Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children.

INTRODUCTION: Diaphyseal forearm fractures are common in children and adolescents. Intramedullary fixation with flexible nails has a high success rate. Complications related to the insertion of the radial nail include injury to the superficial branch of the radial nerve and rupture of the extensor pollicis longus (EPL) tendon. MATERIALS AND METHODS: We report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius. RESULTS: All nine patients underwent operative management, consisting of either EPL release, EPL direct repair, or tendon transfer (using extensor indicis proprius). In all cases, the nail entry site was directly related to the location of EPL. In many of the cases the EPL dysfunction occurred early on but it's recognition was often delayed. CONCLUSION: Based on our findings, we recommend the use of a radial entry point. For surgeons who prefer the dorsal entry point, we recommend that they use an incision which allows visualisation of the extensor tendons and that any post-operative EPL dysfunction is addressed promptly.

Comparison of open and closed staff-assisted glove donning on the nature of surgical glove cuff contamination.

BACKGROUND: We have observed that surgical glove cuffs commonly fold over during an operation, exposing the inside of the glove cuff to the sterile field and wound, a potential source of contamination if the inside of the glove cuff has been in contact with the fingers during glove donning. We hypothesize that open staff-assisted gloving results in more inside-glove cuff contamination than a closed staff-assisted technique. METHOD: We performed a blinded, randomized study comparing open and closed staff-assisted glove donning. Two surgeons were gloved 20 times after covering their fingers and hands with GlitterBug powder. The gloves were turned inside out and the distance of GlitterBug powder from the free edge of the cuff was measured. RESULTS: Staff-assisted open glove donning was associated with significantly more glove cuff contamination than closed staff-assisted glove donning (P= 0.001). CONCLUSION: Given glove cuff 'turn down' intra-operatively, we strongly recommend closed staff-assisted gloving.

The macroscopic arthroscopic anatomy of the infrapatellar fat pad.

PURPOSE: Our purpose was to define the macroscopic anatomy of the infrapatellar fat pad (IFP) when viewed at arthroscopy and to document the common variations. METHODS: Ninety-six consecutive patients between 8 and 50 years of age with no previous knee surgery or fat pad pathology underwent arthroscopic examination of the knee. The fat pad of each patient was observed and described regarding size, color, consistency, and the presence of lobules, villous synovium, and lingulae. RESULTS: The macroscopic arthroscopic anatomy of the IFP was defined. Male fat pads were larger than female fat pads. Two separate parts were described-medial and lateral-with medial dominence being most typical. The specific normal anatomic appearance of each section was defined regarding size, color, consistency, and attributes. Ligamentum mucosum, as the separation limit between the sections, was found in most knees. CONCLUSIONS: The macroscopic anatomy of the IFP is described at arthroscopy performed for internal pathology of the knee. Two distinct parts were defined-medial and lateral-with medial dominance. A typical fat pad was yellow and included an infrapatellar lingula (85%), lobulation (65%), and villous synovium (65%). We found a ligamentum mucosum in 79% of cases. CLINICAL RELEVANCE: Knowledge of the macroscopic anatomy of the IFP and variations will allow the accurate diagnosis of pathology of the fat pad, rather than being a diagnosis of exclusion.