Extensile Exposures in Revision and Complex Primary Total Knee Arthroplasty: A Review of Anatomy, Biomechanics, and Techniques.

Developing adequate exposure when performing a revision total knee arthroplasty is critical to an efficient and safe intraoperative course. Proper planning and knowledge of the relevant anatomy are important when dissecting scar tissue associated with previous trauma or surgery and navigating bone loss. We present a review of the different total knee arthroplasty extensile exposure techniques that have been described in the literature. Specific exposures discussed include the femoral peel, banana peel, medial epicondylar osteotomy, quadriceps snip, tibial tubercle osteotomy, wandering resident, and the V-Y quadricepsplasty with patella turndown. Furthermore, we review the histological healing potential, biomechanical principles that drive post-operative expectations, post-operative rehabilitation protocols, and reported functional outcomes of each technique.

Flexor Carpi Radialis Brevis Resection for Treatment of a Distal Radius Fracture: A Case Report.

The flexor carpi radialis brevis (FCRB) is an anomalous muscle of the forearm that is only present in 3.5 to 8.6% of the population. In the case of volar plating of distal radius fractures, the FCRB inhibits proper fracture exposure and thus hinders proper reduction. A 78-year-old female presented with right distal radius fracture which necessitated internal fixation. Following mobilization and retraction of the flexor carpi radialis tendon, an anomalous muscle belly was identified as the FCRB. With continued difficulty in exposure and fracture site reduction, resection of the FCRB was performed. The patient was able to return to her activities of daily living without pain and demonstrated no appreciable functional deficit. This case report demonstrates a distal radius fracture where FCRB resection was used, resulting in no detrimental clinical outcomes.

Meckel's diverticulum complicated by axial torsion and gangrene.

Meckel's diverticulum is a remnant of the omphalomesenteric duct and is the most common congenital anomalies of the gastrointestinal tract. It has been known to mimic different disease states making its diagnosis difficult. Common complications consist of bleeding, intestinal obstruction and inflammation. The patient discussed in this case study was a 29-year-old Hispanic female who presented with right lower quadrant abdominal pain. A CT scan showed a normal appendix, thickened terminal ileum and a high-grade distal small bowel obstruction with a possible closed-loop obstruction. Laparoscopy revealed Meckel's diverticulum with the rare complication of torsion. The mechanism of torsion has been postulated but with little evidence. The purpose of this case report is to discuss the apparent mechanism of axial torsion secondary to the presence of a mesodiverticular band, provide visual evidence at surgery and recommend all Meckel's diverticulum associated with a mesodiverticular band be resected to prevent further complications.