Circumferential periosteal block versus hematoma block for the reduction of distal radius and ulna fractures: a randomized controlled trial.

PURPOSE: To assess the analgesic efficacy of the circumferential periosteal block (CPB) and compare it with the conventional fracture hematoma block (HB). METHODS: This study was a prospective single-center randomized controlled trial performed in a national orthopedic hospital. Fifty patients with displaced distal radius (with or without concomitant ulna) fractures requiring reduction were randomized to receive either CPB or HB prior to the reduction. Pain was sequentially measured using the visual analogue scale (VAS) across three stages; before administration of local anesthesia (baseline), during administration (injection) and during manipulation and immobilization (manipulation). Further, the effect of demographic factors on the severity of pain was analyzed in multivariate regression. Finally, complications and end outcomes were compared across both techniques. RESULTS: Patients receiving CPB experienced significantly less pain scores during manipulation (VAS = 0.64) compared with HB (VAS = 2.44) (p = < 0.0001). There were no significant differences between groups at baseline (P = 0.55) and injection (P = 0.40) stages. CONCLUSION: The CPB provides a superior analgesic effect over the conventional HB with no documented complications in either technique. LEVEL OF EVIDENCE: Therapeutic Level II.

A Rare Presentation of Extraosseous Ewing Sarcoma Manifesting as a Dumbbell Tumor on the Nape of the Neck.

Ewing sarcoma is a rare poorly differentiated and highly malignant tumor primarily affecting the skeletal system. It most commonly presents during the first two decades of life and rarely might it be of extraskeletal origin. Majority of extraskeletal cases are reported in the paravertebral and lower limb, with very few cases reported in the cervical spine region. We report a case of extraskeletal Ewing sarcoma in a 42-year-old man who presented with a 1-year history of neck swelling associated with neck pain, diagnosed by computed tomography and magnetic resonance imaging scans, in conjunction with histological analysis. Very few cases of cervical EES presenting as dumbbell tumors have been documented in the literature especially in this age group.

Colon diverticulosis adherent to mesh plug migration after laparoscopic hernia repair: A case study and review of literature.

INTRODUCTION: Inguinal hernia repair has evolved from open suture methods to mesh repair which is preformed either open or laparoscopically. Mesh hernia repair has improved the outcome in regards to patient care and recurrence rate but it is also associated with a number of complications. The complications of mesh hernia repair such as deep seated infections, mesh erosion and mesh perforation into nearby viscera has been scarcely reported in literature. CASE PRESENTATION: We report a 43 years old male case of diverticulosis adherent to a migrated mesh plug from previous laparoscopic inguinal hernia repair procedure. DISCUSSION: The choice of mesh material, appropriate suture placement and closure of the peritoneum after mesh repair is very crucial to avoid long term mesh complications. CONCLUSION: The aim of this case report is to present a rare complication of mesh erosion with colovesical fistula and abscess formation.