Review of management of unstable elbow fractures

Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstable fractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury

Simultaneous bilateral ganglion cysts of the anterior cruciate ligaments

Intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are rare, and bilateral ganglion cysts are even rarer. These cysts may cause intermittent or chronic nonspecific knee discomfort. Although three cases of bilateral ganglion cysts have been reported in the literature, the knees were not simultaneously affected in those cases. Herein, we report the case of a 56-year-old woman who presented with simultaneous bilateral ganglion cysts of the ACL that were symptomatic. She was successfully treated with arthroscopic resection and debridement. We also present a brief review of the literature, highlighting the aetiology, diagnosis and management of ganglion cysts of the ACL. To the best of our knowledge, this is the first report of simultaneous bilateral intra-articular ganglion cysts of the ACL

An anatomical variation of the third common digital nerve and recurrent motor branch of the median nerve

Carpal tunnel syndrome (CTS) is an entrapment neuropathy where the median nerve is compressed in the carpal canal. There are many variations of the distal branches of the median nerve at the wrist. Anatomical variations of this nerve have fundamental clinical importance to prevent injuries, especially during limited open or endoscopic surgical procedures. A case is presented of an anomalous course of the recurrent motor branch of the median nerve and high division of the third common digital nerve seen in a limited open carpal tunnel release

Malignant Lymphoma of Bone: A Review of 119 Patients

BACKGROUND: Lymphoma of bone is uncommon. As a result of this, many aspects of primary lymphoma of bone (PLB) are controversial: the definition, treatment strategies, response criteria, and prognostic factors. QUESTIONS/PURPOSES: We sought to determine the following in an analysis from a single center over a four-decade period: (1) 5-year disease-free survival of patients with PLB as well as those with systemic lymphoma with bone involvement; and (2) whether prognostic factors (sex, site of tumor, age) were associated with 5-year survival. METHODS: A total of 119 patients with lymphoma involving the musculoskeletal system were retrospectively evaluated. Among these, 94 patients who had a minimum followup of 6 months (mean, 67 months; range, 6 months to 34 years) were further analyzed for the skeletal site of involvement, the orthopaedic intervention(s) needed, and survival. The overall median age was 45 years (range, 7–87 years). The female-to-male ratio was 1:1.53. There were 70 (65 unifocal, five multifocal) patients with PLB. The femur was the most frequent site involved. Appendicular skeleton involvement was substantially higher in patients with PLB. Thirty-four (36%) patients had at least one surgical intervention. Fourteen patients (41%) needed more than one major surgical intervention. RESULTS: The disease-free 5-year survival for patients with PLB was 81% and for the patients with systemic lymphoma with bone involvement, it was 44%. The disease-free 5-year survival of the patients with PLB younger than 60 years old and 60 years old or older was 90% and 62%, respectively. Age was the only prognostic factor on survival of patients with PLB. CONCLUSIONS: Orthopaedic intervention was usually needed for pathologic fractures, avascular necrosis, spinal cord compression, or for the lesions of the weightbearing bones compromising stability or joint motion. The potential for long-term survival suggests the use of implants and techniques that have the best chance of long-term success. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Transforaminal epidural steroid injection via a preganglionic approach for lumbar spinal stenosis and lumbar discogenic pain with radiculopathy

Background: Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (CLBP) with various degrees of success. Aim: We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs) via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. Materials and Methods: We analyzed the data of 40 patients (February 2008 and April 2009) with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term), six months (midterm) and one year (long term) after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS) and North American Spine Society (NASS) patient satisfaction scores. Results: The mean age of the patients was 59.87 ± 15.06 years (range 30 - 89 years, 25 women). Average follow-up period was 9.22 ± 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P < 0.01, Pearson Correlation Test). Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P < 0.05, linear regression test). At short term evaluation in post treatment (one month), 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8) had a successful long-term outcome at a follow-up of one year. Conclusion: Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores

