Neurolymphomatosis of the Ulnar Nerve Presenting as Cubital Tunnel Syndrome: A Case Report.

Lymphoma is a malignant tumour of the lymphatic system. Neurolymphomatosis occurs when lymphoma cells invade the peripheral nervous system (PNS). Neurolymphomatosis has been reported involving the sciatic nerve, nerve roots and within the axilla and the upper arm. It can cause nerve dysfunction depending on the involved nerve. Neurolymphomatosis involving the ulnar nerve is rare. We report a patient with neurolymphomatosis of the ulnar nerve around the elbow that presented with features of cubital tunnel syndrome. A high index of suspicion is necessary in patients with cubital tunnel syndrome that present with uncommon symptoms such as sudden onset, rapid progression and/or severe pain. Level of Evidence: Level V (Therapeutic).

Reconstruction With Achilles Tendon Allograft Using the Keyhole Technique for Chronic Triceps Insufficiency After Total Elbow Arthroplasty.

Total elbow arthroplasty (TEA) is associated with a relatively high incidence of chronic triceps insufficiency, but there is difficulty in treatment. This case series describes reconstruction with Achilles allografts using the keyhole technique in patients with postoperative chronic triceps insufficiency. Fourteen patients who underwent reconstruction for triceps insufficiency after TEA were included in the study. During this procedure, a keyhole-shaped osteotomy was performed on the proximal olecranon, and a fragment of the calcaneal allograft was shaped into a bone plug to fit the olecranon. The clinical outcomes were assessed in all patients 12 months after reconstruction and at last follow-up (range, 13-54 months). After 12 months, patients had a mean Mayo Elbow Performance Score of 84.3 (range, 75-100), and all achieved a marked improvement compared with before reconstruction (mean, 42.7; range, 20-75). Seven, 4, and 3 patients achieved excellent, good, and fair outcomes, respectively. The mean extension peak torque of the operated-on arm was 34.91 Nm (range, 16.3-63.9 Nm), and the percentage of extension peak torque of the operated-on arm to the opposite arm was from 14.5% preoperative to 76.2% 12 months postoperative. This case series suggests that triceps reconstruction with an Achilles tendon using the keyhole technique is a useful treatment option for triceps insufficiency after TEA. [Orthopedics. 2021;44(4):e498-e502.].

Oral Carbohydrate Administration in Patients Undergoing Cephalomedullary Nailing for Proximal Femur Fractures: An Analysis of Clinical Outcomes and Patient Satisfaction.

PURPOSE: The purpose of this study was to investigate the clinical effects of oral carbohydrate intake for cephalomedullary nailing on proximal femoral fractures and patient satisfaction. SUBJECTS AND METHODS: 88 patients were admitted to our hospital with proximal femoral fracture from July 2019 to December 2019. All patients were treated with closed reduction and internal fixation (CR&IF, Cephalomedullary nailing) under spinal anesthesia. The exclusion criteria included the presence of endocrine disorders including diabetes mellitus (DM), patients treated with steroids, and cognitive impairment. Additionally, those with fasting blood glucose levels above 126 mg / dl or HbA1C> 6.5% were considered as having undiagnosed DM. After obtaining informed consent, the subjects were randomized into either the preoperative oral carbohydrate (POC) group or control group. Patients who were assembled into the control group fasted including water from midnight of the day of the surgical procedure according to the conventional method. Patients assembled into the POC group received 400 ml of oral carbohydrate solution (Nucare NONPO, DAESANG, 12.8%, 1 kcal/ml)) between 21-24 hours on the day before operation and 400 ml oral carbohydrate solution 2 hours before the administration of anesthesia. Serum glucose on the day before operation at 7 am (before breakfast, baseline), immediately before anesthesia, at skin incision, 1 hour, 4 hours, 6 hours, 24 hours after anesthesia, and 3 days after surgery (before breakfast) was measured, and insulin, cortisol, and IL-6 were measured at baseline 7 am at day before operation, immediately before anesthesia, 4 hours and 24 hours after anesthesia, and 3 days after surgery (before breakfast). The patients completed questionnaires about their satisfaction (thirst, hunger, nausea and vomiting, and anxiety) in the morning (before the surgery) on the day of the surgery. Additionally, the length of hospital stay (LOS) and preoperative opioid usage was also investigated. RESULTS: The operative characteristics of the patients did not differ between the groups except for the actual fasting time. The glucose levels were higher in the control group at skin incision; however, there were no significant differences in both groups at other time points. Additionally, insulin, insulin resistance, cortisol, and IL-6 also did not differ significantly between the 2 groups at all time-points. Among the factors related to patient satisfaction, the POC group showed significantly higher scores for thirst and hunger factors and shorter LOS than the control group. CONCLUSION: The intake of oral carbohydrates in patients treated with closed reduction and internal fixation for proximal femoral fractures does not affect the improvement of post-operative insulin resistance. However, there was significant improvement in patients' thirst and hunger before surgery and LOS.

Osteochondroma formation after avulsion fracture of anterior inferior iliac spine: A case report.

BACKGROUND: Hip avulsion fractures occur mostly during adolescence when actions such as kicking or running cause forceful contraction of attached muscle. Osteochondroma is benign tumor that mostly occurs at the metaphysis of a long bone, being usually asymptomatic. CASE SUMMARY: A 15-year-old patient experienced feeling and sound of a break while kicking a ball in soccer game three years prior to his visit to our hospital. A simple X-ray revealed an avulsion fracture of the apophysis of the anterior inferior iliac spine (AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstrated by magnetic resonance imaging to be a pedunculated osteochondroma in the superolateral aspect of the AIIS. For surgical treatment, we performed osteotomy for surgical excision and excisional biopsy. A mass with smooth surface and an unclear superolateral AIIS border was found intraoperatively. Pathologic exam showed definite diagnosis of osteochondroma. Postoperatively, discomfort during hip flexion was improved, and the hip joint range of motion during walking was recovered at the last follow-up, which was three weeks after the surgery. CONCLUSION: This is a rare case to demonstrate relevant previous trauma history prior to the formation of osteochondroma.