Soft Tissue Scarring Research Articles

The Effect of Lateral Column Lengthening on Subtalar Motion: Are We Trading Deformity for Stiffness?

Category:Hindfoot; OtherIntroduction/Purpose:While lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, concern exists as to the effect of this intra- articular osteotomy on subtalar motion. The purpose of this study is to quantify the alterations in subtalar motion following lateral column lengthening (LCL).Methods:The subtalar motion of 14 fresh frozen cadaveric feet was assessed using a three-dimensional motion capture system and materials testing system (MTS). Following potting of the tibia and calcaneus, optic markers were placed into the tibia, calcaneus and talus. The MTS was used to apply a rotational force across the subtalar joint to a torque of 5Nm.Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus was recorded. Specimens then underwent LCL via a calcaneal neck osteotomy which was maintained with a 12mm porous titanium wedge. Repeat subtalar motion analysis was performed and compared to pre-LCL motion using a paired t-test.Results::No statistically significant differences in subtalar abduction/adduction (10.9O vs. 11.8O degrees, p=.48), supination/pronation (3.5O vs. 2.7O, p=.31), or plantarflexion/dorsiflexion (1.6O vs 1.0O, p=.10) were identified following LCL.Conclusion::No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. While these findings do not obviate concerns of clinical subtalar stiffness following planovalgus deformity correction, they suggest that diminished postoperative subtalar motion may be due to soft tissue scarring rather than alterations of joint anatomy.

Percutaneous Arthroscopic Assisted Knee Medial Collateral Ligament Repair

Medial collateral ligament (MCL) injuries are commonly encountered alongside anterior cruciate ligament injuries. Treatment modalities have ranged from conservative management to surgical repair, augmentation, and reconstruction. Various reports have reported residual valgus instability, especially in higher-grade injuries that have been treated conservatively. The MCL provides valgus stability but also is an element of anterior stability to the tibia in addition to the anterior cruciate ligament. In addition, meniscal “lift-off” and “floating” have been described as consequences after MCL injuries, and meniscal dysfunction has been shown to lead to accelerated joint degeneration; therefore, all efforts should be made to treat these injuries adequately. We describe a simple, minimally invasive technique that involves suturing the deep MCL to the medial joint capsule, allowing better MCL healing, causing less soft-tissue scarring, and preventing meniscal extrusion.

Early Plastic Surgery Involvement Improves Outcomes in Total Joint Arthroplasty Patients With Soft Tissue Complications

The authors reviewed the outcomes of patients who have undergone total hip or knee arthroplasty and concurrent soft tissue reconstruction at our institution and describe our combined orthoplastic approach to such patients. This was a retrospective series of 8 patients who underwent the soft tissue reconstruction procedure before or after joint replacement by a single orthopedic surgeon in collaboration with a single plastic surgeon. Five men and 3 women met inclusion criteria. Flap reconstruction was performed in 7 of 8 cases, skin grafting in 3 of 8 cases, and complex wound closure in 1 of 8 cases. The majority of patients had 1 or 2 risk factors for developing wound complications. Five had a good outcome at the final follow-up and 3 had poor outcomes. Of 5 patients who had good outcomes, 4 underwent plastic surgery evaluation for prophylactic soft tissue reconstruction because of prior failed arthroplasty procedure, soft tissue scarring, atrophy, or previous infection. Of 3 with poor outcomes, 2 underwent plastic surgery evaluation for a salvage procedure after they developed soft tissue complications. Joint arthroplasty patients undergoing early plastic surgery evaluation for prophylactic soft tissue reconstruction had better outcomes compared with patients undergoing evaluation for a salvage procedure after soft tissue complications have developed.