Spinal Nerve Root Compositions of Musculocutaneous Nerve: An Anatomical Study

AIM: This study was aimed to investigate the variations in the spinal nerve root compositions of musculocutaneous nerve and to confirm which spinal nerve root is the main ingredient in participating amount. MATERIAL and METHODS: A total of 20 fresh cadavers were dissected. Brachial plexus and its branches were extracted. Musculocutaneous nerve stump was traced back to the roots to identify its fascicular origin. The number of fascicles originating from a particular nerve root and their axial location with in the nerve were noted. RESULTS: The most frequent type of spinal nerve compositions of musculocutaneous nerve was C5, C6, and C7 with incidence of 60%. Musculocutaneous nerve had bundles from C5 root in all specimens, 90% of the specimens had contribution from C6 and only 70% of them had bundles from C7 root. There were a total of 46 (37.7%) bundles in C5 fascicles, 48 (39.3%) bundles in C6 fascicles, and 28 (22.9%) bundles in C7 fascicles. CONCLUSIONS: In electrophysiological studies it should be remembered that C7 or C6 lesions may not impair musculocutaneous nerve functions. The success of musculocutaneous nerve neurotization may be improved if care is taken to ensure whether or not C7 root is contributing to the musculocutaneous nerve

Spinal Nerve Root Compositions of Musculocutaneous Nerve: An Anatomical Study

ABSTRAcT AIm: This study was aimed to investigate the variations in the spinal nerve root compositions of musculocutaneous nerve and to confirm which spinal nerve root is the main ingredient in participating amount. mATERIAl and mEThods: A total of 20 fresh cadavers were dissected. Brachial plexus and its branches were extracted. Musculocutaneous nerve stump was traced back to the roots to identify its fascicular origin. The number of fascicles originating from a particular nerve root and their axial location with in the nerve were noted. REsulTs: The most frequent type of spinal nerve compositions of musculocutaneous nerve was C5, C6, and C7 with incidence of 60%. Musculocutaneous nerve had bundles from C5 root in all specimens, 90% of the specimens had contribution from C6 and only 70% of them had bundles from C7 root. There were a total of 46 (37.7%) bundles in C5 fascicles, 48 (39.3%) bundles in C6 fascicles, and 28 (22.9%) bundles in C7 fascicles. CoNClusIoNs: In electrophysiological studies it should be remembered that C7 or C6 lesions may not impair musculocutaneous nerve functions. The success of musculocutaneous nerve neurotization may be improved if care is taken to ensure whether or not C7 root is contributing to the musculocutaneous nerve. KEywoRds: Musculocutaneous nerve, Cadaver, Spinal nerve roots, Neurotization ÖZ AmAÇ: Bu çalışmanın amacı, muskülokutanöz sinirde spinal sinir kökü bileşimi varyasyonlarını araştırmak ve hangi spinal sinir kökünün katılım miktarı olarak ana bileşeni oluşturduğunu doğrulamaktır. GEREÇ ve yÖNTEm: Toplam 20 taze kadavranın diseksiyonu yapıldı. Brakiyal pleksus ve dallarının ekstraksiyonu gerçekleştirildi. Muskülokutanöz sinir kökü, fasiküler kökenini tanımlamak üzere köklerine kadar geri izlendi. Belirli bir sinir kökünden köken alan fasiküllerin sayısı ve sinir içindeki aksiyal konumları kaydedildi. BulGulAR: Muskülokutanöz sinirin spinal sinir bileşiminin en sık görülen tipi C5, C6 ve C7&apos;ydi ve insidans %60&apos;dı. Muskülokutanöz sinirin tüm örneklerinde C5 kökünden demetler varken, örneklerin %90&apos;ında C6&apos;dan ve sadece %70&apos;inde C7 kökünden demetler vardı. C5 fasiküllerinde toplam 46 (%37,7), C6 fasiküllerinde 48 (%39,3) ve C7 fasiküllerinde 28 (%22,9) demet vardı. soNuÇ: Elektrofizyolojik çalışmalarda, C6 veya C7 lezyonlarının muskülokutanöz sinir işlevlerini bozmayabileceğine dikkat edilmelidir. Eğer C7 kökünün muskülokutanöz sinire katkıda bulunup bulunmadığını belirlemeye dikkat edilirse, muskülokutanöz sinir nörotizasyonu başarısı artabilir