Assessment of Proximal Radio-median Cubital/Radio-Cephalic Arterio-venous Fistula

The present study aims to conducted the Assessment of Proximal radio-median cubital/radio-cephalic Arterio-venous Fistula. Arterio-venous Fistula is life line for long-term hemodialysis for end stage renal disease patients. The order of preference as per National Kidney Foundation/ Kidney Disease Out Come Quality Initiative (KDOQI) is distal Radio Cephalic fistula is considered as gold standard followed by elbow Brachio Cephalic Fistula, transposed Brachio-Basilic Fistula, forearm arterio-venous graft. This is a cross sectional-prospective interventional study, 05/2017 to 04/2019, JNMC, Wardha, MH, with sample size of 66 cases. Out of 66 cases 25 % patients had diabetes mellitus, 48% cases were suffering from chronic glomerulonephritis, 15 % cases were suffering hypertension, 6 % cases had COPD and another 6 % cases had some cardiovascular disease. About 54 % cases had previous access failure. In our study the mean flow volume for AV fistula in proximal forearm was 485± 291 ml/minon postoperative day1, 695 ± 298 on postoperative day 7 and 755± 347 ml/min. Overall postoperative complications in 12% cases was reported in our case study though Yilmiz et al reported postoperative complications in 15% cases.

Insidious Onset Compartment Syndrome of the Forearm in a Teenager: A Case Report and Review of the Literature

Compartment syndrome affecting the upper extremities is a relatively underreported event compared with compartment syndrome affecting the lower extremities. Moreover, insidious onset forearm compartment syndrome has been rarely reported and is usually limited to single case reports. We report a compartment syndrome of the forearm in a teenager. She hit her right proximal forearm lightly on the cash register, but there was no pain. However, the next day, she had difficulty in moving her right hand. Although she underwent electrotherapy, her right forearm gradually became swollen, and she felt numbness in the ring and little fingers of her right hand. Six day after the onset, she came to our hospital and underwent fasciotomy. There was no aftereffect, and very good functional recovery was obtained. All clinicians need to keep the case of forearm compartment syndrome in a young individual with a diffuse course, such as in this case in mind.

Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy

Radial tunnel syndrome (RTS) is an uncommon controversial entity thought to cause chronic lateral proximal forearm pain due to compression of the deep branch of the radial nerve, without paralysis or sensory changes. Diagnostic confusion for pain conditions in this region results from inconsistent definitions, terminology, tests, and descriptions in the literature of RTS and “tennis elbow,” or lateral epicondylitis. A case of bilateral RTS with signs discordant with traditionally used clinical diagnostic tests was successfully relieved with surgical decompression and led us to perform a comprehensive critical review of the condition. We delineate the controversy surrounding its diagnosis and aim to facilitate appropriate management and identify other areas for further study in this controversial condition. Clinical validity and evidence of anatomical rationale for the traditionally used Maudsley’s provocative test is unclear in diagnosis of RTS or in chronic lateral elbow pain, if at all. Neither imaging nor electrophysiological studies contribute to a clinical diagnosis which is supported by short-term improvement after an injection with long-acting local anesthetic and corticosteroid. Accurate diagnosis and treatment of RTS can significantly improve quality of life, but validity and evidence for traditional clinical tests and definitions must be clarified.

SYMPTOMATIC SOLITARY OSTEOCHONDROMA OF PROXIMAL RADIUS IN AN ELDERLY FEMALE: A CASE REPORT

Osteochondroma is a common benign tumor in adolescence but is unusual in elderly age group with atypical site of presentation as proximal radius. Osseous lesions at the level of proximal forearm have often lead to limitations in movements and impingement on surrounding soft tissue structures. Here, we describe a case of a 61 year old female who presented with gross restrictions of forearm rotations with progressively increasing swelling over the proximal forearm. Imaging studies hinted at an osseous lesion with a cartilaginous cap. Surgical excision was done due to rapidly growing mass with functional restrictions. Incidental adjoining bursitis was seen intra-operatively and histopathology conrmed the diagnosis. Patient regained full range of motion and was asymptomatic postoperatively at 8 weeks. Atypical presentations though rare, are a possibility and so surgeons should be aware for appropriate management of these tumors.

