Selective demyelination of a sciatic nerve allograft after SARS-CoV-2 infection - Case report.

Peripheral neurological complications are seen after SARS-CoV-2 infections. These are mostly immune-mediated such as Guillaine-Barré syndrome or chronic inflammatory demyelinating polyneuropathy. We present a 39-year-old man treated with a right sciatic nerve allotransplantation with subsequent clinical and electrophysiological improvement within 30 months of observation. After SARS-CoV-2 infection, he developed clinical deterioration with selective sciatic nerve demyelination in a nerve conduction study. Nerve conduction velocity returned to previous values within six months of treatment. Intravenous immunoglobulins were used at standard dosage. The inflammatory immune process seemed to be a cause of peripheral demyelination isolated to a nerve allograft with good reaction for intravenous immunoglobulin treatment.

Brachial plexus injury after shoulder dislocation: a literature review.

Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.

Dorsal and volar wrist ganglions: The results of surgical treatment.

BACKGROUND: The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. OBJECTIVES: The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. MATERIAL AND METHODS: A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. RESULTS: Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12.1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. CONCLUSIONS: Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.

Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation.

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

Chitosan and its composites: Properties for use in bone substitution.

For many years, research has been carried out on finding an ideal bone substitute. Chitosan (CTS) is a naturally occurring polysaccharide, obtained mainly from, inter alia, the shells of crustaceans. It is characterized by its high level of biocompatibility, biodegradability and antimicrobial properties as well as its support in the healing of wounds. Chitosan, due to its ability to form porous structures, can be used in the production of scaffolds used in the treatment of bone defects. There are numerous studies on the use of CTS in combination with other substances which aim to improve its biological and mechanical properties. The combination of chitosan with the calcium phosphate hydroxyapatite (HAp) has been extensively tested. The objective of the current studies is to verify the properties of scaffolds consisting of chitosan and other substances like polybutylene succinate, human bone marrow mesenchymal stem cells (hBMSCs), collagen, alginate, transforming growth factor - ß (TGF-ß), insulin-like growth factor (IGF), platelet-derived growth factor (PDGF) or bone morphogenetic proteins (BMP). The aim of the current research is to develop a scaffold with sufficiently good mechanical properties. Trials are underway with many of the biological and synthetic components affecting the biological properties of chitosan. This will allow for the creation of a substitute that fully meets the conditions for an ideal artificial bone.

Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review.

Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17-96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2-3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available. The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation. A comprehensive literature search and review was performed using the keywords "glenohumeral dislocation", "shoulder dislocation", "immobilization", "external rotation", and "recurrent dislocation" in PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar databases from their inceptions to May 2016. Three cadaveric studies, 6 imaging studies, 10 clinical studies, and 4 meta-analyses were identified. The total number of 734 patients were included in the clinical studies. Literature analysis revealed better coaptation of the labrum on the glenoid rim in external rotation in cadaveric and imaging studies. However, this tendency was not confirmed by lower redislocation rates or better quality of life in clinical studies. On the basis of the available literature, we cannot confirm the superiority of immobilization in external rotation after glenohumeral dislocation when compared to internal rotation. A yet-to-be-determined group of patients with specific labroligamentous injury pattern may benefit from immobilization in external rotation. Further studies are needed to identify these patients.

Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up.

BACKGROUND: Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury. METHODS: Thirty-three patients (26 men and 7 women; mean age, 45 years and 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000 and 2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of the British Medical Research Council (BMRC) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with the BMRC scale modified by Omer and Dellon and in the remaining areas with the Highet classification. Follow-up lasted 2-10 years (mean, 5.1 years). RESULTS: Good postoperative recovery of nerve function was observed in 100% of musculocutaneous, 93.3% of radial, 66.7% of median, 64% of axillary, and 50% of ulnar nerve injuries. No recovery was observed in 5.6% of median, 6.7% of radial, 10% of ulnar, and 20% of axillary nerve injuries. Injury to a single nerve was associated with worse treatment outcome than multiple nerve injury. CONCLUSIONS: Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low.

Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve.

The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.

Benign nerve tumours of the hand (excluding wrist).

INTRODUCTION: Hand tumours of neural origin are rare in clinical practice. The aim of this work is to present our experience in operative treatment of benign nerve tumours located in the hand. Special emphasis has been put on determining the occurrence rates of particular tumour types characterized by their unique histopathological patterns and describing detailed location of the lesions. The obtained results of treatment were assessed. MATERIALS AND METHODS: The study comprised of 26 patients, both female (19) and male (7). The mean age and age range of the female and male patients were 44.8 years (range, 21-73 years) and 39.6 years (range, 21-74 years), respectively. The patients underwent operative treatment for tumours of neurogenic origin located in the hand between the years 1990 and 2013. In total, 31 tumours in 26 patients were removed. The most common site of tumour origin was small cutaneous branches and only exceptionally the tumours arose from common digital nerves (2 patients). No patient was lost to postoperative follow-up. The shortest period of postoperative follow-up covered 1 year. RESULTS: No tumour recurrence was detected during postoperative follow-up examinations. The patients reported neither pain nor presence of paraesthesias. Neurofibromas (17 tumours) predominated in the gathered clinical material, while the second most common group of tumours were schwannomas (12 tumours). CONCLUSIONS: (1) Benign nerve tumours of the hand are rare. Neurofibromas and schwannomas predominate among them. Tumours having other histopathological patterns are extremely uncommon. (2) The prognosis after resection of benign nerve tumours located in the hand is good and the risk of postoperative complications and recurrence is low.

Evaluation of dynamic formation of cervical spine column based on functional radiological studies in patients after cervical spine injury.

