Cubital Tunnel Syndrome Caused by Anconeus Epitrochlearis Muscle

OBJECTIVE: We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle.METHODS: Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle.RESULTS: AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores.CONCLUSION: The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.

Cubital Tunnel Syndrome Caused by Anconeus Epitrochlearis Muscle

OBJECTIVE: We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. METHODS: Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle. RESULTS: AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores. CONCLUSION: The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.

Loss of Distal Femur Combined with Popliteal Artery Occlusion: Reconstructive Arthroplasty Using Modular Segmental Endoprosthesis: A Case Report

Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.

Factors affecting Fixation Failure in Treatment of Intertrochanteric Fracture of the Femur by Dynamic Compression Hip Screw

PURPOSE: The purpose of this study was to analyze the factors affecting fixation failures of intertrochanteric fractures of the femur treated by dynamic compression hip screw in elderly patients. MATERIALS AND METHODS: Between March 1999 and February 2005, we evaluated 164 cases of intertrochanteric fractures of the femur treated by dynamic compression hip screw. The failure group (group 1) contained 14 cases, and the control group (group 2) contained 150 cases. We compared the fracture pattern, type of reduction, method of fixation, tip-apex distance, location of screw within head, and presence of lateral trochanteric wall fracture between the two groups. The average patient age was 76.1 years (range 63-92) in group 1 and 75.0 years (range 63-93) in group 2. RESULTS: The mode of fixation failure in group 1 included 6 cases of nonunion, 5 cases of varus and cutting-out, 2 cases of excessive sliding of lag screw, and 1 case of plate debonding. There was a significant relationship between the fracture pattern, tip-apex distance, position of lag screw (especially the posterior location), and presence of lateral wall fracture when compared against postoperative fixation failure (P<0.05). The use of bone cement augmentation and the central location of lag screw within the head correlated with the avoidance of cutting-out of lag screw through the head. However, there was no relationship between the type of reduction, the use of additional fixation with a screw, or greater trochanter stabilizing plate when compared against fixation failure. CONCLUSION: The structural integrity of lateral wall support is thought to be an essential factor in successful treatment of unstable intertrochanteric fractures of the femur. Furthermore, methods such as concentric screw placement in the head, minimal tip-apex distance, and cement augmentation may be useful for preventing cutting-out through obtaining secure purchase of the lag screw in the head.

Treatment of Acute Arterial Thrombosis after Total Hip Replacement Arthroplasty Using Urokinase: A Report of Two Cases

Arterial thrombosis of the lower extremity following total hip replacement is a rare but serious complication that threatens the lower limb and sometimes the life of the patient. We report two cases of an arterial occlusion after total hip arthroplasty. The cause of the occlusion is believed to be a thromboembolism in elderly patients due to underlying artherosclerosis. In the case of multifocal artherosclerosis, a vein graft is not feasible and an infusion of a thrombolytic drug is the optimal treatment. However, the result of this method varies.