Comparison of one-year patency rates of end-to-side and side-to-side anastomosis technique in proximal forearm region radial-cephalic fistulas

Objectives In this study, the effects of anastomosis techniques on the results of patients with autogenous radial-cephalic proximal forearm fistula were investigated. Methods Patients who underwent radial-cephalic proximal forearm fistula surgery (arteriovenous fistula) between April 2015 and August 2017 at the Department of Cardiovascular Surgery of Ordu University were compared retrospectively in terms of the results of anastomosis techniques. The study included 131 patients who had arteriovenous fistulas created by side-to-side and end-to-side anastomosis technique. Results There was no significant difference in demographic data, comorbidities, radial artery, and cephalic vein diameters in patients undergoing radial-cephalic proximal forearm fistula surgery. However, it was observed that fistula maturation was earlier in the group with end-to-side anastomosis technique, and the one-year patency rates were higher in the group with side-to-side anastomosis technique. Conclusion In Arteriovenous fistulas created in the proximal forearm region, the one-year patency rate of the side-to-side anastomosis technique was higher, while the maturation of the end-to-side technique observed earlier.

Posterior interosseous nerve entrapment by intramuscular lipoma arising from the supinator muscle - a case report

Background: Lipomas are benign, slow-growing tumors frequently subcutaneous and asymptomatic, intramuscular lipoma constituting a rare subtype. However, a lipoma occurring nearby the proximal radius may cause posterior interosseous nerve (PIN) entrapment. Case presentation: We described an uncommon case of a 45-year-old-man with a history of progressive, painless proximal right (dominant) forearm swelling for 4 months associated with PIN entrapment syndrome, presenting as fingers extension weakness. Intramuscular lipoma was observed in the supinator muscle in the magnetic resonance imaging (MRI). Lipoma surgical excision and release of the PIN through proximal forearm direct anterior approach was performed. Results: The histopathological examination confirmed the diagnosis of benign intramuscular lipoma. The follow-up of the patient showed full recovery within three months postoperatively. Discussion: Intramuscular lipoma is rare; however, it could originate from supinator muscle in the forearm, presenting with vague pain and could lead to compression of nearby neurovascular structures such as the PIN. Clinical evaluation and imaging studies, especially MRI, are crucial for diagnosis. If neural compression is evident, surgical resection is mandatory. Conclusion: Intramuscular lipoma entrapping PIN is rare and requires early clinical diagnosis confirmed by imaging and neurophysiological studies, surgical excision being the method of choice for optimum functional outcomes.

338 Biceps Metastasis Presenting as A Presumed Abscess in Patient with An Undiagnosed Non-Small Cell Lung Cancer - An Unusual Presentation

Lung cancer is the most common cancer worldwide and has highest cancer mortality. Around 50% of cases present with metastasis, however skeletal muscle metastasis is rarely reported. In this case we describe a fifty-nine-year-old male patient who presented complaining of fever and a mass on the distal biceps and proximal forearm over a five-month period, with no reported improvement despite debridement and antibiotics spanning three presentations to the emergency department. Subsequent biopsy at various anatomical sites showed adenocarcinoma, later identified as metastatic from a primary non squamous-cell lung cancer (NSCLC). Metastases from lung cancer are more commonly limited to liver and adrenal glands. Presentation of such a mass in skeletal muscle would raise suspicion for the more-commonly seen soft-tissue sarcoma or hemangiomas. This case illustrates a rare example of lung cancer metastatic to skeletal muscle, more specifically, the biceps. Presentation of the mass was also unique in its morphology of an abscess with purulent discharge, raising the importance of cytology and suspicion for malignancy in an abscess unresponsive to antibiotics. Non-small cell lung cancer can present with skeletal metastasis. A work-up of a mass or abscess of the muscle should include the possibility of soft tissue metastasis.

Vascular Access Perspectives in Patients After Kidney Transplantation

Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

PROSPECTIVE RANDOMISED COMPARATIVE STUDY OF TENSION BAND WIRING AND OLECRANON PLATING FOR TREATMENT OF OLECRANON FRACTURES

Introduction- Olecranon fractures are one of the most commonly seen orthopedic injuries and account for approximately 10% of all proximal . forearm fractures. Operative treatment is open advocated in fractures with an articular incongruity of more than 2 mm, hence only a minority of patients are treated conservatively. The purpose of current study is to compare the clinical and radiological outcome of tension band wiring and plate xation in patients operated for olecranon fractures. Materials and methods- Current study was conducted in a tertiary care center from December 2018 to December 2020. Study compromises of 50 patients operated for olecranon fracture. Implant used -tension band wiring with 2 k wire ,1 ss wire and olecranon plate Classification used - Schatzker classication Clinical and functional outcome were assessed using mayo elbow performance score Results and observations- Study consists of 50 cases of fractures of the olecranon treated by Tension band wiring with Kirshner wire and Olecranon plate. The results were evaluated according to the Mayo elbow performance score. The results obtained in our series were excellent in 41 (82%) patients, good in 6 (12%) patients, fair in 3 (6%) patients and no poor results. Conclusion-it is concluded that the technique of open reduction and internal xation with Kirschner wires and tension band wiring and olecranon plate xation are effective means of treating fractures of olecranon.