Operative treatment of acute shaft and neck lesser metatarsals fractures: a systematic review of the literature.

PURPOSE: Metatarsal fractures are relatively common injuries that they might lead to significant disability and chronic pain if suboptimally treated. Operative treatment is reserved for the displaced fractures. The primary aim of the herein study is to present the union time and rate, as well as the functional outcome of the surgically treated isolated lesser metatarsal shaft and neck fractures. The secondary aim is to present the related complications of each fixation method. METHODS: The electronic databases of Pubmed, Scopus, Embase and Cochrane libraries were searched from January 1990 to December 2020. PRISMA guidelines were used for data collection. We retrieved five articles including in total 154 patients, which were compatible to our inclusion criteria and they were used for this systematic review. RESULTS: A total of 75 patients were treated with percutaneous antegrade pinning resulting in AOFAS score: 96.4 ± 4.8 and time to heal 7.4 ± 1 weeks, 34 patients underwent ante/retrograde pinning resulting in AOFAS score: 95.2 ± 4.75 and time to heal 6.5 ± 1 weeks, and 45 patients underwent open reduction and internal fixation with plate and screws resulting in a time to union 10.9 ± 0.5 weeks. CONCLUSION: Our results demonstrate that K wire intramedullary nailing regardless of the specific technique (antegrade, retrograde, ante/retrograde) is associated with better outcomes compared to open reduction and internal fixation as it permits faster weight bearing and quicker rehabilitation. K-wire fixation is related to statistically significant shorter time for the fracture to heal, by approximately three weeks compared to open reduction and internal fixation. Future research should focus on studies directly comparing the different intramedullary K-wiring techniques and also K-wiring versus plate fixation.

Sensory and Motor Median Nerve Neuropathy Due to a Deep Giant Hand Lipoma: A Case Report.

Lipomas are the most common soft-tissue tumors in the human body, but their location in the hand is rare. Symptomatic hand lipomas, due to nerve compression, are even rarer. We present a case of median nerve neuropathy as a result of a giant palm lipoma, located on the thenar and hypothenar areas of the hand. The patient had typical symptoms of carpal tunnel syndrome, along with compromised thumb motion. Intraoperatively, the recurrent motor branch of the median nerve was sitting on the lipoma under a great tension. This particular location of the motor branch of the median nerve in relation to the lipoma makes this case unique. The tumor was excised protecting the neurovascular structures, and a few weeks later the patient regained full thumb motion, grip strength, and resolution of dysesthesia.

Weil's osteotomy versus distal metatarsal metaphyseal osteotomy for the treatment of metatarsalgia. A metaanalysis of outcome and complications.

BACKGROUND: Weil's osteotomy (WO) and distal metatarsal metaphyseal osteotomy (DMMO) are considered to be the gold standard of managing metatarsalgia. Stiffness and floating toe are the main disadvantages of the WO, whereas delayed union or malunion and prolonged swelling are the main complications of the DMMO. The purpose of this study is to compare these two methods, in terms of outcome and complications, through a metaanalysis of the literature. MATERIALS AND METHODS: Pubmed, Google Scholar and Mendeley databases were searched for studies comparing directly the outcome of DMMO and Weil's osteotomy, with a minimum follow up of six months. The random effects model was used for the metaanalysis. The quality of studies was assessed using the MINORS criteria. RESULTS: Four studies were eligible for the analysis including 211 patients in total. The mean difference of the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and the visual analogue scale (VAS) among the two techniques was - 1,04 (C.I.: -3,50 - 1,43) and - 0,39 (CI: -0,83 - 0,08) respectively. The risk difference regarding postoperative stiffness, swelling and residual metatarsalgia was - 0,09 (95% C.I.: -0,23 - 0,06), - 0,17 (95% C.I.: -0,62 - 0,29) and - 0,06 (95% C.I.: -0,20 - 0,08) respectively. CONCLUSION: Based on the existing literature, Weil's osteotomy and DMMO are equally safe and effective for the treatment of metatarsalgia. More studies of better quality are required, in order to extract safer and absolute conclusions regarding this topic.

