scholarly journals Surgical Treatment of a Medial Clavicle Fracture Nonunion with Medial Clavicle Resection and Stabilization to the Sternum with Palmaris Longus Graft

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
M. O. Dion ◽  
S. Martel ◽  
S. Pelet
Keyword(s):  
Clavicle Fracture ◽  
Nonoperative Treatment ◽  
Joint Stability ◽  
Hardware Failure ◽  
Palmaris Longus ◽  
First Case ◽  
Fracture Nonunion ◽  
Medial Clavicle ◽  
Hardware Migration

Medial end clavicular fractures are a rare occurrence. While most of these fractures can be appropriately managed with a nonoperative treatment, some cases of symptomatic nonunion might be surgically addressed to preserve sternoclavicular joint stability and ensure favorable outcomes. The open reduction and osteosynthesis procedure is a commonly performed procedure to treat clavicular fracture nonunion. However, few revision procedures have been described to address the occasional cases of hardware failure or recurrent nonunion of the medial end. In this report, the authors present a case of symptomatic nonunion of the medial clavicle initially treated with osteosynthesis. Implant failure with hardware migration was then treated by medial clavicle resection and stabilization to the sternum using a palmaris longus autograft and the figure-of-eight lacing technique. Excellent functional outcomes at three years of follow-up were obtained. To the authors’ knowledge, this is the first case reporting on a sternoclavicular stabilization with a tendon autograft for such an important bone deficit.

scholarly journals Nonoperative Treatment of Ulnar Carpometacarpal Fracture–Dislocations

2019 ◽  
Vol 09 (02) ◽  
pp. 160-163
Author(s):  
Isidro Jiménez ◽  
Juan Sánchez-Hernández ◽  
Dimosthenis Kiimetoglou
Keyword(s):  
Closed Reduction ◽  
Case Reports ◽  
Nonoperative Treatment ◽  
Fracture Dislocation ◽  
Joint Stability ◽  
Joint Dislocations ◽  
Secondary Dislocation ◽  
Fracture Dislocations ◽  
Cmc Joint

Abstract Background Ulnar carpometacarpal (CMC) joint dislocations and fracture–dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. Case Description This is a series of eight ulnar CMC joint dislocations and fracture–dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery. Literature Review There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results. Clinical Relevance Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.

Unicortical sternal graft reconstruction for anterior sternoclavicular joint instability

2021 ◽  
Vol 14 (3) ◽  
pp. e237164
Author(s):  
Kate M Parker ◽  
Jeremy S Somerson ◽  
Winston J Warme
Keyword(s):  
Gold Standard ◽  
Joint Instability ◽  
Surgical Intervention ◽  
Shoulder Girdle ◽  
Nonoperative Treatment ◽  
Sternoclavicular Joint ◽  
Joint Stability ◽  
Wide Range ◽  
Medial Clavicle ◽  
Graft Reconstruction

Sternoclavicular joint (SCJ) injury represents 3%–5% of all shoulder girdle injuries, yet can produce significant pain and disability. While conservative management improves symptoms in most cases, surgical intervention may be indicated for patients with symptoms recalcitrant to nonoperative treatment. A wide range of surgical stabilisation techniques is documented in the literature; however, the scarcity of SCJ pathology has hindered development of a ‘gold standard’.We present a minimalistic medial clavicle osteoplasty and SCJ reconstruction using semitendinosus autograft anchored with unicortical sternal tunnels in the 54 years old with chronic SCJ instability. This technique can be performed safely, resulting in joint stability and pain reduction, while avoiding risks and complications noted in the literature with other techniques.

scholarly journals Sternoclavicular Joint Reconstruction for Medial Clavicle Fracture Nonunion

2021 ◽  
Vol 35 (2) ◽  
pp. S9-S10
Author(s):  
Nicole M. Stevens ◽  
Emily Pflug ◽  
Dylan T. Lowe ◽  
Philipp Leucht
Keyword(s):  
Clavicle Fracture ◽  
Sternoclavicular Joint ◽  
Joint Reconstruction ◽  
Fracture Nonunion ◽  
Medial Clavicle

scholarly journals Treatment of isolated talonavicular coalition: Case report and literature review

