the bursal side of the cuff, securing the tendon back to its footprint and preserving intact tendon fibers.Results:This construct demonstrates stable fixation of the tendon to its native footprint, with preservation of tendon integrity. Postoperatively, patients undergo a structured rehabilitation protocol. Return to full activity/sport is expected at approximately 4 to 6 months.Discussion/Conclusion:Transtendinous repair of PASTA lesions provides a reliable method for restoring native tendon integrity, while preserving intact tendon fibers. This technique minimizes tendon trauma compared with traditional “take-down” rotator cuff repair techniques, maintains native anatomy, and facilitates anatomic healing with good functional recovery.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Electrocautery-guided nail plate division to enhance precision in partial nail avulsion.

This study aimed to evaluate the causes, treatment options and associated complications of ear canal tears and avulsions in dogs and cats. This retrospective clinical study includes 14 cats and 10 dogs diagnosed with external ear canal tears and avulsions using otoscopy and/or computed tomography. Information extracted from the relevant clinical records included signalment, clinical signs, diagnostic imaging findings, surgical procedures performed and complications. The most common cause of ear canal tears and avulsions was acute trauma (17/24 cases). In 92% (22/24) of the cases, an interruption of ear canal continuity was visible on otoscopy: in five cases, complete avulsion occurred; in 12 cases, partial avulsion occurred; and in six cases, a perforating tear occurred. Nine patients underwent a total ear canal ablation and lateral bulla osteotomy, seven underwent vertical ear canal ablation, and two patients underwent primary repair of the ear canal. Six patients died or were euthanased within the first 14 days after presentation, and 18 patients were discharged. Short-term follow-up identified two minor complications and four major complications requiring revision surgery. Long-term follow-up data were available for 13 patients, of which three had persistent facial nerve paralysis. Due to the retrospective nature of this study, the surgical treatment options elected depended on surgeon's preference. Outcome was further influenced by owners electing euthanasia due to financial constraints and comorbidities related to their inciting injury. Traumatic external ear canal tears and avulsions appear to result in a favourable outcome when treated surgically.

Fischer GA, Hangan D, Li JG, Saxe B, Christiansen C, Paticoff K, Richman O, Sasson H. Case report of auricular avulsion injury, repair, and adjunctive treatment. Undersea Hyperb Med. 2026 First Quarter; 53(1):105-109. Introduction: The objective of this case report is to present an 11-year-old male patient who sustained a partial avulsion injury of the left ear involving the helix, anti-helix, and scapha, along with initial management and adjunctive treatments throughout the patient’s course in the hospital. Case Report: Traumatic ear avulsion is an uncommon injury that poses unique surgical challenges, as there is no standard of care for its management. The viability of the avulsed tissue is of paramount concern given its small vasculature and limited perfusion. Some techniques used in ear avulsion injuries include microvascular reconstruction, the pocket technique, and direct reattachment. Ear avulsion injuries require a multidisciplinary approach to achieve optimal patient outcomes. Discussion: This case report demonstrates the effectiveness of multiple adjunctive treatments in optimizing revascularization and viability of previously avulsed tissue, resulting in better short-term outcomes and a more favorable long-term prognosis. Keywords: Hyperbaric oxygen treatment; leech therapy; trauma; wounds

The objective of this case report is to present an 11-year-old male patient who sustained a partial avulsion injury of the left ear involving the helix, anti-helix, and scapha, along with initial management and adjunctive treatments throughout the patient's course in the hospital. Traumatic ear avulsion is an uncommon injury that poses unique surgical challenges, as there is no standard of care for its management. The viability of the avulsed tissue is of paramount concern given its small vasculature and limited perfusion. Some techniques used in ear avulsion injuries include microvascular reconstruction, the pocket technique, and direct reattachment. Ear avulsion injuries require a multidisciplinary approach to achieve optimal patient outcomes. This case report demonstrates the effectiveness of multiple adjunctive treatments in optimizing revascularization and viability of previously avulsed tissue, resulting in better short-term outcomes and a more favorable long-term prognosis.

Background: Ingrown toenail [onychocryptosis] is a common condition encountered in primary care and minor surgical practice and most frequently affects the great toe [1,6]. Several surgical and chemical matricectomy techniques have been described to reduce recurrence, particularly in moderate to severe or recurrent cases [1,3]. This study presents a case series evaluating a modified technique using silver nitrate chemical matrix cauterization following partial lateral nail avulsion. Methods: This descriptive case series included patients with clinically diagnosed ingrown toenail treated at Shinas Health Complex. The standardized procedure consisted of partial lateral nail avulsion followed by chemical cauterization of the nail matrix using silver nitrate. Patients were followed to assess healing time, complications, and recurrence. Informed consent was obtained from all patients prior to the procedure. Results: Complete wound healing was achieved within two weeks in all patients. One patient with diabetes mellitus developed a localized postoperative infection, which resolved completely within 10 days with conservative management. Deposition of silver nitrate material beneath the nail plate was observed in one case without long-term complications. The overall success rate [non-recurrence] was approximately 95%. Conclusion: Silver nitrate chemical matrix cauterization after partial lateral nail avulsion appears to be a safe, effective, and practical technique for the management of ingrown toenail, with favorable healing time and a low recurrence rate.