Multi-level Nerve Injury of the Upper Extremity Management and Review of Brachial Plexus Literature: A Case Report

Backround: Brachial plexus injuries are complex cases requiring a thorough understanding of nerve physiology and upper extremity anatomy. Standard approaches and management have been developed but certain situations still arise where these are not feasible options. Objectives: A case of brachial plexus injury is discussed in this report. The patient was a young male who was referred to our center with weakness of the left upper extremity, C5-C7 distribution. Certain components of his injury, such as extensive soft tissue scarring and identification of a long neuroma at the injury site, obliged the surgeons to use unconventional nerve transfers during his surgery. In this paper, we discuss these alternative options in order to support their potential use in complex brachial plexus cases. Other concepts such as single fascicular harvest for nerve transfers and nerve graft augmented nerve transfers are discussed as they were successfully used in this report. Methodology and Results: The patient underwent a total of five surgeries which were a combination of nerve and tendon transfers. Some nerve transfers were augmented with long autologous nerve grafts reaching up to fifteen centimeters in length. Throughout the patients sequence of surgeries, certain nerves, such as the ulnar nerve branch to the flexor carpi ulnaris, successfully served as a donor nerve in more than one occasion. Muscle groups where single nerve fascicles were previously used as a donor nerves also yielded adequate muscle strength and were successfully subsequently used in tendon transfers. Ultimately, the patient was able to achieve good muscle strength, range of motion and outcome scores on his left upper extremity after two years from his final surgery. Conclusion: This report offers multiple alternative options in managing complex brachial plexus cases as well as challenges some concepts in nerve grafting. Alternative donor nerves are offered for transfers, some of which are not previously used in literature. Aside from this, the use of long autologous nerve grafts, single fascicular nerve transfers and repeated use of certain nerves as donor were performed successfully. We hope these procedures and techniques can be added to each hand specialist arsenal for managing complex brachial plexus injuries, specifically when the standard techniques are not feasible.

One bone forearm for massive gap nonunion of distal radius: Our experience and literature review

Background: Large defect or massive gap of nonunion distal radius is a rare entity but not uncommon. It usually presents with manus valgus deformity with a disability and difficult to treat. Due to the extensive gap with surrounding soft tissue scarring, the usual method of gap grafting may not be feasible in these cases. In such cases, the creation of one bone forearm has been found to be a sound and excellent method of treatment. The purpose of this paper is not only to present the results of 5 patients of massive gap nonunion of the distal radius treated by one bone forearm but also to review the relevant literature. Materials and Methods: Five cases of posttraumatic massive gap nonunion of radius were treated by the creation of one bone forearm in the past 8 years. The male-to-female ratio was 4:1 with age ranging from 16 years to 35 years. In all cases, ulnar transposition and fixation in the neutral rotation were done to create one bone forearm. Three cases underwent monoaxial distraction of distal radius to correct distal radio-ulnar joint prior to the definitive procedure of one bone forearm. Results assessed by clinico-radiological evaluation. Finally, literature related to the treatment of such cases were searched by Google search, and systematic review on the subject was done. Results: The follow-up period ranges from 4 to 8 years with an average of 4.5 years. According to clinico-radiological evaluation, one patients came out with excellent result and the remaining 3 had a good result. In toto, all five patients had good functional outcomes. Conclusions: To produce “one bone forearm” for massive gap nonunion of the distal radius is not an outdated but still a dependable, effective, and economical procedure with lesser complication, good outcome, shorter hospital stay, and easier postoperative maintenance.

Fibrin Clots Maintain the Viability and Proliferative Capacity of Human Mesenchymal Stem Cells: An In Vitro Study.

Fibrin Clots Maintain the Viability and Proliferative Capacity of Human Mesenchymal Stem Cells: An In Vitro Study.

