Traumatic injury of the third palmar interosseous muscle in a patient with dementia: A case report.

An 81-year-old man with dementia presented with a third palmar interosseous injury. A fourth flexor digitorum superficialis tendon transfer surgery was performed the following day. The patient achieved adduction of the little finger; however, flexion contracture that began 2 months after the surgery progressed until completion because of issues related to postoperative rehabilitation and home exercise. An injury of the third palmar interosseous muscle is extremely rare and is even more uncommon in older adults. Therefore, careful consideration must be given to determine whether surgery is the best choice, especially if the patient has dementia.

Postoperative subtype P as a risk factor for excessive postoperative sliding of cephalomedullary nail in femoral trochanteric fractures in old patients: A case series of 263 patients using computed tomography analysis.

INTRODUCTION: Although excellent results of cephalomedullary nailing for femoral trochanteric fractures have been reported, excessive sliding has recently been noted as a cause of lag screw cut-out. Excessive sliding is reported as sliding of ≥8mm, which occurs in approximately 40%of cases. This study aimed to evaluate the risk factors for excessive sliding. PATIENTS AND METHODS: Overall, 551 patients who underwent cephalomedullary nail surgery between 2016 and 2021 were recruited. Patients aged ≥65 years who underwent preoperative computed tomography (CT), experienced low-energy trauma, and received follow-up for >4 months were included. Cases were retrospectively reviewed for their postoperative sliding distance and the percentage of excessive sliding (>8 mm). 3D-CT classification, reduction pattern (subtypes A, N, and P) in the lateral view, medullary mismatch, and implant type (short/long Gamma3 nail and INTERTAN) were investigated fortheirimpact on sliding distance andtheincidence of excessive sliding. Complication rates (lag screw cut-out and non-union) were also assessed. RESULTS: Overall, 263 patients (mean age, 84.0±7.4; 186 women) were recruited. The median (range) sliding distance was 3.5 (0-20) mm, and 42 cases (16.0%) had excessive sliding. Sliding distance was significantly smaller in the 2-fragment group than in the 3-fragment group (GP+GA and GP+L) (p=0.02); however, there were no significant differences between the 2-fragment and other fracture-type groups, including the 3-fragment group (GP, GA, GP ± GA, GP ± L), 4-fragmentgroup(GP/L, GP ± L/GA, GP±GA/L), and 5-fragmentgroup. There was no significant difference in sliding distance according to postoperative reduction type between the groups (p=0.83) and no correlation between medullary mismatch and sliding distance. The amount of sliding and rate of excessive sliding were significantly lower in the INTERTAN group than in the Gamma3 nail groups (p<0.01). Logistic regression analysis with excessive sliding as the variable revealed reduction type P as the only risk factor (p=0.024, odds ratio 2.99). There were three lag screw cut-out (1.1%) cases and one non-union (0.4%) case. CONCLUSIONS: Postoperative subtype P is a risk factor for excessive sliding; there was significantly less sliding in the INTERTAN nail group. It is necessary to avoid reduction to subtype P to prevent postoperative excessive sliding. LEVEL OF EVIDENCE: IV.

Ultrasound-guided arthroscopic communication enlargement surgery may be an ideal treatment option for popliteal cysts - indications and technique.

PURPOSE: Several studies have shown an excellent success rate of communication enlargement surgery for popliteal cysts (Baker's cysts). Ultrasound-guided surgery can improve the accuracy of this procedure and may lead to better outcomes. This study describes a simple ultrasound-guided arthroscopic technique to manage popliteal cysts and reduce postoperative pain. METHODS: After routine arthroscopic observation with a standard 2-portal approach, the arthroscope is redirected toward the posteromedial compartment from the anterolateral portal through the intercondylar notch. A posteromedial portal is then placed at this view. Subsequently, a contrast dye (indigo carmine) is injected into the popliteal cyst percutaneously using ultrasonography. This procedure makes it easier to find a capsular fold or valvular opening. The valvular opening between the semimembranosus and medial gastrocnemius is enlarged with a shaver and radiofrequency ablation. Cystectomy is not performed in any case. Finally, the irrigation fluid is suctioned, and the reduced cyst is visualized by ultrasound. Additionally, a periarticular multimodal drug injection is administered into the septum and inner wall of the cyst under ultrasound guidance. CONCLUSIONS: Ultrasound-guided arthroscopic surgery for popliteal cysts can ensure reproducibility and be effective for postoperative pain relief. Thus, this combined procedure may be an optimal treatment option.

