Treatment of bilateral refractory saphenous nerve entrapment neuropathy with pulsed radiofrequency

The application of conventional radiofrequency [CRF] has been successfully used in many chronic pain conditions. Because of its neurodestructive effect, it can cause serious deafferantation sequelae in peripheral sensory neuropathies. Recently, pulsed radiofrequency [PRF] has generated enormous interest among interventional pain physicians for peripheral neuropathies because of its neuromodulatory effect. A 74-year-old male patient, came to our pain clinic with bilateral distal medial thigh pain for more than 10 years which was severe and refractory to medical management and other interventions. He had undergone multiple diagnostic tests and imaging, but the cause was not established. Finally, a diagnostic saphenous nerve block with local anesthetic and steroid provided almost complete relief for couple of days. Subsequently, PRF of bilateral saphenous nerve provided him excellent long-lasting pain relief. This case report highlights the importance of having high index of suspicion for entrapment neuropathy and a simple diagnostic nerve block can either confirm or refute the diagnosis. In other words, an early diagnosis and treatment can be started and unnecessary tests can be avoided?

Open Reduction and Internal Fixation of Isolated Posterior Cruciate Ligament Avulsion Fractures: Clinical and Functional Outcome

PURPOSE: The posterior cruciate ligament (PCL) presents commonly with avulsion fractures of its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. Various fixation techniques have been explored with use of lag screws, steel wires, absorbable screws, suture anchors and straddle nails. The purpose of this study was to evaluate the clinical and functional outcome of open reduction and internal fixation of tibial avulsion injuries of the PCL using cannulated cancellous screws. MATERIALS AND METHODS: We performed open reduction and internal fixation using cannulated cancellous screws in 14 patients (mean age, 33.9 years) with isolated PCL avulsion injuries. Patients with a duration of injury more than 12 weeks were excluded. The minimum follow-up period was 12 months. Results were assessed radiologically and clinically. Final functional outcome was assessed using the Lysholm knee scoring system. RESULTS: The average follow-up period was 13.5 months. At the final follow-up, all 14 patients achieved fracture union. The average flexion was 121.7°±9.2° with full extension achieved in all patients. Mild instability (1+) was noted in 4 patients. The Lysholm functional score was excellent in 11 patients, good in 2 patients and fair in 1 patient with an average score of 97±7.6. CONCLUSIONS: Stable early fixation for PCL avulsion injuries with early controlled mobilization provided excellent to good results. However, fixation should not be discouraged for late-presenting patients because good to fair results can be achieved in such cases.