Shaver Suction Technique for Troubleshooting in Arthroscopic Double Foreign Body Removal From the Hip Joint.

Most arthroscopic techniques provide easy invasive access and subsequent inspection of the lateral segments of the hip joint. However, it is a challenge to visualize medial segments of the hip joint using arthroscopic techniques. Hip arthroscopy offers minimally invasive access to the hip joint as compared to the standard open arthrotomy procedure. Yet, visualization of both the femoral head and acetabulum is difficult. The use of arthroscopic techniques in the diagnosis and treatment of hip-related disorders is still evolving, including great benefits for the postoperative healing and complications. The author describes a case of removing two loose bodies stuck in the superior basicervical rim of the femoral head of a 53-year-old man. The use of the inferomedial arthroscopic technique proved advantageous in preventing the shortcomings associated with standard arthrotomy and other arthroscopic mechanisms. Such shortcomings include the need for traction, alternate portals, and damage to the acetabular labrum and articular cartilage. Through this case report, the author establishes the effective use of hip arthroscopy in the removal of two loose bodies from the hip joint.

Management of a Multi-Level Forearm Microsurgical Reconstruction and the Following Transfusion-Related Acute Lung Injury.

Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by acute respiratory distress following blood transfusion. This case-based technical report documents a case on the management of a multi-level forearm microsurgical reconstruction and the following TRALI syndrome that developed shortly after blood transfusion in a 29-year-old male. Multilevel microsurgical revascularization was performed via saphenous vein autograft arterial reconstruction from the proximal 1/3 ulnar artery to the ulnar side of the deep superficial palmar arterial arch. TRALI was resolved with intensive care unit monitoring and treatment. There are several reports of TRALI in literature, as well as proposed mechanisms of pathogenesis, however, no case on the management of a multilevel forearm arterial reconstruction via a long saphenous vein autograft and associated TRALI syndrome have been reported.

Thenar Compartment Syndrome: What If a Compartment Pressure Measuring Device is Absent?

Compartment syndrome (CS) is a threatening condition characterized by excessive tissue pressure accumulation associated with acute trauma. Compartment syndrome causes a significant reduction in blood flow with subsequent muscle and nerve ischemic necrosis. Recently, reports have described the importance of intramuscular pressure measurements as a basis for CS diagnosis. Unfortunately, the measuring devices that were utilized produced results with unsatisfactory reliability, making a diagnosis and subsequent treatment challenging. Here, we report the use of an anesthesia pressure monitoring device with greater precision for pressure measurements, as well as real-time monitoring of intraoperative compartment pressure decompression efficacy. This device enabled the accurate diagnosis and rapid treatment of a thenar compartment syndrome (TCS) in the left hand of a diabetic female in an emergency setting. She presented extreme pain in the thumb flexion-extension (FE). Her condition was complicated by diabetic cellulitis, primarily of Staphylococcus aureus. Consequently, successful microsurgery in the thenar space, together with debridement, resulted in remarkable pain relief during FE of the thumb metacarpophalangeal (MCP) and interphalangeal (IP) joints, as well as the disappearance of the infection by Day 10. Subsequent one- to two-year follow-up assessments revealed marked recovery.