Cubital tunnel syndrome of the ulnar nerve caused by an epineural ganglion cyst: a case report and review of the literature.

BACKGROUND: The ulnar nerve has a long and complex anatomical course, originating from the brachial neural plexus in the neck with nerve trunk formation at the posterior neck triangle, and on to the axilla. This intricate anatomical pathway renders the nerve susceptible to compression, direct injury, and traction throughout its course. Compression of the ulnar nerve is the second most common compression neuropathy of the median nerve adjacent to the wrist joint, after carpal tunnel syndrome. CASE PRESENTATION: A 45-year-old Sudanese housewife complained of progressive right forearm and hand muscle wasting, pain, and neuropathic symptoms. She was diagnosed with right-sided cubital tunnel syndrome. The diagnosis was derived intraoperatively from a nerve conduction study suggesting the level of conduction block and recommending decompression. Magnetic resonance imaging was not done preoperatively due to financial limitations. An epineural ganglion (15 × 20 mm2) compressing and flattening the ulnar nerve was diagnosed intraoperatively. Surgical decompression of the ulnar nerve and removal of the epineural ganglion achieved a remarkable postoperative result and pleasing outcome. CONCLUSION: Surgical management is the cornerstone of treatment for compressive neuropathy and ranges from simple nerve decompression to complex neurolysis procedures and nerve transposition to adjust the anatomical course of the nerve.

Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture.

Introduction: Although the treatment of choice for unstable intertrochanteric fractures in elderly patients has been internal fixation for a long time, several studies have shown mechanical and technical failures. Primary cemented bipolar (PCB) hemiarthroplasty has been proposed as an alternative with some advantages concerning earlier mobilization and minimal postoperative complications. Materials and Methods: This is a prospective cohort hospital-based study conducted at three tertiary hospitals over a period of two years. A total of 98 patients were enrolled in the study, 38 patients treated with Dynamic Hip Screw (DHS) and 60 patients treated with PCB hemiarthroplasty. Intraoperative events (e.g. duration of surgery and blood loss), hospital stay, weight bearing, Harris Hip score and post-operative complications were used as predictors of final outcome. Mean follow-up was 13.66±5.9 months in hemiarthroplasty group and 11.8±2.7 months at internal fixation group. Results: The two groups were comparable in age, sex, comorbidity, mode of trauma, and classification of fracture. Early mobilisation was significantly better in hemiarthroplasty (p<0.001) where 93.3% of patients started partial weight bearing on postoperative Day 1, while in the DHS group, 73.7% of patients started partial weight bearing after two weeks postoperatively. At the final follow-up, the mortality rate did not differ between the two groups, but general and mechanical complications were more common in the DHS group. The mean Harris Hip score was better in the hemiarthroplasty group (91.14 vs 74.11). Conclusion: Primary cemented bipolar hemiarthroplasty is a safe and valid option in treating unstable intertrochanteric fracture. Although it has been shown to have some advantages over DHS in certain circumstances, lack of randomization and difficulties in standardization of patients and treating surgeon raise a need for more studies with bigger sample size and proper randomization.