The use of the knee spanning Ilizarov method as a treatment procedure in infected nonunion of the distal femur with bone loss

Background Infected nonunion of the distal femur is a very difficult entity to treat; it grossly affects daily living and adds economic burden to the society.There is no consensus on which surgical technique of its management leads to the best outcome. Materials and methods We reviewed 10 patients with infected nonunion of the distal femur and bone loss who were treated by radical surgical debridement and application of the Ilizarov external fixator from January 2010 to December 2015. Results The mean follow-up after removal of the frame was 18.6 months (range, 14 to 30 months). No patient was lost to follow-up. The mean external fixator time was 313.9 days (range, 275 to 362 days) which correlated with the final lengthening achieved. According to Paley’s grading system, eight patients had excellent clinical and radiological results and five excellent and good functional results. Bony union, ability to bear weight fully, and resolution of the infection were achieved in all the patients. Conclusion Distal femoral nonunion is a complicated orthopedic entity as it may be associated with nonunion, infection, bone loss, shortening, soft tissue scar, contracture, restriction of movement, disuse osteopenia. Ilizarov external fixation is a definitive treatment modality in these cases as it gives stability, allows early weight-bearing, compression/distraction at fracture site, helps to arrest infection and achieve union while corticotomy helps to regain length.

Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures.

Delayed or improper repair of nasoorbitoethmoid (NOE) fractures can lead to debilitating outcomes including diplopia, epiphora, nasal obstruction, facial asymmetry, and poor cosmesis. As such, NOE fractures should be repaired promptly and properly to prevent these unwanted sequelae. Treating patients with delayed, untreated, or inadequately reduced NOE fractures is challenging due to scarring and contracture. Saddle nose deformity, telecanthus, enophthalmos, nasolacrimal duct obstruction, and soft-tissue scarring are often encountered in the secondary management of NOE fractures and should be addressed in the overall context of reestablishing facial symmetry and function.

Open arthrolysis for stiff knee after primary total knee arthroplasty

To evaluate the effectiveness of open arthrolysis in treatment of the patient with stiff knee in late stage after primary total knee arthroplasty (TKA). Between January 2014 and October 2017, 7 female patients (7 knees) with stiff knee in late stage after primary TKA were admitted. The patients were 57-71 years old (mean, 63 years). There were 2 left knees and 5 right knees. All patients underwent TKA because of knee osteoarthritis. The interval between TKA and open arthrolysis was 8-30 months (mean, 13.6 months). There were 4 patients with 10-20° of extension deficit before arthrolysis. The range of motion of knee was (54.3±12.1)°. The clinical score, functional score, and total score of Knee Society Score (KSS) before arthrolysis were 76.3±7.6, 67.9±11.1, and 144.1±16.1, respectively. During the arthrolysis, periarticular soft tissue scar was removed, the range of motion of knee was restored, the gap balance and well patellar tracking were maintained. Intensive rehabilitation after operation was supplemented. All wounds healed by first intention, without early stage complications. All patients were followed up 12-32 months with an average of 20.1 months. No abnormality of prosthesis was found by post-operative X-ray films. The knee movement improved significantly when compared with that before arthrolysis. The range of motion was less than 90° in 1 patient and 10° of extension deficit remained in 1 patient after operation. The range of motion was (92.9±4.9)° at last follow-up. The clinical score, functional score, and total score of KSS were 81.9±5.1, 74.3±9.8, and 156.1±13.7, respectively at last follow-up. The above indexes were superior to those before operation ( P<0.05). Open arthrolysis combined with intensive rehabilitation is a significant way to improve knee function for the patient with stiff knee in late stage after primary TKA.

