Management of extensor tendon injuries concerning distal radius fractures.

Introduction: Rupture of the extensor tendons secondary to fractures involving the distal radius is a well-recognized rare complication. In patients with implants particularly, there exists a tendency for attributing the implant as a cause for the tendon rupture. We retrospectively studied the patients with extensor tendon injuries related to distal radius fractures, analyzed the factors leading to the rupture, suggest few preventive measures and describe the management strategy of these ruptures. Materials and methods: 21 patients who were treated for extensor tendon rupture following distal radius fractures in the period of 2014-2022 were retrospectively analyzed. 19 patients had been managed with surgery and two patients conservatively for the distal radius fracture. The time interval between the fracture fixation and tendon rupture, the time interval between tendon rupture and presentation, the extensor tendons injured and the position of the impinging screws or bony spur in relation to the extensor compartments, necessity for implant removal and modality of tendon reconstruction were studied in these patients. Results: Extensor pollicis longus was found to be ruptured in all the patients except one patient with Extensor indicis proprius rupture alone. The time interval between the fracture fixation and tendon rupture averaged at 32.5 months. End to end repair of the ruptured tendons was never possible even in patients who presented earlier. 10 patients underwent intertendinous bridge grafting and 11 patients underwent tendon transfer. All the patients achieved full extension of thumb with no donor deficit. Conclusion: Distal radius fracture related extensor tendon injuries pose a technical challenge to the surgeon and concern to the patient in the form of recurring surgeries. However, with immediate presentation to the surgeon and their use of appropriately designed management algorithm, these patients could be immensely satisfied with the outcome.

The Morphology and Morphometric Analysis of the Radius Bone: A Study on Freshly Frozen Cadavers in the Indian Population.

Introduction The radial bone and the radioulnar joint are vital for the physiological and physical stability of the elbow. The prostheses and plates used in cases of radius fracture are designed based on the morphology of the Western population. This could result in a bone-implant mismatch when applied to the Indian population, resulting in complications. Hence, the study aimed to record the normal values of radius morphology in the Indian population. Methods A total of 30 (eight male and seven female) freshly frozen cadaveric bilateral upper limbs were chosen. Cadavers with previous surgical scars, deformities, and congenital defects of the upper limb were excluded. The radius was excised, and morphometric parameters were measured with a non-elastic measuring tape and a digital caliper and recorded using GeoGebra software. Results All measuring parameters exhibited no significant difference between the right and left side of the bone (p > 0.05), whereas the difference between males and females for most parameters was statistically significant (p < 0.05). The mean difference between the anteroposterior (AP) diameter and transverse diameter of the radial head for the study sample was 0.89 ± 0.06 mm. Thus, the AP diameter was 4% greater than the transverse diameter. The head of the radius was observed to be almost round. The degree of extent of the safe zone was 124.64°, with an average safe arc length of 3.27 ± 0.55 cm. Conclusion The morphometric measurements of the radius in the Indian population are different from the Western population.

Ulnar-Side Wrist Pain Management Guidelines: All That Hurts is Not the TFCC!

BACKGROUND: Ulnar-sided wrist pain is a common clinical problem, most often misdiagnosed as triangular fibrocartilage complex (TFCC) injury. It may be frustrating to the patient, as one may end up wearing a wrist splint for an unusually long period, disrupting their routine. PURPOSE: Because of the dilemmas in the diagnosing the cause of ulnar-sided wrist pain, various algorithms have been suggested but it is an individual's choice to do a systematic assessment and follow in their routine clinical practice. We propose the 'storey concept' for examining the ulnar side of the wrist, with ulnar styloid as the reference point. The lower storey identifies the pathologies of the DRUJ, the intermediate storey identifies the pathologies of the radiocarpal joint and the upper storey identifies the pathologies of midcarpal and carpometacarpal joint. CONCLUSION: Also, it is important to ramify the cause of pain into stable or unstable wrist, with or without arthritis, as this will guide us in managing the pain arising from distal radioulnar joint. In addition to methodical clinical examination, ideal radiographs and high-resolution MRI are critical to diagnose wrist pathologies. The role of wrist arthroscopy has consistently increased, and complements in both diagnosis and treatment of wrist pain especially in ambiguous situations.

Prediction of odor complaints at a large composite reservoir in a highly urbanized area: A machine learning approach.

Odorous compound emissions and odor complaints from the public are rising concerns for agricultural, industrial, and water resource recovery facilities (WRRFs) near urban areas. Many facilities are deploying sensors that measure malodorous compounds and other factors related to odor creation and dispersion. Focusing on the Metropolitan Water Reclamation District of Greater Chicago's (MWRDGCs) Thornton Composite Reservoir (7.9 billion gallon capacity), we used meteorological, operational, and H2S sensor data to train a 3-day advance-warning predictor of local odor complaints, so as to implement targeted odor prevention measures. Using a machine learning approach, we bypassed difficulties in modeling both physical dispersion and human perception of odors. Utilizing random forest algorithms with varied settings and input attributes, we find that a small network of H2S sensors, meteorological data, and operational data are able to predict odor complaints three days in advance with greater than 60% accuracy and less than 25% false-positive rates, exceeding MWRDGC's standards required for full-scale deployment. PRACTITIONER POINTS: A random forest algorithm trained on H2 S, weather, and operations data successfully predicted odor complaints surrounding a large composite reservoir. Thirty-two data attribute combinations were tested. It was found that H2 S sensor data alone are insufficient for predicting odor complaints. The best predictor was a Random Forest Classifier trained on weather, operational, and H2 S readings from the reservoir corner locations. This study demonstrates odor complaint prediction capability utilizing a limited set of data sources and open-source machine learning techniques. Given a small network of H2 S sensors and organized data management, WRRFs and similar facilities can conduct advance-warning odor complaint prediction.