Background: Extrusive luxation, also known as partial avulsion, refers to the partial displacement of a tooth out of its socket following the application of an oblique or axial force. This type of dental trauma often results in disruption of the periodontal ligament and neurovascular supply, predisposing the affected tooth to pulp necrosis, root resorption, or arrest of root development—particularly in immature teeth.Case presentation: This report describes the immediate management of a moderately severe extrusive luxation injury involving an immature permanent maxillary central incisor. The tooth was promptly repositioned into its socket and stabilized using a flexible splint. The patient was followed up periodically, and at the six-year review, the tooth remained asymptomatic with normal color and function. Radiographic assessment demonstrated continued root development, an intact lamina dura, and absence of periapical pathology, although partial pulp canal obliteration was evident.Conclusion: Favorable outcomes in extrusive luxation depend largely on prompt diagnosis, immediate repositioning, and appropriate splinting. Early intervention and long-term monitoring are crucial to preserving vitality and ensuring optimal periodontal healing.

Background:A thorough understanding of posterior hip anatomy is essential for safe and effective posterior hip endoscopy. The sciatic nerve runs laterally to the ischium and hamstring origin. While sciatic nerve injury during proximal hamstring repair is uncommon, the increasing use of endoscopic techniques has led to a rise in iatrogenic injuries. This highlights the need for a structured approach to identifying and protecting the sciatic nerve.Indications:Surgical intervention is indicated for complete proximal avulsions involving all 3 hamstring tendons, partial avulsions involving ≥2 tendons and >2 cm of retraction, and partial avulsions that fail to improve after 6 months of conservative management.Technique Description:There are various safeguards to safely manage the sciatic nerve during posterior hip endoscopy. Proper patient positioning and portal creation are essential steps to minimize sciatic nerve risk. Utilization of prone positioning with strategic padding allows slight hip extension, knee flexion, and hip abduction. In turn, this will relax the nerve and increase the ischiofemoral space. Creation of the subgluteal space is critical, with meticulous resection of the subgluteal bursa to expose the proximal hamstring tendon and surrounding anatomy. A fascial veil consistently separates the tendon from the sciatic nerve and can be partially resected for nerve visualization. Tear exposure is achieved through a longitudinal split between the semimembranosus and conjoint tendon, which also serves as access for ischioplasty. The remaining tendon provides natural protection, while fluoroscopy guides safe bony resection and helps assess ischial width.Results:Endoscopic proximal hamstring repair is an effective approach leading to significant improvement in pain and function. Among endoscopic hamstring repairs, complications—such as persistent peri-incisional numbness and postoperative neuropathy—have each been reported in approximately 8% of cases. This highlights the importance of proper sciatic protection.Discussion/Conclusion:Endoscopic proximal hamstring repair and ischioplasty serve as effective, minimally invasive options for proximal hamstring pathology with careful attention to sciatic nerve safety. A thorough understanding of posterior hip anatomy, strategic patient positioning, precise portal placement, and deliberate dissection techniques is critical for minimizing iatrogenic nerve injury.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Progressive Understanding of Cord, Capsule, and Cable Functional Anatomy Can Optimize Rotator Cuff Outcomes: A 25-Year Perspective.

A thorough understanding of posterior hip anatomy is essential for safe and effective posterior hip endoscopy. The sciatic nerve runs laterally to the ischium and hamstring origin. While sciatic nerve injury during proximal hamstring repair is uncommon, the increasing use of endoscopic techniques has led to a rise in iatrogenic injuries. This highlights the need for a structured approach to sciatic nerve identification and protection. Surgical intervention is indicated for complete proximal avulsions involving all three hamstring tendons, partial avulsions involving two or more tendons and greater than 2 cm of retraction, and partial avulsions that fail to improve after six months of conservative management.There are various safeguards in order to safely manage the sciatic nerve during posterior hip endoscopy. Proper patient positioning and portal creation are essential steps to minimize sciatic nerve risk. Utilization of prone positioning with strategic padding allows slight hip extension, knee flexion, and hip abduction. In turn, this will relax the nerve and increase the ischiofemoral space. Creation of the subgluteal space is critical with meticulous resection of the subgluteal bursa in order to expose the proximal hamstring tendon and surrounding anatomy. A fascial veil consistently separates the tendon from the sciatic nerve and can be partially resected for nerve visualization. Tear exposure is achieved through a longitudinal split between the semimembranosus and conjoint tendon, which also serves as access for ischioplasty. The remaining tendon provides natural protection, while fluoroscopy guides safe bony resection and helps assess ischial width. Endoscopic proximal hamstring repair and ischioplasty serve as effective, minimally invasive options for proximal hamstring pathology with careful attention to sciatic nerve safety. A thorough understanding of posterior hip anatomy, strategic patient positioning, precise portal placement, and deliberate dissection techniques are critical for minimizing iatrogenic nerve injury.Keywords: Sciatic Nerve, Proximal Hamstring Repair, Endoscopy, Ischioplasty, Nerve Protection

