Large solitary glomus tumor of the wrist involving the radial artery.

Glomus tumors are neuromyoarterial glomus body neoplasms that most commonly occur in the subungual areas of the hand. These tumors typically present as painful solitary lesions with localized tenderness. Extradigital glomus tumors are rare and difficult to diagnose because of their varying symptoms and presentation. Misdiagnosis can result in significant chronic pain, disuse syndromes, and disability over prolonged periods. Timely diagnosis and surgical resection are generally curative with complete resolution of symptoms. Surgeons should be aware of this rare condition and consider it in the differential diagnosis when treating a painful soft-tissue mass of the wrist. We report a case of a large solitary glomus tumor that occurred on the volar-radial aspect of the wrist and involved the radial artery. The patient was successfully treated with complete surgical excision of the tumor. There were no symptoms or recurrence at 3-year follow-up. In the literature, this is the first case of large atypical wrist glomus tumor involving the radial artery to be reported with corresponding magnetic resonance imaging, intraoperative, histology, and immunohistochemistry findings.

Biomechanical evaluation of a low-profile, anchored cervical interbody spacer device at the index level or adjacent to plated fusion.

STUDY DESIGN: In vitro biomechanical study. OBJECTIVE: To test the hypotheses: (1) an anchored spacer device would decrease motion similarly to a plate-spacer construct, and (2) the anchored spacer would achieve a similar reduction in motion when placed adjacent to a previously fused segment. SUMMARY OF BACKGROUND DATA: An anchored spacer device has been shown to perform similar to the plate-spacer construct in previous biomechanical evaluation. The prevalence of adjacent segment disease after fusion is well established in the literature.There is currently no evidence supporting the use of an anchored interbody spacer device adjacent to a previous fusion. METHODS: Eight human cervical spines (age: 45.1 ± 13.1 yr) were tested in moment control (±1.5 Nm) in flexion-extension, lateral bending, and axial rotation without preload. Flexion-extension was then retested under 150-N preload. Spines were tested intact and after anterior cervical discectomy and fusion (ACDF) at C4-C5 and C6-C7 with either a plate-spacer or anchored spacer construct (randomized). The specimens were tested finally with an ACDF at the floating C5-C6 segment using the anchored spacer device adjacent to the previous fusions. RESULTS: Both the plate-spacer and anchored spacer significantly reduced motion from the intact spine in flexion-extension, lateral bending, and axial rotation (P < 0.005). There was no statistically significant difference between the 2 fusion constructs in their abilities to reduce motions (P = 1.0). ACDF using the anchored spacer at the floating C5-C6 level (in between the plate-spacer and anchored spacer constructs) resulted in significant motion reductions in all modes of testing (P < 0.05). These motion reductions did not significantly differ from those of a single-level anchored-spacer construct or a single-level plated ACDF. CONCLUSION: The anchored spacer provided significant motion reductions, similar to a plated ACDF, when used as a single-level fusion construct or placed adjacent to a previously plated segment. LEVEL OF EVIDENCE: N/A.

Complications after the fractures of metacarpal and phalanges.

Fractures of the metacarpals and phalanges represent 40% of all upper extremity fractures. Complications associated with these fractures are also prevalent, and can arise with both conservative and surgical treatment of hand fractures, making treatment of complications an essential part of caring for these injuries. In this article the treatment of complications associated with open fractures and infection are reviewed, in addition to current treatment options for malunion and stiffness.