Long-term Follow-up of Intracapsular Schwannoma Excision

The current criterion-standard treatment for schwannomas is intracapsular excision. This study was designed as a long-term follow-up to investigate postoperative symptoms, nervous impairment, and recurrence rate. We performed a long-term follow-up of 18 subjects who underwent intracapsular schwannoma excision. We evaluated preoperative versus postoperative 2-point discrimination (2-PD) in the affected dermatome, pain (visual analog scale [VAS] from 0-10), Hoffmann-Tinel sign, and thermoreceptor response. For reasons of comparison, all examinations were done on both the healthy and affected extremity. Last postoperative follow-up was done on average after approximately 50.4 months. Comparison between preoperative and postoperative sensibility testing (2-PD) in the affected dermatome showed a significant improvement of 22.7% after surgery (5-mm 2-PD; P = 0.02). Compared with the healthy nonoperated extremity preoperatively, subjects showed a significant sensory deficit of 40.9% (9-mm 2-PD; P < 0.000). Postoperatively, 12 of 18 subjects still showed a deficit in 2-PD. However, deficiency was decreased to 23.5% (mean, 4-mm 2-PD; P = 0.003). Through intracapsular schwannoma excision, subjects could drastically improve their pain (from VAS 6.7 to VAS 4.0).During our examination, we clinically suspected recurrence in 3 subjects, which were sent to magnetic resonance imaging to rule out or confirm a recurrent tumor. Many subjects reported ongoing pain and sensory deficits after intracapsular excision of schwannomas. Symptoms right after surgery may be due to iatrogenic nerve injury or residual deficits from compression damage of the tumor mass. As schwannomas are usually growing at a slow rate, early symptoms after a symptom-free period might possibly indicate scarring of soft tissue, which may cause signs of recurrent neurological deficits or pain. Patients with a late onset of symptoms are at the highest risk of having a true recurrence of schwannoma. None of the 3 suspected subjects showed radiological evidence for a recurrent schwannoma, but rather scarring and soft tissue adhesions to the nerve, which could explain the clinical findings.Intracapsular removal of schwannomas is relatively easy to perform, does not cause any additional damage to the nerve in most cases, and is therefore an excellent method for treatment of symptomatic schwannoma patients.

The Role of Immunological Reaction and Pro Inflammatory Mediators in Acne Vulgaris Etiopathogenesis, Applications in Dermatology Practice

Introduction: Acne vulgaris was not infectious-very common-chronic inflammatory-self limitting disease of pilosebaceous units. Affected approximately 85% of adolescent as physiological acne and 10- 15% was manifest as clinical acne. Four major factors were involved in the etiopathogenesis: follicular hyperkeratinization, increased sebum production, abnormality of microbial flora and inflammation process. Acne vulgaris inflammation process was divided into early stages (adaptive Th1 cell &amp; innate immune complement to non spesific antigen) and late stages (innate &amp; adaptive immune response to spesific antigen). Acne vulgaris dermal inflammation was not directly caused by bacteria in the dermis, but it was resulted from biologically active mediators that diffused from follicle. Pro inflammatory mediators in acne had no protective role but it had harmfull effect caused persistent inflammation, soft tissue destruction and scar formation, cell cycles control disturbances-cell survival&amp;apoptosis, termination of differentiation &amp; proliferation, hyperkeratinization, sebaceous glands hypertrophy and lipogenesis, pruritus, pigmentation. Biological active mediators were produced in innate immune response by the binding of the PAMPs bacterial’s to innate surface PPRs (TLR2 &amp; TLR4) of the keratinocytes, sebocytes &amp; phagocytes, through innate cell cytoplasm PPRs-NLRP3 inflammasome activation, through PAR2 gene activation, through FGFR2 of keratinocytes activation. Biological active mediators were also produced by adaptive immune response by the binding bacteria that had been recognized by APC (through MHC class II) to the CD4+ of naive T cells that activated Th1, Th2, Th17 and Treg. Case Report: 5 cases of acne vulgaris 3rd to 4th grade in female, 20-30 years old that had been treated by combination of topical tretinoin 0,05% and flucinolone acetonide 0,025% for 4 weeks were reported. The result were good (decreased acne to 1st grade to no acne), no side effects were reported. Tretinoin 0,025% was choosen as maintain treatment. Discussion: Treatment of choices for chronic inflammation in acne were anti immunological reaction/pro inflammatory antagonists drugs. Steroid (acted in NFƙB pathway) and tretinoin (antagonist TLR2 and FGFR2) topical combination had good result. Tretinoin decreased comedo, sebum production &amp; hyperkeratinization, normalized keratinization and differentiation, replaced disorganized collagen fibers &amp; formed thicker-elastic epidermis (skin rejuvenation), decreased PIH and scar/keloid formation. Steroid decreased chronic persistent inflammation &amp; scar formation and decreased erythema &amp; irritancy that were caused by tretinoin.

