Evaluation of the performance of three tenodesis techniques for the treatment of scapholunate instability: flexion-extension and radial-ulnar deviation.

Chronic scapholunate ligament (SL) injuries are difficult to treat and can lead to wrist dysfunction. Whilst several tendon reconstruction techniques have been employed in the management of SL instability, SL gap reappearance after surgery has been reported. Using a finite element model and cadaveric study data, we investigated the performance of the Corella, scapholunate axis (SLAM) and modified Brunelli tenodesis (MBT) techniques. Scapholunate dorsal and volar gap and angle were obtained following virtual surgery undertaken using each of the three reconstruction methods with the wrist positioned in flexion, extension, ulnar deviation and radial deviation, in addition to the ulnar-deviated clenched fist and neutral positions. From the study, it was found that, following simulated scapholunate interosseous ligament rupture, the Corella technique was better able to restore the SL gap and angle close to the intact ligament for all wrist positions investigated, followed by SLAM and MBT. The results suggest that for the tendon reconstruction techniques, the use of multiple junction points between scaphoid and lunate may be of benefit. Graphical abstract The use of multiple junction points between scaphoid and lunate may be of benefit for tendon reconstruction techniques.

Analysis of tenodesis techniques for treatment of scapholunate instability using the finite element method.

Chronic scapholunate ligament (SL) injury is a common disorder affecting the wrist. Despite advances in surgical techniques used to treat this injury, SL gap re-emergence may occur postoperatively. This paper presents an investigation into the performance of the Corella, schapolunate axis (SLAM), and modified Brunelli tenodesis (MBT) surgical reconstruction techniques used to treat scapholunate instability. Finite element (FE) models were used to undertake virtual surgery, and the resulting scapholunate (SL) gap and angle obtained using the 3 techniques were compared. The Corella technique was found to achieve the SL gap and angle closest to the intact (ligament) wrist, restoring SL gap and angle to within 5.6% and 0.6%, respectively. The MBT method resulted in an SL gap least close to the intact. The results of our study indicate that the contribution of volar scapholunate interosseous ligament to scapholunate stability could be important.

Scratch Collapse Test Is a Useful Clinical Sign in Assessing Long Thoracic Nerve Entrapment.

The scratch collapse test (SCT) is a relatively new clinical test in which a positive result implies entrapment neuropathy of the nerve tested. Initially described for carpal and cubital tunnel syndromes, subsequent authors have found it useful for the assessment of median, ulna, radial, axillary, and common peroneal nerves. We report a case illustrating the value of the SCT in the clinical assessment of thoracic nerve entrapment.

Ten questions on prosthetic shoulder infection.

Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.

Scaphoid non-union in osteogenesis imperfecta.

We report a case of scaphoid non-union in a child with osteogenesis imperfecta (OI) presenting 7 months after a fall. Following diagnosis, conservative treatment was initiated, but despite 4 months in a plaster cast, the fracture had failed to unite. Open reduction and internal fixation was performed (Acutrak screw) with bone graft harvested from the distal radius. Postoperative immobilisation continued for 10 weeks, and at 4 months the child was pain free and had resumed normal activities. The fracture had fully united radiologically at 9 months. Non-union is reported to occur in 23% of paediatric scaphoid fractures when treatment is delayed, and conservative and surgical treatment have both been described. Since OI increases the risk of non-union in long bone fractures, the scaphoid may also be at risk. We recommend a high level of suspicion for non-union in this patient group and a low threshold for consideration of surgical treatment.

The effect of new oral anticoagulants and extended thromboprophylaxis policy on hip and knee arthroplasty outcomes: observational study.

The efficacy and safety of the new oral anticoagulants (NOAC) and the benefits of extended duration thromboprophylaxis following hip and knee replacements remain uncertain. This observational study describes the relations between thromboprophylaxis policies following hip and knee replacements across England's NHS and patient outcomes between January 2008 and December 2011. From the national administrative database, we analyzed mortality, thromboembolic complications, emergency readmission, and bleeding rates for 201,418 hip and 230,282 knee replacements. There were no differences in outcomes for either LMWH or NOAC. We found no advantage in favor of any single anticoagulation policy or in changing policy. This study supports the American Academy of Orthopaedic Surgeons' recommendation that the choice and duration of thromboprophylaxis prophylaxis be decided by the treating surgeon.

Patient Satisfaction: Receiving a copy of the GP letter following fracture or elective orthopaedic clinic.

Following orthopaedic/fracture clinics at our hospital, patients now receive a copy of the letter summarizing an outpatient consultation that is sent to their General Practitioner. We undertook a patient satisfaction questionnaire to determine if patients found this change in practice beneficial. Of the 83 patients who had received this letter, most patients had read the letter (96%) and understood the content (90%). 13% were worried after having read the content and 86% found it helpful. Of the 40 patients who did not receive a copy, 32 (80%) specified that they would wish to in the future. The results support the new practice although it could be improved by identifying those who do not wish to be included thereby reducing costs.

Tumour Lysis Syndrome Occurring in a Patient with Metastatic Gastrointestinal Stromal Tumour Treated with Glivec (Imatinib Mesylate, Gleevec, STI571).

Tumour lysis syndrome (TLS) is a rare side effect of chemotherapy for solid tumours. It describes the metabolic derangements following rapid and extensive tumour cell death following a good response to chemotherapy. Symptoms are those of metabolic derangement and renal failure. Treatment involves rehydration and correction of metabolic abnormalities. TLS should be considered in high risk groups. We report a case of TLS in a patient with metastatic gastrointestinal stromal tumour treated with imatinib mesylate. To our knowledge, this is the first reported case.

Symptomatic pyloric pancreatic heterotopia: report of three cases and review of the literature.

BACKGROUND: Pancreatic heterotopia is a relatively common congenital anomaly which sometimes becomes symptomatic and mimics other upper gastrointestinal tract (GIT) pathologies. It is the presence of abnormally located pancreatic glandular tissue at sites with no structural or vascular contact with the main pancreas. It most often occurs in the proximal gastrointestinal tract. The hallmark of diagnosis is the presence of pancreatic tissue within another, anatomically different organ. CASE REPORT: We report three patients, I, II, and III, 48, 86, and 33 years of age, respectively, surgically treated for symptomatic heterotopic pancreas in the pylorus. A review of the literature on this pathology is hereby presented. Patients I and II had uneventful postoperative recovery, while patient III developed postoperative intra-abdominal sepsis due to leakage from the gastric suture line, which was treated with further surgery. Histology confirmed pancreatic heterotopia in all cases. All patients made full recovery and follow-up endoscopy showed no residual disease. CONCLUSIONS: Most pancreatic heterotopias are asymptomatic and require no treatment. This entity is extremely difficult to diagnose preoperatively as the cause of upper gastrointestinal tract symptoms and therefore requires a high index of suspicion. Symptomatic lesions should be excised, and this can be safely carried out by minimally invasive techniques depending on the size and the anatomical location.