Treatment of Brachial Plexitis: A Complication of Brachial Plexus Regional Nerve Block.

Brachial plexitis is a rare condition characterized by inflammation within the brachial plexus presenting with acute shoulder pain, with motor and sensory deficits of the upper extremity. This case involves a 56-year-old female presenting with brachial plexitis after undergoing rotator cuff repair with a regional nerve block to the right brachial plexus. The diagnosis was made on her clinical presentation of fever with swelling and pain over her right shoulder and imaging showing inflammation and abscess formation with the soft tissue. The case was managed with antibiotic therapy and ultrasound drainage of the abscess. Although this case is a rare occurrence, the likely etiology was secondary to peripheral nerve catheter placement for anesthesia, as well as her probable immunocompromised state with underlying uncontrolled diabetes mellitus. Surgical intervention was avoided because of the high probability of intraoperative complications due to the abscess's location and thus management opted for less invasive measures. Therefore, brachial plexitis with abscess formation is a complication of plexus nerve block, can present without any neurological deficit and is best managed conservatively without surgery.

Feasibility of Transosseous Nonarticular Fixation of Lisfranc Injuries.

BACKGROUND: The optimal techniques for Lisfranc open reduction and internal fixation techniques remain debated. The purpose of the current study was to describe the joints involved in Lisfranc fixation and to determine if nonarticular transosseous internal fixation would be possible. METHODS: Twenty cadaver Lisfranc joints were dissected and the articular cartilage was quantified by calibrated digital imaging software. Utilizing CT data, a computational model of the foot was developed and the mean joint surface was mapped and nonarticular screw paths between bones was determined. RESULTS: For the medial-middle cuneiform (C1-C2) connection, 27.3% of the lateral face of C1 and 43.7% of the medial face of C2 was articular cartilage. Three variations of articular morphology were observed on C1 and 2 on C2. From the 3D models, it was determined that a joint-sparing, transosseous screw trajectory was possible between C1 and the second metatarsal and between C1 and C2. These screw paths were large enough to accommodate clinically useful screw diameters (>5 mm). The screw trajectories were roughly perpendicular to the long axis of the foot and take a plantar-medial to dorsal-lateral orientation. CONCLUSION: The articular surface of the Lisfranc joint was quantified for the first time and may be smaller than some surgeons realize. This study demonstrated the orientation required to minimize articular damage. CLINICAL RELEVANCE: The clinical significance of the current study was that a nonarticular screw trajectory was possible, and this information may help guide the placement of these screws.