The purpose of this study was to evaluate cervical spine function, based on our own functional method of roentgenometric analysis in patients who suffered from cervical spine sprain injury. Study involved 72 patients who suffered from cervical spine whiplash injury. Conventional plain radiographs in all patients included three lateral views: maximum flexion, neutral (resting) and maximum extension. All views allowed roentgenometric evaluation of ligament instability of the lower cervical spine C5-C7 according to the White and Panjabi criteria. Furthermore, based on literature analysis and their own clinical observations, the authors proposed new classification of dynamic formation of cervical spine column. The dynamic formation of cervical column is evaluated based on pathomechanical chain of being between normal and unstable. Authors' own evaluation system in flexion views can be useful in diagnosis and treatment of this type of injury.

Influence of whiplash injury on cervical spine stability.

The aim of this study was to define the influence of whiplash injury on cervical spine stability. The study involved 72 patients who had suffered from sprain injury to cervical spine of 0°-III° according to QTF. To verify the results the authors examined the control group whose representatives have never suffered from any cervical spine injury and met all the exclusion criteria. Conventional plain radiographs in both groups showed three lateral views: maximum flexion, neutral (resting) position and maximum extension view. The results of image studies were subjected to roentgenometric analysis to find mechanical symptoms of instability according to radiological criteria: AADI, anterior translation and regional angulation. The authors demonstrated that there was no influence of whiplash injury on mechanical stability of cervical spine measured on radiograms in static-functional lateral views.

Comparison analysis of the operative treatment results of the femoral neck fractures using side-plate and compression screw and cannulated AO screws.

INTRODUCTION: Femoral neck fractures are among the most frequent and the most dangerous types of musculoskeletal injuries in the elderly population. There is general agreement that because of the morphology of the fracture, internal fixation is the treatment of choice irrespective of the degree of displacement. The optimal surgical treatment of femoral neck fractures remains controversial despite constant progress in the surgical management of such fractures and still remains a serious therapeutic problem. The goal of the present study was to compare the outcome in patients who underwent surgery of femoral neck fractures with AO screws; a compression screw and a side-plate; and a compression screw and a side-plate with an additional AO screw. MATERIAL AND METHODS: The study group included 112 patients who underwent surgery for femoral neck fracture with the use of AO screws; a compression screw and a side-plate; and compression screw and a side-plate with an additional AO screw, at the Orthopaedic Department at Vendsyssel Hospital, Hjörring, Northern Orthopaedic Division, Denmark, between 1 January 2004 and 31 December 2005. Garden's classification was used to classify femoral neck fractures. Implant position and fracture reduction were categorised according to recommendations by Tornkvist and Lindequist. RESULTS AND CONCLUSIONS: Irrespective of fracture morphology, compression screw and side-plate fixation provides better stabilisation to the bony fragments and improves early mobilisation in comparison with AO screws.

Cementless stem stability in dysplastic osteoarthritis of the hip--12 years' experience.

BACKGROUND: The aim of this paper is a retrospective assessment of artificial hip joint function and stability of cementless stems of varied design used in the treatment of deformative and degenerative dysplastic changes in the hip. MATERIALS AND METHODS: The study enrolled 182 patients treated by cementless total hip arthroplasty. The average age of the patients was 44 years and the follow-up time ranged from 2 to 22 years (16.7 years on average). The following features were assessed: endoprosthesis survival judex according to Kaplan-Meier's criteria, functional outcome of the treatment on the Harris Hip Score (HHS) and endoprosthesis stability and changes in periprosthetic bone tissue over time, according to McGovern, Callaghan and Engh. RESULTS: The study revealed a considerable importance of the method chosen for matching the type of endoprosthesis to the anatomy of the dysplastic hip. The highest probability of long endoprosthesis survival time, correct implant placement and good stability in the femoral canal was obtained in the group with anatomical stem implants. The function of the operated hip in the study group had improved three times by the third year of follow-up. CONCLUSIONS: In dysplastic arthrosis, in which the proximal part of the femur has a narrow canal, the intertrochanteric area is often deformed and the angle of antetorsion greatly increased, better stability and osteointegration as well as a considerable functional improvement and extension of survival time can be obtained through using the so called anatomical stem, with anteflexion and antetorsion, fitted in the intertrochanteric area of the bone.

Local experience in the surgical treatment of primary malignant and metastatic bone tumors of the proximal femur.

Background. The introduction of new techniques for fixation of long bones and postresectional prosthetic replacement, combined with chemotherapy and radiotherapy, have created new possibilities for the surgical treatment of primary and metastatic bone tumors. The main problem is still the time of diagnosis and the proper choice of operative treatment. Material and methods. We examined a group 67 patients operated for tumor of the proximal femur between 1985 and 2004, consisting of 48 females (average age 57) and 19 males (average age 46.8). The follow-up period ranged from 1 to 24 years (average 5.7 years). Metastatic bone tumors were found in 51 cases, as compared to 16 primary bone tumors. The clinical outcomes were evaluated by orthopedic and radiological examination, using Enneking's functional scale, depending on the treatment method applied. Results. Following surgical excision of the bone tumor, total postresectional arthroplasty was performed, or, in some patients, hip hemiarthroplasty. In some cases resection of the tumor was followed by plate fixation or the application of an intramedullary device after the resection bone defect had been filled with methylmethacrylate. Conclusions. Excellent or good postoperative outcomes were obtained by 76% of the patients. In 18% of the patients there was tumor recurrence. The most common complication was either surgical wound infection caused by lowered immunity after chemotherapy or breakage of the stabilizing plates.