Anterior cruciate ligament reconstruction complicated by pyoderma gangrenosum.

We report a case of pyoderma gangrenosum as a complication of an anterior cruciate ligament reconstruction in a patient with inflammatory bowel disease, which was misdiagnosed initially as a post-operative wound infection. An early dermatology opinion and skin biopsy should be considered in cases of suspected infection where thorough surgical debridement and antimicrobial therapy has failed to improve the clinical picture.

Surgical repair of a chronic rupture of the rectus femoris muscle at the proximal musculotendinous junction in a soccer player.

A rare case is presented of a longstanding rupture of the rectus femoris muscle at the proximal musculotendinous junction in a semiprofessional soccer player. Its different and unique presentation, the surgical repair, and the remarkable functional recovery are discussed.

Thoracic spinal cord injury without radiographic abnormality in a skeletally mature patient: a case report.

STUDY DESIGN: A case of thoracic spinal cord injury without radiographic abnormality in a skeletally mature patient is reported. OBJECTIVES: To report, for the first time in the literature, a case of thoracic spinal cord injury without radiographic abnormality or any ligamentous injury in a skeletally mature patient, and to propose a unique mechanism of spinal cord traction injury resulting from associated bilateral high-energy lower limb injuries. SUMMERY OF BACKGROUND DATA: Thoracic spinal cord injury without radiographic abnormality is extremely uncommon in skeletally mature patients. Hyperflexion with an associated distraction force usually produces the spinal cord injury, which is associated with posterior ligamentous injury of the spine. In the only reported case of thoracic spinal cord injury without radiographic abnormality in a skeletally mature patient to date (1993), despite the absence of evidence showing bony injury associated with cord damage on plain radiographs and computed tomograms, the magnetic resonance image demonstrated significant injury to the posterior ligamentous structures of the spine. Thoracic spinal cord injury in a skeletally mature patient without associated bony and ligamentous injury has never before been reported. METHODS: A 17-year-old skeletally mature motorcyclist was involved in a road traffic accident and sustained multiple injuries. Clinical examination showed tenderness over L1 and L2 vertebrae with complete loss of sensation and motor power below L2. In addition, the patient also sustained a stable pelvic fracture; fracture of the right acetabulum; open dislocation of the right knee with complete disruption of both cruciate ligaments, the posteromedial capsule, and the medial collateral ligament; open fracture of the left tibia and fibula; displaced fracture of the medial condyle of the left femur; fracture of the right distal radius; and fracture of the right proximal humerus. The plain radiographs of the whole spine and computed tomography scanning of the thoracolumbar spine showed no evidence of bony injury. The contemporary magnetic resonance image scanning of the entire spine showed disruption of the spinal cord from T10 downward, with patchy high signal in the cord and loss of normal architecture. After appropriate management of the associated limb injuries, the patient was transferred to the regional spinal unit for rehabilitation. RESULTS: Thoracic spinal cord injury in a skeletally mature patient occurred in the absence of associated bony and ligamentous injury, and probably resulted from a longitudinal traction force transmitted through the sciatic nerves to the spinal cord as a result of associated high-energy bilateral lower limb injuries. CONCLUSIONS: A rare case of thoracic spinal cord injury without radiographic abnormality manifested as a result of traction injury to the sciatic nerves caused by bilateral violent lower limb injuries in a skeletally mature patient is presented. To the best of the authors' knowledge, such a case has not been reported previously.

Medial epicondylectomy or ulnar-nerve transposition for ulnar neuropathy at the elbow?

We carried out a prospective randomised study comparing medial epicondylectomy with anterior transposition for the treatment of ulnar neuropathy at the elbow. The mean follow-up period was 4.5 years and we assessed the patients neurologically and orthopaedically. Neither procedure appeared to have a significant effect on elbow function. Our study showed better results after medial epicondylectomy; in particular patient satisfaction was higher than after ulnar nerve transposition. There were no significant differences in motor power or nerve-conduction rates and sensory fibres appeared to be more vulnerable to devascularisation.

Obstetric brachial plexus palsy associated with breech delivery. A different pattern of injury.

Most obstetric brachial plexus palsies are due to rupture of the upper roots in babies whose delivery was complicated by shoulder dystocia. If treated by early exploration and grafting, they have a favourable prognosis. We reviewed 36 babies who had had an obstetric brachial plexus palsy after a breech delivery and found that they had a different pattern of injury; 81% had avulsion of the upper roots. This injury cannot be treated satisfactorily by exploration and microsurgical grafting and carries a considerably worse prognosis for shoulder function.

Analgesic effects of intraarticular bupivacaine after day-case arthroscopy.

A blind, prospective, randomized, controlled trial was conducted to assess the analgesic properties of intraarticular bupivacaine after day-case arthroscopy. Forty-eight patients undergoing routine arthroscopy were randomly allocated to receive 10 ml of 0.5% bupivacaine or 0.9% saline into the joint at the end of the procedure. The analgesic effects were assessed by visual analogue scales at discharge, on going to bed, and the following morning. Significant reduction in reported pain was found in the treatment groups on leaving the hospital and later the same evening, although no benefit was found the following day.

Spontaneous compartment syndrome in a patient with diabetes insipidus.

We describe a case of spontaneous muscle necrosis of the anterior tibial compartment occurring in a patient who had a hypophysectomy for a craniopharyngioma five years previously. We know of no other reported cases of spontaneous muscle necrosis in association with diabetes insipidus and feel that there should be increased awareness of the association between the two.