Intraoperative Dissociation and Migration of the Trial Bipolar Cup in Hip Hemiarthroplasty: A Rare Case.

Femoral neck fractures are an ever-increasing pathology, and with the elderly population on the rise, cases of cemented bipolar hemiarthroplasties are also on the rise. This is a rare case of intraoperative dissociation and migration of the trial components of bipolar hemiarthroplasty. Considering the current literature, all junior surgeons should be aware of this possible development during trial reduction. We present the case of an 82-year-old Caucasian woman suffering from a left femoral neck fracture due to a fall. She was treated surgically with a cemented bipolar hemiarthroplasty, but after trial reduction, the trial components dissociated and migrated inside the pelvis. The attempts at recovery through the current approach failed, and a new incision and approach were needed. A small ilioinguinal incision was performed, and the recovery of the trial cup was successful. The patient recovered with no considerable problems. As the reasons for this rare complication are largely unknown, the surgeon should be careful and take measures to prevent this scenario. Moreover, it is wise to weigh the pros and cons of retrieval through other approaches and choose the best course of action for the patient.

Lateral Ankle Instability after Rotational Injury: A Case Report.

Introduction: One of the most common orthopedic injury injuries seen in patients at the emergency department is that of the ankle. There are some efficient protocols for their treatment, but more often the clinician is fo-cused in finding and treating possible fractures and disregards ligamentous lesions that lead to instabil-ity, if they become chronic. Case Report: A patient that suffered an ankle sprain was improperly handled, developed lateral instability of the ankle, and was treated surgically using an autologous semitendinosus graft. A 42-year year-old Caucasian male that after an ankle sprain was examined in various primary health -care centers, four times within six 6 months, with persistent symptoms of his left ankle. After all these months, he was eventually diagnosed with post-traumatic lateral instability of the ankle that was resistant to con-servative treatment. In stress view X-rays, the talar tilt angle was 21°ο and the anterior drawer was measured at 13 mm. The patient was treated surgically with reconstruction of the anterior talofibular and the calcaneofibular ligament using an autologous semitendinosus graft from the left knee. The graft was pinned in the anatomical insertion sites of the ligaments with absorbable screws. A post-surgical physiotherapy regimen was applied for two 2 months. In the post-surgical dynamic stress view X-rays, the talar tilt angle and the anterior drawer were markedly improved, measured at 3°ο and 4 mm, respec-tively. In 11 months post-surgical follow-up, the patient's American Foot and Ankle Score was 85, from the 60 evaluated before treatment. Conclusion: The use of guidelines, regular follow-ups, and functional rehabilitation are key factors to treating ankle injuries. The reconstruction of lateral collateral ligament complex with a semitendinosus graft is one of the surgical options for restoring lateral ankle instability.

The Risk of Injury in Wrist Arthroscopy Portals: A Cadaveric Study.

During wrist arthroscopy, the wrist joint can be visualized from almost every perspective through a combination of standard dorsal and volar arthroscopic portals. This cadaveric study aims to compare all wrist portals described in terms of their safety in order to rank them according to the distance from the nearest structure at risk for arthroscopic wrist procedures. Twenty-nine cadaveric formalin-embellished upper limbs were examined. Needles were inserted at dorsal and volar portal sites to perform the measurements. During the subsequent dissection, distances were measured as the shortest possible distance from the nearest structure at risk for each portal. Safe zones were determined for all portals, and the safety classification of arthroscopic wrist portals was proposed, ranking them from the safest to the most perilous. Applying the proposed safety classification to arthroscopic practice, wrist arthroscopy can be performed with a lower risk of iatrogenic complications arising from the implementation of the wrist portals.

Giant Posttraumatic Angiolipoma of the Forearm: A Case Report and Review of the Literature.

Angiolipoma is a type of lipoma, a benign soft tissue tumor. It is distinguished by the excessive degree of vascular proliferation and the presence of mature adipocytes. It occurs commonly on the trunk and extremities. Angiolipomas larger than 4 cm are classified as "giant," and due to their size, histological evaluation is necessary to exclude malignancy. We report a case of a male patient who suffered from a giant noninfiltrating intramuscular angiolipoma which formed after venipuncture in the antecubital fossa. Clinical examination showed a palpable painless soft mass. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a giant angiolipoma on the right forearm. Surgical removal of the mass was performed, and the biopsy was negative for malignancy. To the best of our knowledge, this is the first report in the literature of posttraumatic intramuscular angiolipoma. Physicians and orthopedic/general surgeons should be aware of the possibility of soft tissue masses in a posttrauma situation.

Safe zones in volar portals for wrist arthroscopy, evaluation of central portal : a cadaveric study.

