Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome.

 Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure.  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia.

Giant Median Nerve Due to Hamartoma Causing Severe Carpal Tunnel Syndrome.

Introduction: Lipofibromatous hamartoma (LFH) is a very rare, benign, slow-growing peripheral nerve tumor.

Case Report: We present a case of LFH of the median nerve, which caused enlargement of the median nerve and the digital branches in a young male, and was treated surgically. Our treatment choice was resection of large portions of the fibrofatty tissue and decompression of the carpal tunnel.

Trimalleolar Fracture-Dislocation of the Ankle with a Double Fragment of the Medial Malleolus: A Separate Fracture Subtype?

Introduction: Lauge-Hansen classification for ankle fractures is helpful in directing the management of the fracture and has got prognostic significance. However, trimalleolar fractures with double medial malleolar fracture are not yet described.

Case Report: Two cases of trimalleolar fracture-dislocation of the ankle with a double fracture of the medial malleolus are reported.

New Treatment Strategy for a Delayed Skin Necrosis Related to a Calcaneal Fracture.

In calcaneal avulsion fractures, skin necrosis as a result of pressure from the underlying fragment is a fairly common and serious complication. In spite of proper treatment, skin healing complication may occur. We report a calcaneal fracture case complicated by skin necrosis and managed with a novel treatment strategy including application of Platelet Rich Plasma (PRP) and Vacuum Assisted Closure (VAC).

Hallux Osteoid Osteoma: A Case Report and Literature Review.

Osteoid osteoma is a benign bone tumour that mostly affects males in the second and third decade of their life. The lesion mainly occurs in long bones, usually in the femur and tibia, causing severe localized pain that is worse at night and responds to nonsteroidal anti-inflammatory drugs (NSAIDs). Diagnosis is usually made on the basis of history and radiographic findings.

Small diameter acetabulum and femoral head in total hip arthroplasty for developmental dysplasia of the hip, with no femoral osteotomy.

We present the results of 66 total hip arthroplasties in 62 patients of mean age 46 years (24-74 years), with developmental dysplasia of the hip. In all cases the centre of rotation of the new hip was positioned at the site of the true acetabulum. In all patients cementless press fit acetabular components of small diameter (42-44 mm) were used, articulating exclusively with a 22.

A Missing Flexor Hallucis Longus Muscle and Tendon in a Young Female Patient: A Case Report of a Rare Anomaly.

Anatomic variations of the long flexor tendons of the foot are not common. Tendinous bands connecting the flexor hallucis longus and the flexor digitorum longus are well known and have even been classified. Although the congenital absence of the flexor pollicis longus in the hand is well known, we found no reports of the absence of the flexor hallucis longus in the foot.

Modified Wilson's Osteotomy for Hallux Valgus Deformity. A New Approach.

We introduce a new set of modifications and present the results from 48 patients (a total of 60 feet operated), who underwent this modified Wilson's osteotomy for the correction of Hallux Valgus. Patients were of an average age of 52 years old (from 21 to 75 years of age) and were followed up for a mean of 12 months post-operatively. Patient evaluation was made with the symptom scoring system as presented by Kataraglis et al.

Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing.

Aim: Numerous studies have been published regarding the comparison between intramedullary nail and the dynamic hip screw and plate for the fixation of intertrochanteric fractures in elderly patients. In this paper we present a comparative study of these two methods regarding their systemic effects on this group of patients.

Materials-methods: This is a randomized trial of 120 consecutive patients with an intertrochanteric fracture treated with either extramedullary fixation (dynamic hip screw and plate; DHS, Synthes-Stratec, Oberdorf, Switzerland) or intramedullary nail (Gamma nail, Stryker Howmedica, Freiburg, Germany and Endovis BA, Citieffe, Bologna, Italy).

Complete avulsion of the extensor mechanism of a finger with simultaneous dislocation of the proximal interphalangeal joint.

We report a rare case of open dislocation of the proximal interphalangeal (PIP) joint, associated with simultaneous avulsion of the central band and distal insertion of the extensor mechanism, rapture of the proximal volar plate, and rapture of the ulnar collateral ligament of the PIP joint.Although isolated IP joint injuries are common, they rarely occur simultaneously in a single finger. Even more rarely are they accompanied by a complete avulsion of the extensor mechanism.

Total Dislocation of the Talus without a Fracture. Open or Closed Treatment? Report of Two Cases and Review of the Literature.

Complete dislocation of the talus not accompanied by a fracture is a very rare injury. The injury is encountered as a closed one even more rarely. Reviewing the literature we found that proposed treatments for total talus dislocation varied from primary talectomy or arthodesis (to avoid complications) to closed reduction and an under knee cast.

Bilateral transient bone marrow edema or transient osteoporosis of the knee in pregnancy.

Transient osteoporosis or transient bone marrow edema is an uncommon self-limiting condition of unknown etiology. The most commonly affected joint is the hip, followed by the knee, ankle, and the foot. Simultaneous involvement of both hips has been reported exclusively in pregnant women.

Classifying fractures of the distal radius: impossible or unnecessary? Review of the literature and proposal of a grouping system.

