[THE CHALLENGE OF DIAGNOSING RARE LIFE THREATENING SKIN LESIONS].

INTRODUCTION: Skin lesions seen after delivery are frequent and mostly shallow, without the need for special care or diagnosis challenge. In the following case, an infant was born at 35 weeks gestation, presented after the delivery with a well-demarcated, necrotic plaque over the right forearm with neurologic deficit. The differential diagnosis includes life-threatening reasons, therefore, emergent laboratory and imaging tests were held. Treatment was given after consulting a multidisciplinary team of experts, including antibiotic treatment, blood products and anticoagulation and physiotherapy treatment was started. Under this treatment, improvement was noticed but there was still a motor restriction. He was discharged home on his 24th day of life, with the working diagnosis of Congenital Volkmann Ischemic Contracture (CVIC). On his seventh week of life, he arrived to the emergency room with focal seizure resulting from an infarct seen on an MRI. He was diagnosed with cerebral palsy at the age of five months. In conclusion, Congenital Volkmann Ischemic Contracture is a rare diagnosis, however, awareness is of importance since fast treatment is crucial for future prognosis.

The Use of Medicinal Leeches for the Treatment of Venous Congestion in Replanted or Revascularized Digits.

PURPOSE: A noteworthy cause of failure in digital replantation is venous insufficiency. External bloodletting with medicinal leeches is a common treatment for venous insufficiency after distal digital replantations. The objective of this study was to evaluate the salvage rate of digits replanted proximal to the distal interphalangeal (DIP) joint that were treated with medicinal leeches for venous congestion. METHODS: We retrospectively reviewed the charts of patients with complete or incomplete digit amputation admitted between January, 2008 and April, 2014. We included all patients with venous congestion in one or more digits replanted or revascularized at the middle or proximal phalangeal level, who were treated with medicinal leeches. Treatment initiation and duration were based on clinical judgment. Demographic, therapy, and surgical data were collected. RESULTS: Of 145 patients with 205 digits that were replanted or revascularized, 25 digits were treated with medicinal leeches for venous congestion. Venous congestion was diagnosed later than 48 hours after operation in 24 of the 25 digits. Of the 25 digits, 11 survived (44.4%) (8 of 22 replanted digits and all 3 revascularized digits). No complications were recorded except for substantial blood loss requiring transfusion in one patient. CONCLUSIONS: External bloodletting with medical leeches might be less effective with late treatment or with a higher volume of congested tissue, as is characteristic of proximal finger replantation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Efficacy of a telerehabilitation intervention programme using biofeedback among computer operators.

Computer operators spend long periods of time sitting in a static posture at computer workstations and therefore have an increased exposure to work-related musculoskeletal disorders (WRMSD). The present study is aimed at investigating the feasibility and effectiveness of a tele-biofeedback ergonomic intervention programme among computer operators suffering from WRMSD. Twelve subjects with WRMSD were assigned an ergonomic intervention accompanied by remote tele-biofeedback training, which was practised at their workstations. Evaluations of pain symptoms and locations, body posture and psychosocial characteristics were carried out before and after the intervention in the workplace. The hypothesis was partially verified as it showed improved body position at the workstation and decreased pain in some body parts. Tele-biofeedback, as part of an intervention, appears to be feasible and efficient for computer operators who suffer from WRMSD. This study encourages further research on tele-health within the scope of occupational therapy practice. Practitioner summary: Research concerning tele-health using biofeedback is scarce. The present study analyses the feasibility and partial effectiveness of a tele-biofeedback ergonomic intervention programme for computer operators suffering from WRMSD. The uniqueness and singularity of this study is the usage of remote communication between participants and practitioners through the Internet.

Anatomy and function of lumbrical muscles.

The lumbrical muscles are unique in having their origin and insertion on tendons. The lumbricals assist in metacarpophalangeal joint flexion; they contribute to interphalangeal joint extension by acting as deflexors of the proximal interphalangeal joint. Anatomically, they are highly specialized in terms of their architectural properties, with a small physiologic cross-sectional area but long fiber length. Their unique properties indicate that they are probably important in fast, alternating movements and fine-tuning digit motion.

Early combined neurosurgery and orthopaedic surgery in Neonatal Brachial Plexus Palsy.

