The Simultaneous Compression of the Median and Ulnar Nerves by Lipoma: A Case Report and Review of the Literature.

Entrapment syndromes in the hand are very common and usually idiopathic. However, it can be the expression of nerve compression by a nearby structure or tumor. Space-occupying lesions are widely reported as a cause of median or ulnar nerve compression in the wrist. Nevertheless, a simultaneous compression of the median and ulnar nerves by a tumor is a rare condition. To the best of our knowledge, only three cases are described in the English literature. Herein, we present a case of a simultaneous compression in the wrist of the median and ulnar nerves by lipoma in a 79-year-old patient while also elucidating the reasons for the rarity of this condition and reviewing its clinical and therapeutic particularities.

Experience with the distally based sural flap: a review of 25 cases.

The reconstruction of soft tissue defects in the distal areas of the lower extremity remains a challenge. The distally based sural neurocutaneous flap based on the sural nerve and the superficial sural artery has been used for skin defect reconstruction of the distal third of the leg, the hindfoot, ankle, and heel. We describe our experience and evaluate the reliability of this surgical technique. From 2004-2010, 25 patients with an average age of 32.5 (6 to 70) years were treated using the distally based sural flap for reconstruction of skin defects of the lower third of the leg, the heel, the ankle, and the hindfoot. The skin defect was secondary to trauma in 20 patients (80%) and compromised tendon or bone in all cases. One venous congestion and 2 partial flap necroses were observed. The mean follow-up was 25 (9 to 46) months. The plastic result was assessed as satisfactory in all patients. The donor site morbidity was minimal. The sural flap is a good way to reconstruct soft tissue defects of the lower extremity; this surgical technique provides an alternative to microsurgical reconstruction.

Nonunion of the scaphoid treated by anterior vascularized bone graft: a review of 26 cases.

OBJECTIVE: To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid. METHODS: This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot's classification and only one case showed a proximal pole necrosis (type IV). The fixation was ensured by K-wire. The mean immobilization period was 9 weeks. RESULTS: At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18 degree Nineteen patients (73%) were free of pain, and the others had occasional pain. CONCLUSIONS: It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.

Unusual combined fracture dislocation of the wrist and metacarpophalangeal joints: a case report and review of the literature.

Volar perilunate fracture dislocation is an extremely rare carpal injury, but associated with metacarpophalangeal joint dislocation of both the ipsilateral index and middle finger has never been reported. We report one case of a 28-year-old man following a high-energy trauma. After performing closed reduction of the metacarpophalangeal joint injury, open reduction of the wrist injury through volar approach was done, and a K-wire fixation was used to stabilize the scaphoid fracture and lunotriquetral joint. After a 16 months?follow-up period, the wrist regained a full range of motion without symptoms, and the fractured bone was strengthened in a good position.

Glomus tumour of fingertip: report of eight cases and literature review.

Glomus tumour is a rare, benign, soft-tissue tumour. Eight patients with eight histologically confirmed glomus tumours have been operated within the past 10 years. The median age at the time of diagnosis was 40 years. The tumour was located in the fingertip in all cases. The evolution ranged from 1 to 7 years. Clinically, the paroxysmal pain was usually characterised. Imaging findings were helpful in diagnosis. In post-operative, there was an immediate pain relief. No recurrence was observed during the last follow-up period of 4 years and 10 months.

Operative management of nonunion scaphoid fracture in children: a case report and literature review.

Scaphoid fractures are uncommon in children, but if maltreated, they can result in nonunion. The authors report a case of left scaphoid nonunion in an 11-year-old boy. The operative management of this pseudarthrosis was performed (K-wire fixation and bone grafting of scaphoid). After a 10-month follow-up period, the left wrist regained a full range of motion with no impairment. The roentgenograms showed union of the scaphoid. Surgical management of scaphoid nonunion fractures in children offers successful fusion, with very low nonunion rate and patient's satisfaction.

[Soft tissue chondroma of the thumb. A case report]. / Le chondrome des parties molles du pouce. A propos d'un cas.

BACKGROUND: Soft-tissue chondroma is a rare and benign cartilaginous tumour often localised in the extremities. The thumb is very rarely affected. AIM: We report a new case typical for this lesion with review of literature. CASE REPORT: 43 year-old man presented with soft tissue tumour of the left thumb for about 4 years without any symptoms. Radiographs of the thumb showed a calcification out of the bone. Surgery resection of the tumour was complete and easy. Histological examination confirmed the diagnosis of soft-tissue chondroma. There was not tumoral recurrence at three years follow-up. CONCLUSION: Soft tissue chondroma is not a diagnosis evoked when we have a soft tissue tumor of the hand. Diagnosis is confirmed by pathology which should eliminate a low grade chondrosarcoma. Complete surgical resection will avoid reoccurence.

Upper limb compartment syndrome after an adder bite: a case report.

Compartment syndrome after an adder bite is extremely rare, whose effects are only secondary to the cytotoxic and hemorrhagic effects of venom. Here we reported a case of compartment syndrome in the upper limb following an adder bite in the thenar eminence. Elevated compartment pressure was documented and immediate surgical fasciotomy was practiced. The patient achieved complete recovery with a good functional result. We discussed the controversies on fasciotomy and non-invasive measures in such a situation, and recommended intracompartmental pressure monitoring during the management of compartment syndrome following adder bites.

Intercondylar fracture of the distal humerus in youth: two case reports.

Intercondylar fracture of the distal humerus in youth is an extremely rare injury. Three cases have been reported in the literature to date. We describe two cases, aged 15 and 14 years, both of whom were boys. The stability in this injury allowed non-operative treatment and a favorable outcome.