Ilizarov techniques for upper tibial nonunions: How difficult is it to achieve excellent results?

Introduction: Upper tibial nonunions (UTNUs) pose challenging difficulties such as soft-tissue scarring, infection, deformity, shortening, and small fragments with intra-articular extension. We present a retrospective analysis of probably the largest series of UTNUs using the Ilizarov techniques. Factors determining the outcome based on difficulty scores and NU scores were also assessed. Patients and Methods: Forty-one patients with UTNU (within 10 cm of joint line) were evaluated retrospectively. Fourteen were aseptic and 27 were septic. The mean NU distance was 5.6 cm from the knee joint. The Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores were evaluated and compared with NU severity score (NUSS), NU level of difficulty score (NULODS), and infection severity score (ISS). External fixation duration (EFD) was compared to NUSS and NULODS to determine which is better in predicting the outcome. We also compared our results with the literature. Results: We achieved union in all except one. The mean EFD was 333 days. The mean regenerate lengthening was 8.6 cm. The ASAMI bone score was: excellent – 16, good – 22, fair – 2, poor – 1. The ASAMI functional score was: excellent – 16, good – 14, fair – 9, poor – 2, and failure – 0. We found a positive correlation between NUSS, NULODS, and ISS. EFD correlated better with overall NULODS and subset of NULODS gap score compared to NUSS and NUSS gap score, respectively. Conclusions: Ilizarov is an effective method to treat UTNU. It corrects the deformity, provides stable fixation, achieves union, and corrects limb length discrepancy.

Phosphoglyceride crystal deposition disease in the abdominal wall: a case report

BackgroundPhosphoglyceride crystal deposition disease (PGDD) is characterized by phosphoglyceride crystal deposition that simulates neoplasia in soft tissue scars or bone. Reports of PGDDs are rare. Here, we present the case of a patient with PGDD in the abdominal wall.Case presentationA 57-year-old Japanese man with worsening right lower abdominal pain had no significant family or occupational history. Laboratory data showed elevated inflammatory markers with a white blood cell count of 14,400 × 109/L and C-reactive protein of 11.8 mg/L, but no other abnormalities. Helical computed tomography (CT) revealed a tumor in the abdominal wall (longest dimension, approximately 10 cm). Positron emission tomography–CT revealed fluorodeoxyglucose accumulation in the mass only (SUVmax, 41). Clinical and radiographic findings suggested malignant lymphoma, undifferentiated sarcoma, or liposarcoma. He underwent exploratory laparotomy and further treatment. At surgery, we found a huge milky-whitish mass with a rough surface in the transversus abdominis. Complete resection was performed and his postoperative recovery was good. Surprisingly, the final pathologic diagnosis was phosphoglyceride crystal deposition disease with the characteristic crystal deposition in a corolla shape, histiocytic reaction with abundant foreign-body-type giant cells, and no evidence of neoplasia. The patient remains asymptomatic with no disease recurrence.ConclusionAlthough phosphoglyceride crystal deposition disease in the abdominal wall is rarely encountered in clinical practice, its inclusion in differential diagnosis is important. Given the occurrence at sites of invasive procedures, we believe efforts to reduce invasiveness when performing surgery and follow-up for early detection of recurrence are important.