Three cases are presented in which neurosurgical reconstruction of a Neonatal Brachial Plexus Palsy was combined with orthopaedic reconstruction of a posterior glenohumeral dislocation. The authors believe that a combined procedure is indicated if the neurological deficit meets the criteria for neural reconstruction and the complication of a posterior glenohumeral dislocation has occurred prior to nerve surgery. Two children with C5-6 lesions and a third child with a pan-plexus lesion obtained good shoulder function following the combined reconstruction.

Biomechanical study of cross-locked cruciate versus Strickland flexor tendon repair.

PURPOSE: Zone II flexor tendon repairs may create a bulging effect with resistance to tendon gliding. A biomechanical study was performed comparing the 4-strand cross-locked cruciate (CLC) to a 4-strand Strickland repair, both with and without an interlocking horizontal mattress (IHM) suture, in terms of strength characteristics and work of flexion. METHODS: Sixteen fresh-frozen human fingers were placed in a custom jig. Flexor digitorum profundus tendons were sectioned at the A3 pulley level. Fingers were separated into 2 repair groups: 4-strand CLC and 4-strand Strickland core suture. Work of flexion was determined for each group, with and without an IHM circumferential suture. Final repair including IHM was tested for 2-mm gap failure and ultimate load to failure. RESULTS: The CLC-IHM had a significantly smaller increase in work of flexion than the Strickland-IHM. For both suture types, the circumferential suture resulted in a statistically significant increase in work of flexion; however, peak entry force produced upon entry of the repair into the A2 pulley was reduced, although the decrease was not statistically significant for each group. The CLC-IHM had a significantly higher ultimate load to failure. CONCLUSIONS: (1) The CLC-IHM suture method is stronger with less work of flexion than the Strickland-IHM method. (2) This new, combination repair method of CLC core suture with IHM circumferential suture is biomechanically superior to the commonly performed Strickland-IHM technique.

Percutaneous CT-guided curettage of osteoid osteoma with histological confirmation: a retrospective study and review of the literature.

Osteoid osteoma is a benign bone tumour usually occurring in young individuals (10-30 years). It presents with intense pain (typically nocturnal), which can be alleviated by salicylates. Treatment consists of surgical excision or destroying the nidus and it is curative. In the past, surgery was performed in an "open" fashion and the nidus had to be removed with a bone block. This extensive type of surgery could be associated with some rates of both failure and complication. There is growing evidence to suggest that percutaneous CT-guided removal or destruction of the nidus is a good alternative and it is indeed gaining worldwide popularity. We present a series of 18 consecutive patients with osteoid osteoma of the pelvis, femur, and tibia, treated percutaneously under CT guidance. Removal of the nidus was performed using a 4.5-mm cannulated drill and a cannulated curette of our own design. Tissue samples for histological evaluation were obtained in the same way. The mean follow-up time was 29 months. Sixteen patients were initially cured. The procedure had to be repeated in two patients and was eventually successful (primary and secondary success rates 88 and 100% respectively). The diagnosis was histologically confirmed in 14 cases out of 18 (77%). In four cases no histological confirmation of osteoid osteoma could be achieved. There were only two minor complications, one case of femoral neuropraxia and one case of skin abrasion. Percutaneous CT-guided removal seems to be efficient and safe for the treatment of osteoid osteoma. The use of a cannulated drill and a cannulated curette facilitates efficient removal of the tumour and procurement of tissue for diagnosis.

Idiopathic adhesive capsulitis: long-term results of conservative treatment.

BACKGROUND: Adhesive capsulitis, also termed "frozen shoulder," is controversial by definition and diagnostic criteria that are not sufficiently understood. The clinical course of this condition is considered self-limiting and is divided into three clinical phases. Several treatment methods for adhesive capsulitis have been reported in the literature, none of which has proven superior to others. OBJECTIVES: To evaluate the long-term follow-up of patients with idiopathic adhesive capsulitis who were treated conservatively. METHODS: We conducted a long-term follow-up (range 5.5-16 years, mean 9.2 years) of 54 patients suffering from idiopathic adhesive capsulitis. All patients were treated with physical therapy and non-steroidal anti-inflammatory drugs. RESULTS: An increased statistically significant improvement (P < 0.00001) was found between the first and last visits to the clinic in all measured movement directions: elevation and external and internal rotation. CONCLUSIONS: Conservative treatment (physical therapy and NSAIDs) is a good long-term treatment regimen for idiopathic adhesive capsulitis.