Median Nerve Neuropathy Caused by Persistent Median Artery Thrombosis.

Persistent median artery thrombosis mimicking carpal tunnel syndrome is rare. Here, we report the pathological, ultrasonography, and intraoperative findings of a case of persistent median artery thrombosis mimicking carpal tunnel syndrome. A 34-year-old man reported to our clinic with a complaint of numbness in his left thumb, index finger, and middle finger, which are innervated by the left median nerve. He also reported that he felt pain in his left wrist and distal forearm while working. Although findings of the usual provocative tests and nerve conduction studies were normal, ultrasonography revealed arterial thrombosis at the carpal tunnel level, whereas magnetic imaging showed persistent median artery thrombosis in the carpal tunnel. Three months after surgical resection of the thrombosed section of the artery, the patient fully recovered with no residual pain or limitations in the use of the affected arm. His patient-reported outcomes improved as well. It is important to investigate the existence of persistent median artery thrombosis if a patient presents with atypical symptoms of carpal tunnel syndrome. Ultrasonography is useful for the diagnosis of persistent median artery thrombosis. Surgical resection of a thrombosed persistent median artery in patients with carpal tunnel syndrome yields good results.

Outcomes of Rerouting the Palmaris Longus to Extensor Pollicis Longus Tendon Transfer through the Second Extensor Compartment for Radial Nerve Palsy.

Background: A palmaris longus (PL) to extensor pollicis longus (EPL) is a standard tendon transfer used to restore thumb extension in patients with radial nerve palsy. This transfer is done by withdrawing the EPL from the third compartment and passing it subcutaneously to reach the PL. We modified this transfer by rerouting the EPL through the second extensor compartment to improve the retropulsion of the thumb. The aim of this study is to report the outcomes of this modified transfer. Methods: Four patients with traumatic radial nerve palsy underwent the modified PL to EPL transfer. They also underwent transfer of the pronator teres (PT) to extensor carpi radialis brevis (ECRB) and flexor carpi radialis (FCR) to extensor digitorum communis (EDC). Patients were followed up for at least 1 year after surgery. The data with regard to age, gender, cause of radial nerve palsy, duration between injury and surgery, and duration of follow-up was recorded. At final follow-up, the arc of motion at the interphalangeal joint (IPJ), metacarpophalangeal joint (MCPJ), palmar and radial abduction and retropulsion were measured for the reconstructed thumb and contralateral normal thumb. Results: All patients were male, with a mean age of 34.3 (range, 19-46) years. The mean duration between the injury and surgery was 15.9 (7-27) months, and the mean post-operative follow-up period was 16.8 (12-25) months. All patients recovered good thumb function. The mean arc of motion of the affected and contralateral thumb were IPJ flexion: 52°/80°; IPJ extension: 21°/14°; MCPJ flexion: 30°/33°; MCPJ extension:24°/31°; radial abduction: 70°/74°; palmar abduction: 68°/75° and retropulsion: 4.8cm/5.0cm. Conclusion: Rerouting the PL to EPL tendon transfer through the second extensor compartment in radial nerve palsy can restore good thumb function especially retropulsion. Level of Evidence: Level IV (Therapeutic).

Effectiveness of ultrasonographic evaluation under general anesthesia for radial nerve palsy associated with humeral fractures during the first operation.

PURPOSE: To evaluate the effectiveness of sonographic evaluation of the radial nerve at the first operation for closed humeral fracture cases. METHODS: Seventeen cases of closed humeral fractures were included in this study. These cases were categorized into two groups: Group P, consisting of seven cases with complete radial nerve palsy after the injuries; and Group C, consisting of ten cases without radial nerve palsy after the injuries. Sonographic evaluation of the condition of the radial nerve was performed before or after open or closed reduction and internal fixation (ORIF or CRIF) during the first operation. RESULTS: Five of seven Query ID="Q2" Text=" As keywords are mandatory for this journal, please provide 3-6 keywords." cases in Group P showed entrapment or compression of the radial nerve at fracture sites with sonography. Simultaneous radial nerve exploration (SRNE) confirmed sonographic findings in these five cases. The other two cases showed no abnormal sonographic findings except swelling of the radial nerve. CLIF without SRNE was selected and additional sonographic reevaluation of the nerve after CRIF confirmed there were no iatrogenic nerve injuries in these two cases. All of the ten cases in Group C showed no abnormal sonographic findings of the radial nerve. Five of these ten cases selected ORIF, exposed the nerve at the time of approaching the fracture site, and matched sonographic findings. The other five cases without exposure of the nerve confirmed no iatrogenic radial nerve injuries with additional sonographic reevaluation after ORIF or CRIF. All cases in Group P had complete resolution of radial nerve palsy within 4 months postoperatively, and no case in Group C had postoperative iatrogenic radial nerve palsy. CONCLUSIONS: Sonographic evaluation of the radial nerve at the first operation was a useful method to detect conditions of the nerve which can prevent compression or entrapment of the nerve and the need for secondary nerve exploration.