PALATAL VERSUS BUCCAL ANTRAL APPROACH FOR MAXILLARY SINUS LIFTING AND IMPLANT PLACEMENT

INTRODUCTION: Implant placement in the maxillary posterior alveolar ridge is often complicated by post extraction bone resorption, pneumatization of maxillary sinuses, and poor quality of alveolar bone. In these situations, the residual vertical bone height is reduced making standard implant placement difficult. Elevation of the maxillary sinus floor using the lateral antral approach is one possible solution. Palatal window osteotomy approach for maxillary sinus floor lifting is a new surgical technique used to increase vertical bone height prior to implant placement. OBJECTIVES: This study was designed for clinical evaluation of the maxillary sinus lifting technique using a palatal approach versus buccal approach. MATERIALS AND METHODS: this study was carried out as a randomized controlled clinical trial, the study sample included 14 patients. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. All patients were divided into two equal groups, had gone maxillary sinus lifting together with implant placement, group1 :( study group) seven patients had sinus lifting through the palatal approach technique simultaneously with implant insertion. In group2 (control group) seven patients had maxillary sinus lifting using buccal antral approach technique simultaneously with implant insertion. Clinical and radiographic evaluation was done through 6 months postoperatively. RESULTS: Regarding postoperative clinical evaluation, group 1 was superior to that of group 2 in tissue management, because the vestibular anatomy in this group was not altered neither postoperative swelling occurred consequently nor disharmonious soft tissue scarring. Regarding the postoperative radiographic evaluation, group 1 was significantly increased in bone density around dental implants and less marginal bone loss postoperatively, however group 2 had higher vertical amount of bone gained around implants postoperatively. CONCLUSIONS: The palatal sinus lifting approach permitted higher postoperative comfort, less postoperative edema, less marginal bone loss around implants, and higher bone density around implants postoperatively.

PROSPECTS FOR THE DEVELOPMENT OF REGENERATIVE TECHNOLOGIES. CURRENT KNOWLEDGE OF PLATELET RICH PLASMA AND THE POSSIBILITY OF ITS APPLICATION IN TREATMENT OF COMPLICATED UROLOGICAL DESEASES

Currently, the most actual problem in daily work of a surgeon is to get satisfactory results of the surgery, and to decrease the quantity of different complications, such as: recurrence of diseases, inflammatory and infection damage of operating wounds.The most difficult for surgery treatment are urological diseases associated with the decrease of tissue vascularization, which leads to common fibrosis and the prevalence of soft tissue scarring, consequences of the radiation therapy.Impaired wound healing is usually associated with lack of adequate blood supply, decrease of regenerative properties, increase of pro-inflammatory mechanisms. Platelet rich plasma is able to produce a lot of different growth factors, which stimulate neoangiogenesis, cytokines and сhemokines secretion, initialization of inflammatory cascade. These features lead to activation of regenerative mechanisms and growth of new blood vessels. In the present time, several forms of platelet rich plasma with different biological activity have been studied. The methods of its preparation and activation have been described. In this work the modern information of platelet rich plasma will be described in details.

Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications

PurposePosttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. MethodsPubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords “acetabular”, “fracture”, “arthroplasty”, and “post traumatic arthritis” published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. ResultsWith 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27–74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%–63%), implant loosening (1%–24%), and infection (0%–16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. ConclusionDespite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.

A Median Nerve Anterior Transposition Procedure for Multi-Recurrent Hemodialysis-Related Carpal Tunnel Syndrome.

Some long-term hemodialysis patients suffer from multi-recurrent carpal tunnel syndrome because amyloid originating from β2-microglobulin continues to be deposited mainly in the flexor tendons, tendon sheaths and flexor retinaculum during maintenance hemodialysis. These amyloid deposits inside carpal canal (tunnel) tissues increase carpal canal pressure and this leads to compression of the median nerve. When multi-recurrent carpal tunnel syndrome occurs, previous operative scarring of soft tissue may prohibit further enlargement of the carpal canal even if any carpal canal decompression procedure is used. For this reason, we developed a median nerve anterior transposition procedure, as a new approach in the treatment of multi-recurrent hemodialysis-related carpal tunnel syndrome. Median nerve anterior transposition procedures were performed on seven hands in six patients with multi-recurrent carpal tunnel syndrome. The mean age of the patients was 68.3 years and the mean hemodialysis duration was 35.3 years. Mean follow-up period was 9.9 months. The median nerve is transposed from inside to outside of the carpal canal under local and infiltration anesthesia without a pneumatic tourniquet on an outpatient basis. This procedure is based on the same principles applied in ulnar nerve anterior transposition procedures for cubital tunnel syndrome. Main preoperative patient complaints were intolerable tingling and/or pain in the diseased hands throughout the day. Following the surgeries, preoperative clinical symptoms began to subside and eventually improved in all hands. Postoperative abductor pollicis brevis muscle power using manual muscle testing improved except in one hand. Abnormal preoperative distal motor and sensory latency were improved except in two hands following the surgeries. The median nerve anterior transposition procedure is a beneficial treatment for patients suffering from hemodialysis-related multi-recurrent carpal tunnel syndrome.