Capitellum and trochlea fractures. A systematic review of the literature.

Purpose: To investigate the outcome of capitellum and trochlea fractures through a systematic review of the contemporary literature. The effect on the outcome, of the posterolateral column comminution and the surgical approach used for fixation, was also evaluated. Methods: PUBMED, SCOPUS and MENDELEY databases were searched for capitellum and trochlea fractures and a systematic review was conducted according to PRISMA guidelines. The minimum one year clinical outcome and the flexion extension arc of these fractures, as well as the risk of developing degenerative arthritis were evaluated. The studies included to the meta - analysis were assessed based on the Newcastle Ottawa score. A fixed effect model was performed to compare the outcome and range of motion among Dubberley type A and type B fractures as well as between the extended lateral approach and the posterior transolecranon approach which were performed for Dubberley type B fractures. Furthermore the relative risk of degenerative arthritis (DA) among type A and type B fractures was also estimated. Chi square test was used to test heterogenity among studies. Results: Ten nonrandomized case series were eligible to our inclusion criteria, including 76 patients in total. The fixed overall Mayo Elbow Performance Score (MEPS) and the Range of Motion (ROM) of the Dubberley type A fractures was 86 (95% C.I.: 85,1-86,9) and 124 0 (95% C.I.: 122 0-124 0) respectively. The fixed overall MEPS and ROM of the Dubberley type B fractures was 84 (95%C.I.: 79,9-88,1) and 122 0 (95% C.I.: 120 0-123 0) respectively. Significant heterogenity was found though between studies regarding MEPS of type B fractures. The fixed overall MEPS and ROM for fractures treated with an extended lateral approach was 89,4 (95% C.I.: 85,36-93,44) and 123 0 (120 0-126 0) respectively. The fixed overall MEPS and ROM for fractures treated with a posterior transolecranon approach was 68,75 (95% C.I.: 67,89-69,6) and 122 0 (114 0-130 0) respectively. The degenerative arthritis relative risk (RR) of type B compared to type A fractures was 3,91 (95% C.I.: 0,84-18,13). Conclusion: There is no statistically significant difference among type A and type B fractures, in terms of outcome and ROM. The posterior transolecranon approach leads to a lower MEPS as opposed to the extended lateral approach. High quality studies comparing directly the outcome of type A and type B fractures are required, in order for safe conclusions to be extracted.

Percutaneous fixation of Lisfranc joint injuries: A systematic review of the literature.

OBJECTIVE: The aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation. METHODS: We searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well. RESULTS: Average AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant. CONCLUSION: Percutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Ulnar Nerve Injuries Post Closed Forearm Fractures in Paediatric Population: A Review of the Literature.

Ulnar nerve injury as a result of closed forearm fractures in children is a rare but disastrous complication, affecting significantly the function of the upper extremity. The management of these injuries is still controversial in the literature. This is a review of small case series and case reports, in which an algorithm of treatment is proposed. A brief description of a relative case, which was treated successfully in our department, is presented as well. This case motivated the authors to perform this study.

Sciatic Nerve Palsy due to a Superior Gluteal Artery Pseudoaneurysm PostBone Marrow Biopsy: A Case Report and Review of the Literature.

INTRODUCTION: Sciatic nerve radiculopathy can present as a result of intraspinal or extraspinal causes. Intraspinal disorders can be disk hernia, spinal trauma, tumors, or infection, whereas extraspinal cause representsa disorder outside the lumbar spine. A gluteal artery (GA)false aneurysm can potentially compress the sciatic nerve and causes radiculopathy, with subsequent motor and sensory deficits. This condition can result mainly from trauma or infection, but it can also be iatrogenic. CASE REPORT: We report a case of an 85-year-old male with a left sciatic nerve palsy as a result of a superior GA pseudoaneurysm post bone marrow biopsy (BMP). A short review of the literature regarding this topic is presented as well. Only a small number of similar cases are reported in the literature. CONCLUSION: This case report emphasizes on the high suspicion index that the clinician should have managing a patient who suffers from sciatic nerve palsy with a history of a previous procedure around the pelvis' area, such as BMP.