Surgical treatment of femoral medial condyle fracture with lag screws and proximal tibial plate: A case report.

INTRODUCTION: Femoral medial condyle fracture is a rare fracture. Here, we report a case of femoral medial condyle fracture treated with lag screws and proximal tibial plate as a buttress plate. CASE PRESENTATION: A 80-year-old woman fell down 15 steps at her home and reported to our hospital with severe right knee pain. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. The patient had an uneventful postoperative recovery. At the latest follow-up, the patient achieved a range of motion of 0° to 120° and could walk without pain. DISCUSSION: Femoral medial condyle fracture is a rare fracture. As with any articular injury, anatomical restoration of the joint surface must be obtained, then lag screw fixation is required. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. Nevertheless, there are no available anatomical plates that fit either the femoral medial condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. We used a locking compression plate - proximal tibial plate 4.5/5.0 (Depuy Synthes TRAUMA) as a buttress plate. The implant fitted well and enhanced joint stability. Postoperative radiographs confirmed anatomical reduction, and the patient achieved a good result. CONCLUSION: The locking compression plate for proximal tibia is an acceptable solution for femoral medial condyle fracture.

Para-articular osteochondroma of the infrapatellar fat pad: A report of three cases.

INTRODUCTION: Para-articular osteochondromas are not very common. We performed simple marginal excision for three cases. PRESENTATION OF CASE: We encountered three cases of para-articular osteochondroma of the infrapatellar fat pad. All patients were men, with an average age of 43 years. The symptoms were very similar to those of anterior knee pain, which were increasing swelling and reduction of the range of motion. After simple marginal excision was performed, the symptoms improved and no recurrences or malignant transformation occurred during the mean postoperative period of 51 months. DISCUSSION: Forty-seven cases of para-articular osteochondroma have been reported, and excision is the standard treatment. Local recurrence has been reported in only one case, and malignant transformation has never been reported. However, in some reports there was no specification of the excision method, which was simply referred to as "excision." Thus, we used a simple marginal excision for all three of our cases. CONCLUSION: We report three cases of para-articular osteochondroma of the infrapatellar fat pad that were effectively treated using simple marginal excision.

Obturator internus muscle abscess caused by methicillin-resistant Staphylococcus aureus in an adult: A case report.

INTRODUCTION: Obturator internus muscle (OIM) abscess is a rare condition, usually affecting children after trauma or muscular effort. Blood cultures always yield positive findings, with Staphylococcus aureus being the most common culprit. There are few reports in adults. PRESENTATION OF CASE: We report a case of OIM abscess in an adult. A 24-year-old male was admitted to our hospital because of right hip pain and fever. He was diagnosed with OIM abscess, and methicillin-resistant Staphylococcus aureus (MRSA) was detected on bacterial examination. The patient was successfully treated with a surgical drainage procedure and antibiotics. DISCUSSION: There are only five reported cases of OIM abscess in adults. The patient had no history of recent hip trauma, but had intractable acronyx of the right great toe, which was being treated for 2 years. MRSA was also detected from cultures of samples obtained from the toe. A toe infection can lead to bacteremia. CONCLUSION: In conclusion, we report the first case of OIM abscess in an adult caused by MRSA. Surgical drainage, debridement, and systemic antibiotic treatment were administered, resulting in a successful outcome.

Wound management with negative pressure wound therapy in postoperative infection after open reconstruction of chronic Achilles tendon rupture.

INTRODUCTION: Deep infection after reconstruction of chronic Achilles tendon rupture is a major and intractable complication. CASE REPORT: We report a case of late deep infection following a surgery for chronic Achilles tendon rupture, and its simple and successful treatment with negative pressure wound therapy (NPWT). Six months following the reconstruction of chronic Achilles tendon rupture, a deep infection developed and reconstructed part of the tendon ruptured again. After appropriate debridement. DISCUSSION: There is no definitive treatment strategy for postoperative infection following open Achilles tendon repair. NPWT was applied to the wound, to promote wound healing and healthy granulation. In our case, NPWT promoted the wound healing and the infected Achilles tendon with tendon loss formed a healthy bridge with granulation tissue spontaneously. The patient resumed her normal activities of daily living, without requiring tendon transfer surgery. NPWT seems to be a simple and successful candidate for this situation. CONCLUSION: NPWT seems to be effective for the treatment of postoperative infection following Achilles tendon repair, even in cases of tendon loss.