A new sign allowing diagnosis in the pathologies of the extensor tendons of the hand

IntroductionThe thorough knowledge of the anatomy of the extensor tendon system of the hand is crucial for clinical examination and detection of tendon injuries. The Juncturae between the EDCII and other extensor tendons presents different incidences, shapes (“r” or “y”) and morphologies (Type I, II, III). The EIP does not receive connection. These characteristics may result in variable effects on extensor tendons during active finger movements. The purpose of this study is to investigate and describe a new sign helping diagnosis for injuries or pathologies of EIP and EDC index finger (EDC II), based on a cadaveric dissection and clinical observation. Materials and methodsThe authors performed a clinical observational study in 520 patients in order to distinctly evaluate by means of inspection and palpation the EIP and EDC II tendons and an anatomical analysis of extensor tendon apparatus of long fingers was then performed in 89 cadaver hands focusing the investigation on the juncturae system. ResultsThe observational studies showed that during the flexion of the III, IV and V fingers, associated to the active extension of the I and II fingers, the EDC of the III, IV and V fingers moved the EDC II in ulnar direction by means of juncturae action. The EIP remained in its position becoming visible and isolated from the migrated EDC II. ConclusionsThis feature allows the distinct clinical evaluation by observation and palpation of both EDC II and EIP tendons and may be helpful in clinical conditions such as diagnosis of tendon lesions, pre-operative planning of EIP transfer and extensor tendon tenolysis associated to soft tissue scar at the second MPj.

The Case Report of Sclerosing Osteomyelitis Garre of the Mandible

A 21 years old female patient reported with the complaint of face asymmetry, pain, acne and rash on the skin in the mental area of the lower jaw (right side) and became sick at the age 1.5 years old after face trauma. She has experienced 4 low-efficient operations for diagnosis correction. Preoperative examination by 3D CT showed sclerosing focies in mental area of the mandible. On the base of anamnesis, clinical signs (pain, enlarged mandibular bone tissue, skin diseases, and typical radiological picture) were strongly suspected Garre osteomyelitis associated with SAPHO syndrome. Subsequent computer simulation (stereolithographic model, 3D-printed) allowed planning surgery. In January 2018 was held operation with extraoral approach–partial resection and leveling of the sclerosed bone in the area of lesion (according to printed CT scan model), dissection of soft tissue scars after previously performed operations. In 5 days, the patient left hospital in good condition with recommendations for further examination, sanation of odontogenic infection, radiological control. This disease refers to atypical primary chronic forms of osteomyelitis and is rare in clinical practice of maxillofacial surgeons, especially in adults. Treatment consists of surgical and conservative phases. The prognosis is favorable, but syndrome is often persistent.

Proximal Phalanx Fracture Management.

The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons. We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions. Stable fractures can be successfully treated nonoperatively, whereas unstable injuries benefit from surgery. Regardless of the surgical intervention employed, the overriding goal is to restore anatomy and impart enough stability to allow for early motion. The surgical dissection contributes to soft tissue scarring and should be minimized. Clinical success is achieved when acceptable fracture alignment and stability occur in the setting of unobstructed tendon gliding and early active range of motion.