Reviewing the literature it was found that no classification of fractures of the distal radius is universally accepted regarding reproducibility, treatment orientation, and ability to predict outcome. The authors find the use of the existing classifications extremely difficult in practice, especially when trying to communicate, and believe that classification, treatment, and prognosis cannot be directly connected because of the complexity of fracture patterns and treatment options. Five hundred fractures of the distal radius were studied and a grouping system was developed in which fractures are positioned according to the direction of displacement of the distal part and the existence of an intra-articular extension.

Littler's flap revisited: an anatomic study, literature review, and clinical experience in the reconstruction of large thumb-pulp defects.

Background: An anatomic study and the authors' clinical experience with 15 flaps used for resurfacing sizable thumb defects are presented.

Material/methods: Sixteen upper extremities from fresh cadavers were dissected to delineate the anatomy, vascular pattern, and reconstructive potential of the heterodigital island flap. Fifteen heterodigital island flaps were also performed between 1996 and 2004 in 15 patients (mean age: 41.

Simultaneous dislocation of the radial head and distal radio-ulnar joint. A case report.

Isolated dislocation of the distal radio-ulnar joint and isolated dislocation of the radial head in adults are not common injuries. A simultaneous dislocation of the radial head and distal radio-ulnar joint with no other injury seems to be extremely rare since only one report was found in the English literature. A similar case, but with some differences in presentation and treatment is reported.

Anterior cruciate ligament reconstruction: outcome using a patellar tendon bone (PTB) autograft (one bone block technique).

Objective: The aim of this study was to determine the outcome of anterior cruciate ligament (ACL) reconstruction using a patellar tendon bone autograft (one bone block technique).

Method: We retrospectively evaluated a case series of patients who had received arthroscopic ACL reconstructions using patellar tendon bone autograft. Fifty-four (54) ACL reconstructions were evaluated at a mean of 38 months (range 25-62 months).

Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.

Diabetic patients, and especially elderly patients in a low-nutritional or immunocompromised state, are prone to a variety of opportunistic infections. 'Myiasis' is a term that refers to non-iatrogenic infestation of tissues by larvae, commonly known as maggots, of dipterous flies. Myiasis as a complication of fracture treatment by means of external fixation of long bones has not been reported.

Diagnostic value of conventional arthrography in investigating post-traumatic ulnar wrist pain: are MRI and MR arthrography always necessary?

Background: Ulnar wrist pain is a difficult problem to diagnose and treat. Many diagnostic methods can be used, each having its own value, but the surgeon should know which is the simplest and most appropriate for each case.

Case Report: Such a case, investigated adequately by conventional arthrography is presented.

Multifocal infection after hip fracture fixation: a case report.

We present the case of a seventy five year old female diabetic patient, who sustained an inter-trochanteric fracture of her left hip and was treated by dynamic hip screw fixation on the same day. The patient developed multifocal infection with three different and unusual types of bacteria isolated in blood and wound cultures. In spite of aggressive and repeated wound debridement, infection and blood sugar levels were impossible to control until metal removal, which led to fracture malunion.

Mid-term results of total knee arthroplasty after high tibial osteotomy.

Background: The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis.

Materials And Methods: Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were compared with a matched group who underwent primary TKA.

Synergistic action of protease-modulating matrix and autologous growth factors in healing of diabetic foot ulcers. A prospective randomized trial.

This study tests the hypothesis that addition of a protease-modulating matrix enhances the efficacy of autologous growth factors in diabetic ulcers. Fifty-one patients with chronic diabetic foot ulcers were managed as outpatients at the Democritus University Hospital of Alexandroupolis and followed up for 8 weeks. All target ulcers were > or = 2.

Internal fixation of proximal humerus fractures using the Polarus intramedullary nail.

Introduction: It has been stated that proximal humeral fractures are the last unsolved fractures in orthopedics. In this study, we evaluate the results of the Polarus nail, in order to constitute to the controversial problem of the treatment of proximal humerus fractures.

Patients And Methods: Between 2003 and 2005, 27 patients with severely displaced proximal humeral fractures were treated with the Polarus intramedullary system.

External fixation of intertrochanteric fractures in elderly high-risk patients.

This study concerns 56 elderly high-risk patients with an intertrochanteric fracture of the femur, who were treated with the Citieffe/Ch-N external fixator between November 2002 and February 2004. A short intraoperative time (37 minutes), no need for peroperative blood transfusion, fast mobilisation and a short hospitalisation (average 6 days, thus reducing the total cost) were noted. Union was obtained in all patients after 6 months.

Are two screws enough for fixation of femoral neck fractures? A case series and review of the literature.

There is still a controversy in literature regarding the treatment of subcapital fractures of the hip with internal fixation. Different methods have been tested and studies such as in cadavers mainly prejudge the three cannulated screws application. We present a series of 20 patients in which percutaneous fixation with two parallel cannulated screws under specific technical conditions has led to an uneventful fracture union.

Ulnar nerve dislocation at the elbow: review of the literature and report of three cases.

Ulnar nerve instability without compression at the cubital tunnel is not common and even more rare is a dislocating nerve. We review the literature regarding the etiology of instability, its incidence and treatment. Snapping around the medial humeral epicondyle can also be caused by a subluxing medial head of the triceps.