Background: The ingrown toenail is a common problem and occurs when the edge of the nail grows into flesh at the side of the nail, causing a painful injury. This punctured skin can become inflamed and infected. They are most frequently observed in adolescents and young adults but may occur in neonates, infants and the elderly, with slightly higher male to female ratio, the great toe is the most commonly involved. Various methods of treating ingrown toenails have been described, ranging from conservative approaches to extensive surgical procedures. Phenol matricectomy was used by some investigators; however there is no generally accepted procedure with low failure rate. Objectives: To compare two common methods of treatment of ingrown toenail: (partial nail avulsion with phenol 50% matricectomy versus partial nail avulsion alone) regarding postoperative complications and recurrence. Patients and Methods: This is an open labeled prospective comparative therapeutic study. It was conducted at the Department of Dermatology- Baghdad Teaching Hospital, Medical city, Baghdad, Iraq, from March 2015-November 2016. A total number of 24 patients with 26 ingrown toenails were enrolled. They were allocated into 2 groups; the 1st group was treated with partial avulsion and phenol 50% matricectomy while the 2nd group was treated with partial avulsion alone. Post-operative pain, infection and other complications were assessed after one week and one month. At 6 months the recurrence rate was evaluated. In each visit photographs were taken and patients' satisfaction was documented. Results: Regarding patients' satisfaction 95% were fully satisfied in group 1 compared with 80% in group 2 at 6th month visit. Post-operative pain was comparable in both groups which lasted 1-2 days and relieved by simple analgesics. Infection was noticed in one patient in group1 and non in group2. The recurrence rate was 20% in group 2 and no recurrence was observed in group 1 six months after surgery. Conclusion: Partial nail excision with phenol matricectomy is a good procedure for patients complaining of recurrent ingrown toenail problem as it is easy to perform, not costly, with unremarkable complications and very low recurrence rate.

The onset of symptoms associated with pelvic floor dysfunctions and injuries after pregnancy and childbirth has been well documented and studied. Avulsion of the levator ani muscle (LAM) is known to be a risk factor for these conditions. This study aimed to evaluate the prevalence of LAM avulsion in patients after their first vaginal delivery, associating this finding with factors related to pregnancy and birth. In a cross-sectional study, we evaluated 100 postpartum women after their first vaginal delivery to identify LAM avulsion using ultrasound imaging and to correlate the presence of this injury with pregnancy and birth-related factors. Of the 100 primiparous women evaluated, 46% had some degree of avulsion after delivery. Among these, 37% had complete and 63% had partial avulsion. Regarding laterality, 63% of the lesions were unilateral, affecting the muscle asymmetrically, and 37% were bilateral. The weight of the newborn was a significant factor and showed a statistically significant difference between the groups with and without avulsion. Another statistically significant difference observed between the groups was forceps delivery. The impact of pregnancy and childbirth factors on the pelvic floor muscles is not yet fully elucidated. Identifying these factors is crucial for developing multidisciplinary strategies to prevent such injuries during pregnancy and delivery, thereby reducing their consequences and impact on women's quality of life.