Ulnar Nerve Innervation to Triceps: A Cadaveric Study and a Technical Note on Partial Triceps to Biceps Transfer.

BACKGROUND: The loss of elbow flexion is a routinely encountered problem in clinical practice. There is no literature on ulnar nerve innervation to triceps in addition to the radial nerve which is dual nerve innervation to triceps in the Indian population. We intend to study the incidence of ulnar nerve innervation to the medial head of triceps in Indian population and also the clinical feasibility of transfer of long and medial head of triceps tendon to biceps around the medial aspect of humerus. MATERIALS AND METHODS: A cross-sectional study was conducted using 32 fresh-frozen skeletally mature cadavers of Indian origin. The possible contribution of the ulnar nerve to medial head of triceps in addition to the radial nerve was recorded. The arm length, the distance where the ulnar nerve pierces the medial intermuscular septum from medial epicondyle; the distance of the ulnar nerve fascicle from the medial epicondyle was also measured. RESULTS: The incidence of ulnar nerve innervation to the medial head of triceps was 43.8%. Mean arm length was 29.13 cm. Mean distance where the ulnar nerve pierced the medial intermuscular septum from medial epicondyle was 9.93 cm. Mean distance of the ulnar nerve branch to the triceps from medial epicondyle was 8.01 cm. CONCLUSION: This study reveals the presence of dual nerve innervation to triceps in 43.8% of the Indian population. The clinical implication would be to look for the possible contribution of the ulnar nerve fascicle to the medial head of triceps, which will help us to include the medial head along with the long head of triceps while performing partial triceps-to-biceps tendon transfer, and the other use would be as a donor fascicle when performing a nerve transfer.

Assessment of Usefulness of Anthropometric Data for Predicting the Scaphoid and the Screw Length: A New Technique.

BACKGROUND: Headless screw is frequently used for scaphoid fracture fixation. Aim of the study was to assess the correlation between the axial length of the scaphoid and the axial length of the middle phalanx of index, middle, ring and little finger so as to provide an indirect method to assess the length of the scaphoid and thereby the length of the screw. METHODS: Thirty five fresh frozen cadavers with seventy wrists and hands were dissected. The age, sex and side were recorded. The axial length of the scaphoid, axial length of the middle phalanx of index, middle, ring and little finger were recorded and a correlation was assessed. Five cadavers were randomly selected and radiographs of the hand were done. Pearson coefficient correlation was assessed between the axial length of the middle phalanx of ring finger on a radiograph and actual length of middle phalanx. RESULTS: A significant positive correlation was noted between the axial length of the scaphoid and the axial length of the middle phalanx of ring finger (r = 0.646), also a positive correlation between the axial length of middle phalanx of ring finger on a radiograph and the axial length of the scaphoid measured by vernier caliper (r = 0.91). CONCLUSIONS: A preoperative radiograph of the wrist with hand will help us indirectly assess the axial length of the scaphoid by measuring the axial length of the middle phalanx of ring finger.

An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre.

BACKGROUND: Epidemiological studies on traumatic brachial plexus injuries are few and these studies help us to improve the treatment, rehabilitation of these patients and to allocate the resources required in their management. Epidemiological factors can vary in different countries. We wanted to know the situation in an Indian centre. MATERIALS AND METHODS: Data regarding age, sex, affected side, mode of injury, distribution of paralysis, associated injuries, pain at the time of presentation and the index procedure they underwent were collected from 304 patients. Additional data like the vehicle associated during the accident, speed of the vehicle during the accident, employment status and integration into the family were collected in 144 patients out of the 304 patients. RESULTS: Road traffic accidents accounted for 94% of patients and of the road traffic accidents 90% involved two wheelers. Brachial plexus injury formed a part of multitrauma in 54% of this study group and 46% had isolated brachial plexus injury. Associated injuries like fractures, vascular injuries and head injuries are much less probably due to the lower velocity of the vehicles compared to the western world. The average time interval from the date of injury to exploration of the brachial plexus was 127 days and 124 (40.78%) patients presented to us within this duration. Fifty-seven per cent had joined back to work by an average of 8.6 months. It took an average of 6.8 months for the global brachial plexus-injured patients to write in their non-dominant hand.

Von Hippel Lindau disease [VHL]: magnetic resonance imaging spectrum in a single patient.

In this case, we describe the wide magnetic resonance imaging (MRI) spectrum in a single patient who had multi organ involvement. Von Hippel Lindau Disease is a rare inherited autosomal dominant disorder characterized by development of benign and malignant lesions involving multiple organs. Imaging plays a vital role in the diagnosis and surveillance of VHL as it can differentiate benign from malignant lesions. The median life expectancy of VHL is 49 years and the commonest cause of death in patients with VHL is renal cell carcinoma and neurologic complication from cerebellar hemangioblastomas.