2018 ◽  
Vol 46 (12) ◽  
pp. 5322-5330
Author(s):  
Xiaojun Duan ◽  
Liu Yang
Keyword(s):  
Growth Period ◽  
Nonoperative Treatment ◽  
Ankle Arthritis ◽  
Ankle Pain ◽  
Tarsal Coalition ◽  
Talocalcaneal Coalition ◽  
First Case ◽  
Tarsal Bones ◽  
Late Growth

Tarsal coalition refers to an abnormal fibrous, cartilaginous, or bony connection that develops between two or more tarsal bones. Talocalcaneal coalition and calcaneonavicular coalition account for more than 90% of all cases of tarsal coalition. Coalition exists early at birth, but bony connection usually develops during the patient’s late growth period. Isolated cases of talonavicular coalition have rarely been reported. We herein report a case involving an 11-year-old patient with an isolated talonavicular coalition from a soft tissue to bony connection who was treated with arthroscopy for ankle arthritis. To our knowledge, this is the first case in which the whole formation of the talonavicular coalition was observed with a series of radiographic and magnetic resonance imaging examinations. The pain caused by the talonavicular coalition was managed by nonoperative treatment, while the ankle pain caused by the arthritis was relieved after ankle arthroscopy. At 6 years postoperatively, the patient remained pain-free while walking for 30 minutes and was satisfied with the operative outcome. Continuous follow-up confirmed that after the formation of talonavicular coalition, the coalition can continue to progress, forming bony talocalcaneal coalition and calcaneocuboid coalition.

When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

2020 ◽  
Vol 13 (12) ◽  
pp. e235986
Author(s):  
Alexander Tindale ◽  
James Jackson ◽  
Darina Kohoutova ◽  
Panagiotis Vlavianos
Keyword(s):  
Portal Vein ◽  
Complete Resolution ◽  
Chylous Ascites ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Portal Vein Stenosis ◽  
First Case ◽  
Vein Stenosis ◽  
Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

2020 ◽  
Author(s):  
Arti Maria ◽  
Tapas Bandyopadhyay
Keyword(s):  
Cerebrospinal Fluid ◽  
Neurodevelopmental Outcome ◽  
Neurological Sequelae ◽  
Glucose Levels ◽  
Csf Analysis ◽  
First Case ◽  
Time Of Admission ◽  
Cerebrospinal Fluid Protein ◽  
Hypernatremic Dehydration

AbstractWe describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

2021 ◽  
pp. 175319342110241
Author(s):  
I-Ning Lo ◽  
Kuan-Jung Chen ◽  
Tung-Fu Huang ◽  
Yi-Chao Huang
Keyword(s):  
Simple Procedure ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
High Satisfaction ◽  
Ultrasound Assessment ◽  
Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

Penile Lymphoepithelioma-Like Carcinoma: A Rare Case With PD-L1 Expression

2021 ◽  
pp. 106689692098834
Author(s):  
Raquel Machado-Neves ◽  
Bernardo Teixeira ◽  
Elsa Fonseca ◽  
Pedro Valente ◽  
Joaquim Lindoro ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Tumor Cells ◽  
Rare Case ◽  
Malignant Tumors ◽  
Squamous Cell Carcinomas ◽  
The Third ◽  
The Past ◽  
First Case ◽  
Lymphoplasmacytic Infiltrate

Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.

scholarly journals Endovascular repair of de novo post-stenotic aortic coarctation aneurysms with complex collateral supply: two cases with long and medium term follow-up

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar Abdel-Hadi ◽  
John Thomson ◽  
Simon J. McPherson
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Coarctation ◽  
De Novo ◽  
Aortic Aneurysms ◽  
Medium Term ◽  
First Case ◽  
Case Presentations ◽  
Selective Embolisation

Abstract Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.

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