Complex trigger wrist associated with carpal tunnel syndrome: a case report.

BACKGROUND: There are few reports of trigger wrist in the literature, as it is a rare pathology. Furthermore, various authors report that it is also hard to diagnose. It manifests with neurological symptoms at the affected wrist, which are usually induced by wrist movement, and can lead to partial or full loss of wrist function and sensitivity. The reason for reporting this specific case is that it was hard to differentiate between trigger finger and trigger wrist by clinical symptoms; no pathology was palpable or clearly seen on magnetic resonance imaging scan of the wrist. We propose a new diagnostic statement relative to this pathology. CASE PRESENTATION: A case of a 45-year-old white slavic man with trigger wrist associated with carpal tunnel syndrome, caused by a fibroma of the flexor tendon sheath, is reported. Despite careful clinical examination, it was not possible to differentiate between trigger finger and trigger wrist. Magnetic resonance imaging was performed to arrive at the right diagnosis but did not reveal any pathology in the wrist area. Carpal tunnel release was performed with a fibroma identified and excised. Wrist function was maintained well; no signs of carpal tunnel syndrome were seen at last follow-up. CONCLUSIONS: Trigger wrist can be misdiagnosed as trigger finger even if adequate clinical evaluation is performed, and this can lead to inadequate treatment. We state that, when clinical symptoms of both trigger wrist and trigger finger are present, except painful palpation of the A-1 pulley region, the case should be referred to as trigger wrist.

Сomparative analysis of large diameter bearing ceramic monoblock acetabular components.

Introduction: The goal of total hip arthroplasty (THA) is to provide ease to patients with persistent and exhausting pain. Durability is the main challenge associated with any tribological pair, with the aim of minimizing wear and thus avoiding problems with aseptic loosening of components and osteolysis. When polyethylene inserts are used in young patients, we should always consider their disadvantages, e.g., increased wear of the interacting components. Proper selection of friction pairs allows prolonged implant life. Ceramic-on-ceramic (CoC) friction pairs should provide long-term wear of the friction components. Objectives: To evaluate the mid-term results of using the monoblock Maxera Cup (Zimmer Biomet) acetabular system in cementless THA. Methods: We operated on 151 patients using the monoblock Maxera Cup (Zimmer Biomet) acetabular system. The mean follow-up duration was 6 years (73.8 ± 11.7 months). Fifty-seven women and 94 men aged 19-64 years were surgically treated. All 170 THA cases in 151 patients were divided into 3 groups according to the diameters of the CoC friction pairs used (40, 44, and 48 mm). As a control group, we have taken 50 patients who received 50 THA using a standard 36 mm CoC friction pair. The achieved functional results were evaluated using the HHS scale, WOMAC scale, and SF36 scale. We also evaluated the mean duration of surgical intervention and blood loss. Results: When assessing long-term results, the average HHS significantly increased from 34.10 (before surgery) to 87.50 (postoperation) points in the 1st group, from 46.24 to 96.5 points in the 2nd group, and from 38.70 to 92.10 points in the 3rd group. From preoperative examination to 1 year after surgery, there was a 2.4-fold improvement in the functional results in group 1 and 1,8 and 2.9 -fold improvement in groups 2 and 3, indicating excellent treatment results. Inconsistent creaking in the implanted joint was noted in only 2.6% of cases in which a CoC friction pair with a diameter of 44 mm was used. We did not observe any complications associated with aseptic or septic loosening of the components either clinically or radiologically during the 7-year follow-up period after surgery in the entire patient population. Conclusions: 1Use of the CoC monoblock allowed us to expect an increase in the life cycle of the implant and provided good joint function and perception by the patient.2Monoblock cups provided good joint function and perception by the patient.3Acoustic effects, in the form of minor creaking, did not affect the functional results.

Three-Dimensional Models in Planning of Revision Hip Arthroplasty with Complex Acetabular Defects.

BACKGROUND: Careful preoperative planning in revision cases with complex acetabular defects is crucial for optimal surgery outcome. However, in many cases, computed tomography (CT) scans cannot give a clear understanding of the pelvic destruction. Three-dimensional (3D) models-based on CT data can help surgeon in planning of complex acetabular reconstruction. MATERIALS AND METHODS: We used 3D plaster pelvic models in 17 revision cases. There were 5 patients with Paprosky II C acetabular defects, 2 patients with Paprosky IIIA defects, and 10 patients with Paprosky IIIB defects (3 patients among them with pelvic discontinuity). We used 3D printer and digital 3D models based on CT scan data for 3D models printing. In 3 cases with Paprosky IIIB defects, we implanted custom-made acetabular components with the porous coating, also printed on the 3D printer. RESULTS: In 14 cases, we used trabecular metal (TM) augments with TM cups. In 100% of cases, number and type of planned and used augments were same. In 9 (64.3%) cases, size of planned and used cups was same. In other cases, the difference was not >2 mm. CONCLUSIONS: Use of 3D plaster models for the revision hip arthroplasty planning with complex acetabular defects has shown high accuracy in the clear understanding of acetabular bone deficiency.