The effectiveness of distraction lengthening in traumatic hand amputation with Ilizarov mini fixator.

BACKGROUND: Bone distraction lengthening has been used for hand reconstruction. The healing process involved in this technique is affected by many factors. Here, the effectiveness and rates of healing of the phalanges and the metacarpals were evaluated in cases of traumatic finger amputation treated using an Ilizarov mini-fixator. METHODS: Fourteen phalanges and twelve metacarpals in 15 patients (13 males and 2 females) were treated with distraction lengthening using an Ilizarov mini-fixator between 2014 and 2017. All the digits had been subjected to traumatic amputation, and shortening of the remaining digit had occurred despite successful replantation in some cases. The healing indices of phalanges and metacarpals were analyzed. RESULTS: The mean patient age was 42.8 years. The mean lengthening of the phalanges was 13.3 mm, while that of the metacarpals was 26.5 mm. The mean consolidation times were 144.4 days for the phalanges and 154.1 days for the metacarpals. The mean healing indices of the phalanges and metacarpals were 114 days/cm and 60 days/cm, respectively. No bone grafts were needed in any of the patients. CONCLUSIONS: Distraction lengthening of the digits after traumatic amputation is an effective procedure for hand reconstructive surgery for either the phalanges or the metacarpals and is less invasive than other techniques. The rate of healing of the metacarpals is two times faster than that of the phalanges.

Radiotriquetral arthrodesis for rheumatoid wrist with flexor tendon rupture: A case report.

Flexor tendon rupture in the wrist of patients with rheumatoid arthritis is a rare complication, and there is no standard treatment for the wrist joint. Here, we present the case of a rupture of the flexor digitorum profundus of the left index finger owing to a rheumatoid wrist. Plain radiography and computed tomography showed carpal collapse, especially lunate, and arthrosis between the capitate and lunate. For stability and mobility of the wrist and index finger, resection of the lunate and radiotriquetral (RT) arthrodesis using the distal ulna as a bone graft and arthrodesis of the distal interphalangeal joint of the index finger were performed. At 2 years postoperatively, her wrist was painless and stable on radiography without recurrence of tendon rupture, and the arc of motion of the dorsal-palmar flexion of the wrist joint was 125°. RT arthrodesis could be a surgical choice of "mobile" partial wrist arthrodesis.

Evaluation of intramedullary nail fixation via the Neviaser portal for proximal humerus fracture.

OBJECTIVES: To our knowledge, no cases have been reported so far regarding the treatment of proximal humerus fracture with intramedullary nail fixation via the Neviaser portal. This study aimed at evaluating the results of intramedullary nail fixation via the Neviaser portal for proximal humerus fracture. METHODS: Four patients with 2-part proximal humerus fracture, who underwent the intramedullary nail fixation via the Neviaser portal, were included in this study. All the patients were females, and the mean age was 78.8 years. We evaluated their clinical and radiographic findings retrospectively. RESULTS: The mean follow-up period was 12 months. All the patients achieved a bone-union without severe complications, such as deep wound infections or any neurological deficits. At the final follow-up, mean shoulder flexion, abduction, and external rotation were 123.5°, 118°, and 36°, respectively. Mean visual analog pain scale (VAS) score at the final follow-up was 21/100. Complications related to the implants were observed in two patients. In one patient, protrusion of the proximal tip of the nail occurred from the entry point, and this caused secondary subacromial impingement. In the other patient, insertion of the end-cap from the Neviaser portal was not possible, and this resulted in the failure of fixation postoperatively. CONCLUSION: The Neviaser portal may be suitable for the insertion of an intramedullary nail, because it facilitates to make an entry-point at the top of the humeral head. However, the problems related to the use of the present instruments still remain and need to be improved.

Elbow septic arthritis associated with pediatric acute leukemia: a case report and literature review.

Acute leukemia in children presents with various clinical manifestations that mimic orthopaedic conditions. The association of septic arthritis of the elbow with acute leukemia is very rare, and the correct diagnosis of acute leukemia is often established only after treatment of the septic arthritis. In this article, we present a three-year-old child patient with elbow septic arthritis related to acute leukemia, diagnosed promptly by bone marrow aspiration on the same day as emergency surgical debridement of the septic elbow joint due to the maintenance of a high index of suspicion, and treated with chemotherapy as soon as possible. The emergency physician and orthopaedist must recognize unusual patterns of presentation like this. Since delay in initiating treatment of septic arthritis may result in growth disturbance, elbow septic arthritis associated with pediatric acute leukemia must be treated promptly and appropriately. Early diagnosis is a good prognostic feature of childhood acute leukemia.