Pubovisceral muscle (PVM) avulsion affects over a third of women post-vaginal childbirth and is a significant risk factor for pelvic floor dysfunction (PFD). Prior studies show that even a 5mm posterior-inferior shift of the perineal body (PB) enlarges the genital hiatus, contributing to prolapse. Building on this, we investigated the relationship between PVM avulsion andPB movement, correlated prolapse metrics, and sacrum/coccygeal movement with the injury. Moreover, we used statistical shape modeling (SSM) to see shape variation among different groups. A total of 112 MR defecography scans were included from a mixed sample of clinical defecography's. This includes 68 radiologic cystocele patients, 20 patients who were obstruction defecation patients, and 20 nulliparous patients, taken from previous studies Routzong et al. (Ann Biomed Eng 51(7):1461-70); Martin et al. (Int Urogynecol J 36:1607-1615); Routzong et al. (Comput Methods Biomech Biomed Eng 24(2):122-30). These scans were analyzed using axial T2 images to assess PVM avulsion. Patients were categorized into four groups: asymptomatic-nulliparous, non-avulsed, partial avulsed, and avulsed. The asymptomatic group was excluded from statistical analysis because of differences in demographic variables. Measurements were performed on mid-sagittal slices using HOROS at rest and evacuation. SSM was then used to assess shape variation of the pelvic floor. Among 89 parous patients, 25 had avulsion, 18 partial avulsions, and 46 were non-avulsed. The avulsed group was significantly older (p = 0.001), with more pregnancies (p = 0.049) and deliveries (p = 0.021). At rest, they showed increased pubic symphysis-to-PB distance (p < 0.001), and greater bladder descent during evacuation (p = 0.003). Vaginal apex was well-supported in the non-avulsed group at rest (p < 0.001), while sacrococcygeal angle (p = 0.031) significantly increased in avulsed patients. SSM identified shape variation with the avulsed group having the greatest descent of the pelvic floor musculature, perineal body shift, and overall increased levator bowl area. In a cohort of women undergoing pelvic MR defecography, we observed PVM avulsion is associated with inferior PB shift, increased bladder descent, and shape changes to the sacrum/coccyx, underscoring its impact on level III support. Despite limitations from the retrospective design and patient selection, these findings offer valuable insight into the anatomical consequences of avulsion during rest and defecation.

Purpose: Chronic paronychia and ingrown nails (onychocryptosis) are common nail disorders that cause pain, functional impairment, and reduced quality of life. They occur frequently in both dermatology and primary care settings. Effective management requires an understanding of the underlying mechanisms and available treatment approaches. This review summarizes the etiopathogenesis, clinical features, and evidence-based management of chronic paronychia and ingrown nails, providing practical guidance for physicians.Current Concepts: Chronic paronychia is a multifactorial inflammation of the nail folds persisting for more than 6 weeks, typically initiated by disruption of the cuticle barrier. This disruption allows moisture, irritants, and microbes to penetrate the periungual area, resulting in chronic inflammation, fibrosis, and retraction. Candida species are often isolated but function predominantly as secondary colonizers. Environmental triggers such as frequent wet work, artificial nails, and anticancer therapies (including epidermal growth factor inhibitors and taxanes) can further compromise the periungual barrier. Ingrown nails arise from penetration of the nail plate into, or overgrowth of, hypertrophic folds. These changes are promoted by improper trimming, tight footwear, anatomical predisposition, systemic disease, or trauma.Discussion and Conclusion: Management primarily aims to remove triggers, control inflammation, and restore the periungual barrier. Early stages usually respond to conservative measures, including topical corticosteroids, calcineurin inhibitors, antifungal agents, footwear modification, nail splinting, and patient education. Severe or refractory cases may require surgical intervention, such as square flap excision for chronic paronychia or partial nail avulsion with phenol matricectomy and soft tissue resection for ingrown nails. Individualized therapy can improve outcomes, minimize recurrence, and enhance quality of life.

Background: Ingrown toenail (onychocryptosis) is a common and painful condition that affects daily activities and quality of life. Treatment options include conservative and surgical interventions, with varying efficacy and patient outcomes. This study aimed to compare the effectiveness of conservative versus surgical management of ingrown toenails in Bangladeshi patients. Methods: This prospective observational study was conducted at the Nail Unit, Aurora Skin and Aesthetic Center, Dhaka, over six months (10 January to 09 July 2024). A total of 100 patients with clinically diagnosed ingrown toenail were enrolled and equally divided into two groups: 50 patients received conservative treatment (topical antibiotics, proper nail trimming, and footwear advice) and 50 underwent surgical intervention (partial nail avulsion with/without matrixectomy). Outcomes measured included healing rate, healing time, pain reduction (VAS), recurrence, infection, patient satisfaction, and work/school absenteeism. Data were analyzed using statistical package for the social sciences (SPSS) version 25. Results: The groups were comparable in terms of age, sex, affected toe, and disease severity. Surgical treatment showed significantly better outcomes: complete healing in 94% versus 78% (p=0.02), shorter mean healing time (10.1±2.7 versus 13.5±3.2 days; p&lt;0.001), greater pain reduction (VAS: 5.1 versus 4.2; p=0.001), and lower recurrence (4% versus 18%; p=0.03). Patient satisfaction was higher in the surgical group (92% versus 68%; p=0.003), with fewer missed workdays and repeat visits. Conclusion: Surgical management of ingrown toenails provides superior outcomes in terms of healing, pain relief, and recurrence compared to conservative treatment, and should be considered for definitive management.

Outcomes of Non-Operative versus Operative Management for Partial Articular-Sided Tendon Avulsion (PASTA) in Athletes: A Systematic Review