The purpose of this cadaveric study is to determine safe zones utilizing volar portals for wrist arthroscopy, by quantitatively describing the neurovascular relationships of a volar radial and a volar ulnar wrist arthroscopy portals in comparison with those of a newly described volar central portal (7) , considering the advantages in visualization of volar portals for wrist arthroscopy over the standard dorsal (19) . The neurovascular structures and the tendons of nine frozen human cadaveric upper limbs were exposed, while the aforementioned volar portal sites were pointed out with pins. The horizontal distance between the portals and the closest neurovascular branch or tendon was measured with a digital caliper, followed by statistical analysis of the data. The median interquartile range distances from portals to structures at risk were measured and safe zones around each portal were established. This study provides a safe approach to the volar radial and ulnar aspects of the radiocarpal and midcarpal joints, while volar radial and ulnar portals should be considered for inclusion in the arthroscopic examination of any patient with radial and ulnar sided wrist pain respectively (17,18) . Regarding the volar central portal, it is reproducible, safe and both the above joints can be inspected through one single incision (7) .

Closed Rupture of Anterior Tibialis Tendon after Minor Injury without Medical History: A Surgical Repair.

INTRODUCTION: Closed rupture of the anterior tibial tendon is uncommon, with only a few cases being documented in literature. It usually happens in the forceful plantar flexion of the foot while in eversion and the simultaneous contraction of the anterior tibialis muscle. CARE REPORT: We present the case of a 65-year-old man with closed rupture of the tibialis anterior tendon after injury who was treated by primary surgical repair. The surgical technique as well as the rehabilitation protocol are described in detail. CONCLUSION: Primary surgical reconstruction repair is indicated in younger, active individuals. It appears that early diagnosis and treatment provides the best clinical results, while delayed treatment usually requires the use of a tendon graft in combination with tendon transfers, giving inferior results compared to primary tendon repair.

Association between the capitate-triquetrum distance and carpal collapse in static scapholunate instability.

Long-standing scapholunate instability frequently leads to progressive deterioration of the adjacent joint cartilages in a consistent repetitive sequence of arthritis. The purpose of this study was to investigate whether the capitate-triquetrum distance is related with the occurrence of carpal collapse in cases of static scapholunate instability. In this retrospective study, 41 patients formed two groups based on the capitate-triquetrum distance; twenty-four with distance of less than 5mm and 17 with distance of 5mm or more. No significant difference was detected with respect to age, sex distribution, dominant hand involvement, initial treatment and time from injury to final x-rays. Three patients (3/24, 12.5%) of the C-T < 5mm group and 10 patients (10/17, 58.8%) of the C-T ≥ 5mm group had no sign of carpal collapse. This difference was statistically significant (p=0.017). Capitate-triquetrum distance could reliably contribute in the decision making process in difficult cases of static scapholunate instability.

Association between the capitate-triquetrum distance and carpal collapse in scaphoid nonunion.

The effect of the lunate type on carpal collapse in cases of scaphoid nonunion has not been thoroughly investigated. The purpose of the present study was to determine whether any association exists or not between the capitate-triquetrum distance and occurrence of carpal collapse in cases of scaphoid nonunion. In a retrospective study, 76 patients with scaphoid nonunion formed two groups based on the capitate-triquetrum distance: forty-three patients with distance of less than 5 mm and 33 patients with distance of 5 mm or more. The two groups were comparable with respect to sex distribution, age, dominant hand involvement, manual labor, nonunion location and time from injury to final x-rays. Six patients (13.9%) in the capitate-triquetrum<5 mm group and 13 patients (39.4%) in the capitate-triquetrum≥5 mm group had no signs of collapse, with significant difference (p<0.05). Capitate-triquetrum distance could contribute in the decision making process for cases of scaphoid nonunion without straightforward indication for surgical intervention.

Metastasis of bronchogenic carcinoma to the 5th metacarpal bone: a case report.

BACKGROUND: Metastatic lesions to the hand are very rare and represent 0.1% of all osseous metastases. CASE PRESENTATION: We present a patient with metastasis of bronchogenic carcinoma of the lung to the 5th metacarpal to draw the attention for the potential of such lesions to be developed in this region. Due to the extensive metastasis to the hand the patient was referred to the oncologists. CONCLUSION: The surgeon should be cautious regarding the differential diagnosis, the usual poor prognosis of such patients and the questionable need for reconstructive surgery.

Anatomical variation of co-existence of 4th and 5th short metacarpal bones, sesamoid ossicles and exostoses of ulna and radius in the same hand: a case report.

INTRODUCTION: The anatomical variations of bones in the hand are common. The existence of exostosis and shortening of metacarpal bones has been described in the literature as part of the hereditary multiple exostosis syndrome but no case has been reported with the co-existence of sesamoid ossicles in the same patient. CASE PRESENTATION: We report a case with co-existence of distal ulnar and radial exostoses, 4th and 5th short metacarpals and sesamoid ossicles in the wrist area. CONCLUSION: This variation may help the interpretation of pain or sensory disorders in the hand and wrist areas.