Ray Resection as a Personalized Surgical Technique for Progressive Hand Macrodactyly in a 60-Year-Old Patient: A Case Report and Literature Review.

Hand macrodactyly is a very scarce deformity. It was first described over 200 years ago and was characterized as "local gigantism" of one or multiple digits. Benign bone overgrowth, massive increase of soft tissue volume, and nerve involvement are associated with hand macrodactyly have been consistently reported in the literature.

Excisional Arthroplasty for Isolated Scaphotrapeziotrapezoidal Arthritis with the Use of Palmaris Longus Tendon.

Isolated scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) is a relatively common condition. Scaphotrapeziotrapezoidal arthrodesis is the traditional treatment, while excisional arthroplasty with the use of flexor carpi radialis (FCR) or polycarbon implants represents a promising alternative surgical management. The present study aims to assess a novel alternative technique of excisional arthroplasty with the use of palmaris longus (PL) tendon as interposition material.

Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision.

Background: Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed.

Questions/purposes: (1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery?

Methods: Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion.

Composite rib and serratus anterior pedicle transfer for reconstruction of an osteomyelitis of the humerus.

We report the case of a 40 year-old male with Staphylococcus aureus osteomyelitis of the proximal humerus after open reduction and internal fixation of a fracture from motor vehicle accident. Removal of the osteosynthesis, extensive debridement and intravenous antibiotics administration was done followed by external fixation stabilization and reconstruction with a combined pedicled flap using the serratus anterior reversed flap and the 6th rib. At the last follow-up, healing of the bone flap was observed; the patient experienced useful motion of his upper extremity without any evidence of recurrent infection.

Microsurgical reconstruction of complex oromandibular defects: An update.

Free flaps are the gold standard for reconstruction of the mandible, tongue and floor of the mouth. Free fibular flaps are the most preferable option for reconstruction of complex mandibular defects, as well as for tongue and mouth floor reconstruction, since they are harvested easily, present excellent sculptability and good functional outcomes. Alternative options for bone reconstruction include the fibular and iliac crest free flap, and for soft tissue reconstruction include the anterolateral thigh, the radial forearm free flap, and the nasolabial island flap.

The history of microsurgery.

Microsurgery is a term used to describe the surgical techniques that require an operating microscope and the necessary specialized instrumentation, the three "Ms" of Microsurgery (microscope, microinstruments and microsutures). Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively smaller blood vessels and nerves that have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Currently, with obtained experience, microsurgical techniques are used by several surgical specialties such as general surgery, ophthalmology, orthopaedics, gynecology, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery and more.

Gunshot and blast injuries of the extremities: a review of 45 cases.

Gunshot wounds and blast injuries constitute a major public health problem, as the increasing availability of firearms and explosives in conjunction with increasing violence in the city setting have brought this reality into civilian life. Extremities are most commonly involved; therefore, orthopedic surgeons should be trained to manage these types of injuries. Complete and accurate assessment of the injury itself is of great importance, as it will determine the severity and the risk of patients.

Posterior subdeltoid and external rotators preserving approach for reduction and fixation of displaced extra-articular fractures of the scapula.

Background: Operative management of scapular body fractures, when indicated, typically involves extensive exposure through a posterior approach. We present our experience with a deltoid preserving approach that allows excellent exposure of the fracture lines for reduction and fixation while minimizing muscle detachment and overall tissue trauma.

Technique: Exposure of the scapula was obtained through a posterior incision.

Similar 2-point discrimination and stereognosia but better locognosia at long term with an independent home-based sensory reeducation program vs no reeducation after low-median nerve transection and repair.

Study Design: Prospective controlled study.

Introduction: Previous studies evaluated the effectiveness of sensory reeducation (SR) after peripheral nerve injury and repair. However, evidence for long-term clinical usefulness of SR is inconclusive.

Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears.

Background: Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome.

Methods: Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature.

Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients.

Background: Four-corner fusion is a rational surgical option for the management of degenerative conditions of the wrist. Most related studies have compared four-corner fusion with scaphoid excision or proximal row carpectomy, with a variety of reported results. To enhance the literature, we performed this study to evaluate a series of patients with degenerative conditions of the wrist treated with four-corner fusion using 3 surgical techniques and to discuss the clinical and radiographic outcome of the patients.

Pachydermodactyly: An Unknown Entity.

Pachydermodactyly is a rare benign disease that usually affects the dorsal skin and subcutaneous tissue of the proximal interphalangeal joints of the index, middle, ring, and little fingers; the thumb is usually spared. Hyperkeratosis on the dorsal side of the affected areas is common. We present a case of a 19-year-old man who was diagnosed with pachydermodactyly after evaluation of a painless, progressive swelling and hyperkeratosis at the proximal interphalangeal and distal interphalangeal joints of all fingers, bilaterally, for 6 years before presentation.

Osteochondral humeral head fracture after posterior shoulder subluxation: A case report.

Traumatic posterior shoulder subluxations are rare entities which require clinical suspicion upon presentation. Although literature presents many sequels of posterior shoulder subluxations, we have not come across any shearing type osteochondral fracture in the literature. In this case report we present diagnosis, treatment and follow-up results of this rare fracture in a 26-year-old male following a fall from a motorcycle.

Triceps brachii distal tendon reattachment with a double-row technique.

Case reports and small series have reported variable results regarding the treatment of choice for patients with triceps brachii tendon ruptures. Early surgical repair has been recommended for acute complete ruptures of the triceps brachii distal tendon to prevent late functional disability. However, controversy exists regarding the optimum surgical technique of reattachment.

Recurrent fluctuant mass of the wrist and forearm associated with chronic tenosynovitis by Mycobacterium kansasii.

This article presents a case of a painless fluctuant mass on the volar aspect of the wrist and forearm of an immunocompetent 45-year-old man with no history of significant underlying disease. This mass proved to be a chronic tenosynovitis associated with Mycobacterium kansasii infection. The patient, who had a history of multiple minor cuts and abrasions plus exposure to an aquatic environment, had a wide resection of the lesion and elective tenosynovectomy.

Partial fasciectomy for Dupuytren's contractures.

One hundred ninety-six patients with Dupuytren's contractures were treated by partial fasciectomy and adequate postoperative rehabilitation. All patients had flexion contracture of the proximal interphalangeal joint of >20 degrees ; 93 patients had flexion contracture of the associated metacarpophalangeal joint of >30 degrees ; 143 patients had risk factors for Dupuytren's disease. Primary skin closure and splinting were done in all patients.

Effect of sensory re-education after low median nerve complete transection and repair.

Purpose: To compare the sensory results of patients with low median nerve complete transection and repair, with and without sensory re-education.

Methods: We studied 40 patients, aged 20 to 32 years, with low median nerve complete transection. Primary epineural repair using 8-0 single-strand sutures was done in all patients.

Lipomatosis of the sciatic nerve: report of a case and review of the literature.

We report a case of lipomatosis of the sciatic nerve, also known as lipofibromatous hamartoma. A male, 26-year-old, presented with gait impairment, leg pain, and foot drop compatible with sciatic nerve's compression. The preoperative magnetic resonance imaging (MRI) revealed diffuse thickening of the proximal third of the sciatic nerve with adipose tissue interspersed among the nerve fascicles.