Comparison of Risk Factors Between Syndesmotic Screws With and Without Breakage.

Background Screw fixation continues to be a commonly used treatment for syndesmotic disruption; however, screw breakage remains a complication post-fixation. Despite this complication, investigation on the variability of surgical placement in conjunction with syndesmotic screw characteristics affecting breakage has not been fully elucidated. The purpose of this study is to compare patients with syndesmotic screw breakage versus those with intact screws based on surgically controlled variables. Methods A total of 176 patients and 260 syndesmotic screws were included in the study, 88 patients each with and without broken syndesmotic screws. A retrospective analysis of patients who underwent syndesmotic screw fixation was performed. Patients with syndesmotic screw breakage were compared to those with intact screws. Screw width and length, the number of screws used, fracture type, and the number of cortices for fixation were all collected. Further analysis included radiographic measurement of syndesmotic screw angle and height of placement above the tibial plafond. Results Decreased screw width, increased number of screws used, and younger age were all associated with increased rates of screw breakage (p < .001, p = .019, p = 0.020). No statistical difference was appreciated between groups based on screw length, number of cortices used, or angle relative to the tibial plafond (p = .2432, p = .4699, p = .9233). Conclusion Higher placement of syndesmotic screws above the tibiotalar joint, specifically greater than 20 mm above the tibial plafond, increases the screw breakage rate. Decreased screw width, increasing numbers of screws used, and younger age were all also associated with increased rates of screw breakage. No difference was appreciated based on the screw angle relative to the tibial plafond.

Temporal Bone Resection for Squamous Cell Carcinoma of the Lateral Skull Base: Systematic Review and Meta-analysis.

OBJECTIVE: Temporal bone squamous cell carcinoma (TBSCC) is rare and often confers a poor prognosis. The aim of this study was to synthesize survival and recurrence outcomes data reported in the literature for patients who underwent temporal bone resection (TBR) for curative management of TBSCC. We considered TBSCC listed as originating from multiple subsites, including the external ear, parotid, and external auditory canal (EAC), or nonspecifically from the temporal bone. DATA SOURCES: PubMed, Cochrane Library, Embase, and manual search of bibliographies. REVIEW METHOD: A systematic literature review conducted in December 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Survival data were collected from 51 retrospective studies, resulting in a pooled cohort of 501 patients with TBSCC. Compared to patients undergoing lateral TBR (LTBR), patients undergoing subtotal (SBTR) or total (TTBR) TBR exhibited significantly higher rates of stage IV disease (P < .001), positive surgical margins (P < .001), facial nerve involvement (P < .001), and recurrent disease (P < .001). A meta-analysis of 15 studies revealed a statistically significant 97% increase in mortality in patients who underwent STBR or TTBR. On multivariate analysis, recurrent disease was independently associated with worse overall survival (P < .001). On univariate analysis, facial nerve involvement was also associated with decreased overall survival (P < .001). CONCLUSION: Recurrent disease was associated with risk of death in patients undergoing TBR. Larger prospective multi-institutional studies are needed to ascertain prognostic factors for a wider array of postoperative outcomes, including histology-specific survival and recurrence outcomes.

Syndesmosis screw breakage: An analysis of multiple breakage locations.

INTRODUCTION/PURPOSE: Concerns have been raised about screw breakage within the tibia or fibula, referred to as intraosseous breakage. The purpose of this investigation is to analyze the technical aspects of syndesmotic screw placement in multiple anatomic breakage locations. MATERIALS: A retrospective analysis of over 1056 patients who underwent syndesmosis fixation was completed. Demographics, screw length, width, number, height above the tibial plafond, angle, breakage location, and breakage location on the screw were collected and analyzed. RESULTS: Intraosseous (IO) screw breakage (91 screws, 68 patients) was more common than clear space (CS) breakage (28 screws, 18 patients) (P = < 0.001). Within the IO group, screw breakage within the tibia (60 screws, 52 patients) was more common compared to fibula breakage (29 screws, 24 patients) (P = < 0.001).Increased BMI and the use of multiple screws were associated with IO breakage (P = .007) and CS breakage (P = .012), respectively. Increased screw angle and age were associated with fibular IO breakage (P = .021, P = .036) when compared to other IO breakage locations. Screw angle and placement showed no significant differences between compared groups (P = .629, P = .570). CONCLUSION: Syndesmosis screw breakage, overall, occurred more commonly in an IO location. When compared to IO breakage, the use of multiple syndesmosis screws is most associated with CS breakage. Increased BMI is associated with increased IO breakage when compared to CS breakage. Patients with IO screw breakage within the fibula had increased age and placed at a higher angle when compared to other IO breakage locations. No other factors related to screw placement, including the height of placement, were found to be significantly associated with location of screw breakage.

Acute Lymphoblastic Leukemia Masquerading as Guillain-Barré Syndrome.

INTRODUCTION: Neurological manifestations of acute lymphoblastic leukemia (ALL) have been reported as cranial neuropathies or meningeal symptoms most common in children. However, ALL can rarely involve the nerve roots causing symmetrical polyradiculopathy which can present with rapid onset paralysis, mimicking Guillain-Barré Syndrome (GBS). The symmetrical polyradiculopathy can be the earliest manifestation of ALL occurring even before the hematological and systemic manifestations. CASE REPORT: We report a case of a healthy 29-year-old man who presented with subacute bilateral lower extremity weakness and numbness preceded by a respiratory infection. He was initially treated as a suspected (GBS) but cerebrospinal fluid (CSF) findings suggested an alternative diagnosis. His prior TB exposure created a diagnostic confusion. Lumbar spine magnetic resonance imaging revealed nerve root enhancements at L4-L5 and L5-S1 that are seen in GBS and TB arachnoidids. Brain magnetic resonance imaging demonstrated bilateral distention of the optic nerve sheath complexes with CSF suggestive of intracranial hypertension. CSF revealed elevated protein, nucleated cells 2145 leukocytes/mm 3 , numerous atypical lymphoid cells. He was later diagnosed with ALL associated symmetrical polyradiculopathy presenting with GBS-like symptoms. CONCLUSION: Symmetrical polyradiculopathy is a rare complication of ALL and can be confused with acute inflammatory demyelinating polyneuropathy. ALL associated polyradiculopathy in young individuals can be clinically indistinguishable from GBS. Our case highlights that when CSF findings are atypical for GBS, ALL should be considered on the differential diagnosis in patients presenting with GBS like symptoms.