Xiphodynia as an Unusual Cause of Chest Pain: A Case Series.

Introduction Treatment options for xiphodynia are injections with local corticosteroid injections or surgical resection of the xiphoid process. Currently, there is no consensus as to which treatment is the most optimal. Objectives The aim of this case series was to compare the safety and efficacy of conservative and surgical treatment for patients with xiphodynia. Patients and Methods A retrospective case series was performed. All patients presenting with xiphodynia between 2016 and 2021 were eligible. Demographic data and treatment regimes, including preoperative work-up and surgical technique, were extracted from the electronic patient files. In addition, all patients received a follow-up phone call with a questionnaire. Patient satisfaction was measured using the Numeric Rating Scale. Results A total of five patients, suffering from xiphodynia for up to 10 years, completed the follow-up questionnaire (median patient age, 57 years; range 51-68 years). Three of these patients initially received conservative treatment with local injections with corticosteroids for at least 6 months. One patient was satisfied with the results and did not opt for surgical treatment. Eventually, four patients were treated surgically by removing the xiphoid process. No postoperative complications were recorded and 100% of the patients who underwent a xiphoidectomy were free of symptoms and satisfied with the results. Conclusion Symptoms related to xiphodynia can be relieved using conservative or surgical treatment, where the latter seems to be a safe and effective solution.

Lisfranc injuries: fix or fuse? : a systematic review and meta-analysis of current literature presenting outcome after surgical treatment for Lisfranc injuries.

AIMS: This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. METHODS: A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. RESULTS: A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. CONCLUSION: This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842-849.

Subclavian artery occlusion after a clavicle fracture.

A 44-year-old man with a 9-day-old left displaced midshaft clavicle fracture was initially treated conservatively. The patient experienced an increase of pain with tickling and cold sensation in the left upper extremity. CT angiography showed left subclavian artery occlusion over 3 cm at the level of the fracture. At surgical repair, a subclavian-brachial bypass was constructed and fracture fixation was done with an eight-hole locking compression plate. Follow-up at 6 months showed full range of motion of the left shoulder, an open bypass and fracture consolidation.

Resecting orbicularis oculi muscle in upper eyelid blepharoplasty--a review of the literature.

BACKGROUND: Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. However, the rationale for muscle resection along with skin is uncertain. METHODS: A PubMed search was performed using the following keywords: 'blepharoplasty' and 'muscle' as well as 'blepharoplasty' and 'orbicularis'. This yielded 419 different hits. All abstracts from English, Dutch, German or French papers were scanned for potential relevance; of which 59 papers were retrieved. The papers were considered to be relevant for our review if they described their technique for upper blepharoplasty and if they mentioned whether or not they resected orbicularis oculi muscle. Papers describing blepharoplasty combined with other surgical interventions were not included unless specific remarks about the blepharoplasty and the role of orbicularis resection were made. Studies describing a surgical technique specifically designed to create an epicanthal fold in Asians were excluded as well. RESULTS: In total, 55 papers were included for review. Various reasons for muscle resection are described; most authors resect muscle without providing a reason to do so. In more recent literature, a trend towards muscle preservation is observed. CONCLUSIONS: A lack of consensus about what is to be done with the orbicularis oculi muscle in upper lid blepharoplasty is demonstrated. This amounts to a shortcoming, especially in training young plastic surgeons. Therefore, an algorithm is proposed.