Midcarpal Instability: The Role of Wrist Arthroscopy.

The evidence behind management options for midcarpal instability (MCI) is scarce, relying solely on case series. Established treatments cause significant loss of wrist motion. As understanding of the condition has progressed, surgeons have been trying soft tissue techniques. The treatment option should be chosen for the appropriate type and grade of MCI. The Hargreaves grading system for palmar MCI aids treatment decision-making. A possible role for arthroscopy in treatment of MCI has been developed using arthroscopic thermal capsular shrinkage, appropriate for cases with dynamic instabilities. Static deformities require a soft tissue reconstruction or a partial wrist fusion.

Complexities of abdominoperineal surgery: synchronous resection of an ano-rectal adenocarcinoma and pelvic schwannoma.

Abdominoperineal resection (APR) is indicated for low rectal/ano-rectal cancers. It necessitates fastidious pelvic dissection posing certain operative difficulties. We present the surgical challenges in a unique case of a patient presenting with a low rectal adenocarcinoma and a synchronous pelvic schwannomas, both requiring resection. A 71-year-old gentleman presented for surveillance colonoscopy following previous excision of colonic polyps. This investigation revealed a polypoid mass at the ano-rectal junction which was histologically proven as an adenocarcinoma with high-grade dysplasia. A staging computed tomography scan revealed an incidental 10 × 15 cm homogeneous, pre-sacral mass. After meticulous operative planning, the patient underwent successful open resection of this mass and concurrent APR for his low rectal lesion. This case demonstrates a rare presentation of a low rectal adenocarcinoma and concurrent pelvic schwannoma. We discuss the technical difficulties encountered in the management of such complex pelvic tumours and highlight the successful outcomes of the synchronous resection.