Tarsal tunnel ganglion cyst: intraneural or extraneural site?

Intraneural ganglion cysts are very uncommon lesions, whose diagnosis has increased since the articular theory and the description of the MRI findings were established. We present a case report of a 59-year-old man with symptoms of tarsal tunnel syndrome. Foot and ankle MRI demonstrated the presence of an intraneural cystic lesion in the posterior tibial neve and its connection with the subtalar joint through an articular branch. The identification of the specific radiological signs like the «signet ring sign¼ allowed establishing an adequate preoperative diagnosis, differentiating it from an extraneural lesion and facilitating the articular disconnection of the nerve branch during surgery.

Resección de radios de la mano en pacientes pediátricos / Ray resection in paediatric population

Objetivo. Valoración de los resultados clínicos y funcionales de la resección completa de los radios de la mano en población pediátrica y descripción de los aspectos técnicos más relevantes de la cirugía. Material y método. Estudio retrospectivo observacional de pacientes intervenidos en el periodo comprendido entre 2010-2015. Criterios de inclusión: resección de uno o más radios de la mano y seguimiento mínimo de un año. Evaluación de las características clínicas, resultados funcionales y estéticos, complicaciones, necesidad de apoyo psicológico y grado de satisfacción. Resultados. Cuatro pacientes cumplieron criterios de inclusión. La edad media fue de 5 años (rango 1-14 años). Las causas fueron: hamartoma lipofibromatoso, amputación traumática, deficiencia radial y sindactilia compleja. El segundo radio fue resecado en tres pacientes y el tercer y cuarto radio en un paciente. No se realizó transferencia de radios adyacentes. No existieron complicaciones postoperatorias ni durante el seguimiento. Ningún paciente precisó ayuda psicológica. Todos presentaron excelentes resultados estéticos, funcionales y con un alto grado de satisfacción. Discusión. La resección completa de uno o más radios de la mano se utiliza como técnica de rescate en pacientes con lesiones vasculares, tumores, traumatismos, infecciones o malformaciones congénitas. Las publicaciones existentes son pequeñas series en pacientes adultos o casos clínicos aislados, no existiendo apenas referencias en población pediátrica. Conclusión. La resección de radios de la mano es una técnica útil y segura en la población pediátrica que proporciona excelentes resultados estéticos y funcionales en aquellos casos en los que es imposible la preservación de uno o varios dedos (AU)

Aim. Evaluation of clinical and functional outcome of ray resection in paediatric population and description of key aspects of surgical technique. Material and methods. We performed a retrospective review of all patients undergoing surgery between 2010-2015. Inclusion criteria: one or more ray resections of the hand and a minimum of one year follow-up. Evaluation of clinical characteristics, functional and cosmetic results, complications, need for psychological support and patient or family satisfaction. Results. Four patients met the inclusion criteria. The mean age at surgery was 5 years (range, 1-14 years). Aetiology was: fibrolipomatous hamartoma, traumatic amputation, radial deficiency and complex syndactyly. Second ray was resected in three patients and third and fourth ray in one. No finger transfer was performed. No immediate post-operative complications were found at the final evaluation. None of them needed psychological support. All the patients showed excellent clinical and functional results with a high grade of satisfaction. Discussion. Ray resection of the hand has been used as salvage procedure in patients with vascular lesions, tumours, trauma, infections or congenital malformations. There are only a few published studies including small samples in adults or case reports, with no references in the paediatric population. Conclusion. Ray resection of the hand is a useful and safe technique in paediatric population, obtaining excellent cosmetic and functional results in those cases in which it is impossible to preserve one or more fingers (AU)

Ray resection in paediatric population. / Resección de radios de la mano en pacientes pediátricos.

AIM: Evaluation of clinical and functional outcome of ray resection in paediatric population and description of key aspects of surgical technique. MATERIAL AND METHODS: We performed a retrospective review of all patients undergoing surgery between 2010-2015. INCLUSION CRITERIA: one or more ray resections of the hand and a minimum of one year follow-up. Evaluation of clinical characteristics, functional and cosmetic results, complications, need for psychological support and patient or family satisfaction. RESULTS: Four patients met the inclusion criteria. The mean age at surgery was 5 years (range, 1-14 years). Aetiology was: fibrolipomatous hamartoma, traumatic amputation, radial deficiency and complex syndactyly. Second ray was resected in three patients and third and fourth ray in one. No finger transfer was performed. No immediate post-operative complications were found at the final evaluation. None of them needed psychological support. All the patients showed excellent clinical and functional results with a high grade of satisfaction. DISCUSSION: Ray resection of the hand has been used as salvage procedure in patients with vascular lesions, tumours, trauma, infections or congenital malformations. There are only a few published studies including small samples in adults or case reports, with no references in the paediatric population. CONCLUSION: Ray resection of the hand is a useful and safe technique in paediatric population, obtaining excellent cosmetic and functional results in those cases in which it is impossible to preserve one or more fingers.