ABSTRACT
A 54-year-old woman with rheumatoid arthritis developed loss of finger extension in the left hand. History, physical examination, and electromyography led to the diagnosis of posterior interosseous nerve palsy secondary to synovitis of the elbow. Anterior decompression and synovectomy resulted in a complete recovery. A literature review describes similar cases and compares outcomes.
Subject(s)
Arthritis, Rheumatoid/complications , Elbow Joint/innervation , Fingers/innervation , Paralysis/etiology , Peripheral Nervous System Diseases/etiology , Elbow/innervation , Female , Humans , Middle Aged , Paralysis/surgery , Peripheral Nervous System Diseases/surgery , Synovitis/etiologyABSTRACT
We describe a case of posterior interosseous nerve palsy that developed after application of a hinged elbow external fixation device. Our hypothesis that forearm pronation during ulnar half pin insertion may have been causative is supported by anatomic findings noted during subsequent cadaveric dissection. Based on our observations we recommend that the ulnar half pins required with this device be inserted with the forearm in supination.
Subject(s)
Elbow Injuries , External Fixators , Joint Dislocations/surgery , Joint Instability/surgery , Paresis/etiology , Postoperative Complications , Radius Fractures/surgery , Adult , Bone Nails , Cadaver , Female , Humans , Pronation , SupinationABSTRACT
We reviewed the outcome of radial nerve decompression in 28 patients with an average 28-month follow-up period. The outcome was determined by both subjective (ie, questionnaire) and objective assessments. Only 11 of the 28 patients (39%) had excellent or good results. However, 64% subjectively assessed their results as excellent or good. Results were worse in patients receiving workers' compensation or who were in litigation. The difference was statistically significant. Although previous studies have found a high rate of good results, we believe that a high rate of morbidity is associated with both the disease and its treatment. Based on our results we suggest that great caution be taken before performing radial tunnel release and strict adherence to the indications noted during the preoperative examination.
Subject(s)
Decompression, Surgical , Nerve Compression Syndromes/surgery , Radial Nerve , Adult , Aged , Elbow Joint/physiopathology , Female , Humans , Male , Middle Aged , Nerve Compression Syndromes/physiopathology , Range of Motion, Articular , Retrospective Studies , Treatment OutcomeABSTRACT
The use of arthroscopy was evaluated in 47 patients who were treated for suspected triangular fibrocartilage complex (TFCC) tears, scapholunate (SL) tears, and/or lunotriquetral (LT) tears. Wrist arthroscopy was performed using traction and standard portals. Any TFCC tear found was debrided to a stable rim. SL and LT tears were debrided to bleeding bone. The range of follow-up was 1.5 to 50 months (average, 15.4 months). Patient grading was determined usin the Mayo Modified Wrist Score. For the 28 patients with TFCC tears, the results were excellent in 13, good in 8, fair in 2, and poor in 5. For the 23 patients with SL tears, the results were 11, 9, 1, and 2, respectively. Of the 5 patients with LT tears, 1 result was excellent, and 4 were poor. Workers compensation did not affect results. Arthroscopic debridement of SL and TFCC tears has proven effective. Debridement of LT tears has not been as successful. Based on our results, we feel that arthroscopic debridement of SL and TFCC tears is warranted.
Subject(s)
Arthroscopy/methods , Endoscopy/methods , Wrist Injuries/diagnosis , Wrist Injuries/surgery , Cartilage, Articular/injuries , Cartilage, Articular/surgery , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Injury Severity Score , Ligaments, Articular/injuries , Ligaments, Articular/surgery , Male , Range of Motion, Articular , Sensitivity and Specificity , Treatment Outcome , Wrist Injuries/pathologyABSTRACT
This article evaluates common techniques for coverage of digital tissue defects including skin grafts, advancement flaps, rotation flaps, thenar flaps, and fillet flaps. An appreciation of the physiology of flap healing in relation to the health of the defect site and the potential functional result better guides the choice of optimal-tissue coverage.
Subject(s)
Finger Injuries/surgery , Surgical Flaps/methods , Graft Survival , Humans , Postoperative Complications , Skin Transplantation/methods , Soft Tissue Injuries/surgery , Treatment OutcomeABSTRACT
A 66-year-old woman presented with a bronchoesophagopleural fistula 10 weeks after thoracic photodynamic therapy for malignant mesothelioma. This is the third reported case of an esophagopleural fistula developing subsequent to photodynamic therapy for mesothelioma. We review the literature on this topic and report our successful management of this complication.
