Surgical procedures to improve hand function in tetraplegic patients: patient satisfaction and outcomes over a 20-year period.

The aim of the present study was to report our experience in the evolution in surgical strategy and patient satisfaction after upper limb reconstruction in tetraplegic patients. A total of 72 patients (114 upper limbs) underwent surgery between 1997 and 2017. Since April 2003, tenodesis of the extensor digitorum communis tendons was no longer performed because it limited wrist flexion, and two-stage operations to restore active grasp were replaced by one-stage procedures. In total, 34 patients (58 upper limbs) completed questionnaires about function and satisfaction at a mean follow-up of 14 years (range 4-24) since their first operation; 26 were satisfied, 30 would have the operation again and 31 benefitted from the surgery. Surgical procedures, such as tendon transfers, arthrodesis and tenodesis, can have a positive effect on patient-perceived function and satisfaction in the long term in most of these patients.Level of evidence: IV.

10-year results of the Nesovic procedure combined with adductor release for groin pain in 33 competitive athletes.

The authors present a 10-year review of the postoperative bilateral release of the adductor brevis and gracilis muscles combined with a bilateral abdominal myo-fascio-plasty according to Nesovic for groin pain in competitive athletes. We present the 10 years results of 33 patients operated on between April 2002 and May 2006 diagnosed with a "sports hernia". The injury was treated with a bilateral abdominal procedure according to Nesovic combined with a bilateral adductor release after unsuccessful conservative treatment of at least 2 months. There were 32 male patients between 18 and 43 years and one female patient aged 25 years with a mean age of 28.8 at time of surgery. All procedures were bilateral. Patients were seen in the postoperative clinic and a questionnaire was collected after 2 years and 10 years. Within 16 weeks, 30 patients (90,9 %) returned to the same or a higher level of sports activities. 10 years after surgery 31 patients (93,9%) remained free of pain. 1 patient has minor pain after training (VAS 0-1) and only 1 patient still experiences pain (VAS ≥ 5) after heavy work. 13 patients (39,3%) are still performing sports today, and 19 of 20 patients (95%, 57% of total cohort) were pain free to the end of their sporting careers. The bilateral Nesovic procedure with bilateral adductor release has a high success rate for the competitive athlete with chronic groin pain. It also is a procedure that gave most athletes suffering from a certain type of groin pain a solution till the end of their sporting careers.

Andreas Vesalius on the anatomy and function of the lower thoracic vertebrae.

Some remarkable statements made by Andreas Vesalius (1514-1564) in his principal work De Humani Corporis Fabrica (1543) about the anatomy and function of the lower thoracic vertebrae are discussed in the light of information from the literature. Their accuracy is evaluated on the basis of several pieces of anatomical evidence and clinical cases.

Measurement of ulnar variance and radial inclination on X-rays of healed distal radius fractures. With the axis of the distal radius or ulna?

Ulnar variance and radial inclination are radiological parameters frequently used to evaluate displacement of distal radius fractures. In most studies measurements are based on the long central axis of the distal radius, although the axis of the distal ulna can also be used. The purpose of this study was to determine which axis is more reliable. Four observers performed measurements on standard anteroposterior digital wrist X-rays of 20 patients taken 1 and 2 months after sustaining an extra-articular distal radius fracture. Intraobserver reliability was similar with both methods. No difference was found in interobserver reliability between both methods for ulnar variance, but for radial inclination it was better with the axis through the radius. Measurements on two X-rays of the same wrist taken at a different moment were similar with both methods. It can be concluded that the central axis of the distal radius can remain the basis to determine ulnar variance and radial inclination.

Which patients undergo a surgical reintervention following a distal radius fracture?

Not all malunited distal radius fractures cause pain or functional impairment, and only few patients require a surgical correction or a salvage procedure. The purpose of this retrospective study was to investigate differences between 38 patients who underwent a reintervention and 65 patients who did not. The only discriminative variable in the current study was age : 46 years in the reintervention group versus 59 years in the non-reintervention group (p < 0.0001). Differences in gender or type of malunion were not significant, and thus not discriminative. It can be concluded that patient age may be more often associated with a reintervention than gender or radiological characteristics of wrist fractures.