Spaghetti wrist: management and outcome.

OBJECTIVE: To determine the outcome of emergency management of the spaghetti wrist. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan, from January 2000 to December 2003. PATIENTS AND METHODS: During this period, all patients of more than 12 years, with sharp clean cut volar forearm lacerations (spaghetti wrist) of <6 hours were included, with a follow-up of one year, clinically and with nerve conduction studies, where appropriate. Sensory and motor recovery was evaluated according to S0-S4 and MRC (medical research council) scale respectively. The power of first dorsal interosseous and adductor pollicis was used to monitor the recovery of ulnar nerve; and abductor pollicis brevis and opponens pollicis for the median nerve. The tendon recovery was evaluated by Strickland Adjusted System Score. RESULTS: This study comprised of 10 patients (M:F, 4:1), of 14 to 38 years (mean 22.9 years). Injury was accidental in 70%; due to broken glass in 50% and kite string in 40%; involving right hand in 70%. 8.2 (4-12) structures per patient were involved. The injury involved median nerve in 70%, ulnar nerve in 60%, (30% had both nerves involved), flexor carpi ulnaris in 70%. There was predilection of injury for medial structures. In 80%, wrist flexors were involved, and all wrist joints recovered to the full range of movements and power. The ulnar nerve showed less total motor and sensory recovery than median nerve. However, sensory and motor recovery was good. Overall functional results were good and did not correlate with neurophysiological studies. CONCLUSION: Immediate primary repair is safe and has good outcome, which also depends upon good physiotherapy, close follow-up and patients' compliance. Overall clinical and functional assessment is more appropriate than series of individual observations and neurophysiological studies.

Ruptured amebic liver abscess.

A 20 years old male was referred from a district hospital having a refractory amebic liver abscess, not responding to metronidazole and aspiration. At presentation, he had pain in the right upper abdominal quadrant (RUAQ) with guarding and rigidity, accompanied by fever, vomiting and dyspnea. A diagnosis of ruptured amebic liver abscess (ALA) was made. The patient was managed successfully with ultrasound (US)-guided percutaneous catheter drainage (PCD) and metronidazole.