Progressive Ulnar Neuropathy due to anomalous Distal Forearm Muscle: Distal Forearm Decompression.

This case study examines a 45-year-old man who presented with advanced ulnar innervated intrinsic muscle atrophy in the hand, and clawing of the ring and little fingers. This case is unique due to discovery of an anomalous distal forearm muscle with the spontaneous onset and rapid nature of progressive neuropathic symptoms. Further, this patient demonstrated primarily intrinsic motor deficits and denied any sensory deficits on presentation. At surgery, an anomalous distal forearm muscle was found to be compressing the ulnar nerve. This muscle crossed in an oblique fashion, originating from the volar forearm fascia and inserted into the pisiform and proximal abductor digiti minimi fascia. At 5 months after surgery, the patient's ulnar innervated intrinsic muscle strength was improved but still not normal. This case study details the patient's presentation, assessment, surgical management, and postoperative outcome.

A Propensity-Matched Analysis of Tranexamic Acid and Acute Respiratory Distress Syndrome in Trauma Patients.

INTRODUCTION: Tranexamic acid (TXA) protects the vasculature endothelium after hemorrhage, resulting in a decreased capillary leak. These properties may protect patients receiving TXA from acute respiratory distress syndrome (ARDS), however, clinical studies have yet to examine this topic. We hypothesized that trauma patients receiving TXA would have lower incidence of ARDS. METHODS: This was a retrospective review of adult (18+ y) patients who presented to a large Level I trauma center with an injury severity score ≥ 16 from admit years 2012-2020. Propensity matching was employed to examine how TXA administration is associated with ARDS. RESULTS: There were a total of 2751 patients meeting study criteria, with 162 (5.9%) received TXA. Of the 162 patients that received TXA, only 12 (7.4%) received pre-hospital TXA, while 4 (2.5%) received TXA both pre-hospital and in hospital. Of the 63 patients developing ARDS, 62 (98.4%) did not receive TXA. After propensity matching, 304 patients remained, with 152 in each cohort. The incidence of ARDS (P = 0.08), pneumonia (P = 0.68), any pulmonary complication (P = 0.33), and mortality (P = 0.37) were not different in patients receiving TXA on propensity matching. CONCLUSIONS: TXA did not protect trauma patients from pulmonary complications; however, nearly all patients developing ARDS did not receive TXA. Larger studies should examine this relationship to improve understanding of therapies that may prevent ARDS.

Trifid and ventrally curved xiphoid process with two sternal foramina.

In this report, we present the case of a 56-year-old man with an asymptomatic, ventrally curved, trifid xiphoid process with two foramina found incidentally during a CT screening. The objective of this report is to advance the knowledge and recognition of such variations and to discuss the clinical relevance. The xiphoid process was trifid with two xiphoid foramina, one above the other, between the middle and right processes. The right process was longest (approximately 4 cm) and the middle process, the shortest (approximately 2 cm). The upper xiphoid foramen was larger (approximately 0.5 cm) than the lower one (approximately 0.3 cm). No additional musculoskeletal variations were observed on imaging. In summary, this constellation of distinctive variations of the xiphoid process in a single individual provide an opportunity to further discuss the development of the sternum, associated anatomical variations, and potential clinical ramifications from such variations in hopes of advancing knowledge and recognition of such anomalies for clinicians.