[Show abstract][Hide abstract] ABSTRACT: To review the outcome of 121 patients who underwent arthroscopic resection of a humeroradial synovial plica for persistent lateral elbow pain.
92 men and 29 women aged 24 to 56 (mean, 38) years with chronic lateral elbow pain underwent arthroscopic resection of a humeroradial synovial plica using a motorised soft tissue shaver, followed by intensive physiotherapy. The modified elbow score and range of motion were assessed, as were wound healing, infection, soft tissue swelling or effusion, tenderness, ligamentous instability, and motor strength.
No patient had any ligamentous instability. 80 patients were pain-free at 3 months; only 3 patients were taking pain medication at 6 months. All patients had full pronation and supination; the mean range of motion was 3º to 135º of flexion. The mean modified elbow score at 12 months was 93.2 (range, 72-100). The percentages of patients with excellent, good, fair, and poor score were 70%, 17%, 8%, and 5% at 3 months, 74%, 20%, 3%, and 3% at 6 months, and 76%, 18%, 3%, and 3% at 12 months, respectively.
A humeroradial synovial plica is one of the causes of chronic lateral elbow pain. Arthroscopic resection of the synovial plica followed by intensive physiotherapy achieved good outcome.
Journal of orthopaedic surgery (Hong Kong) 04/2015; 23(1):11-4. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Double dislocations of carpometacarpal and metacarpo-phanlageal joints are rare. We report an unusual case of simultaneous dislocation of both CMC and MCP joints in the thumb.PRESENTATION OF CASEA 31 year old male was admitted following a road traffic accident. He was complaining of pain and deformity of right thumb. The X-ray examination revealed simultaneous dislocation of both CMC and MCP joints. He underwent closed manipulative reduction and percutaneous K wire fixation. The wires were removed after six weeks. After a course of physiotherapy he regained full range of pain free movements.DISCUSSIONThe incidence of simultaneous dislocation of both CMC and MCP joints in thumb are associated with high energy injuries. The options of treatment are conservative with cast immobilisation and serial X-rays or operative including closed manipulative reduction and K wire fixation or open reduction and internal fixation.CONCLUSION
The option of treating this rare injury with closed manipulative reduction and percutaneous K wiring gives excellent and predictable results.
International Journal of Surgery Case Reports 11/2014; 5(12). DOI:10.1016/j.ijscr.2014.11.031
[Show abstract][Hide abstract] ABSTRACT: Introduction
Wrist pain is very common and there are several causes for this condition. It is extremely important to establish an accurate diagnosis so that appropriate treatment can be directed at the cause.
Presentation of case
We describe a case of a young man who presented to us with wrist pain of insidious onset. He had previous (ganglion) excision from the same wrist. Clinically there was tenderness in the base of second metacarpal with no swelling. The radiograph and MRI scan were suggestive of Brodie‘s abscess. But surgical exploration and subsequent histopathology showed evidence of osteoid osteoma.The patient had full resolution of symptoms after three months of surgery.
Osteoid osteoma of the wrist bones are rare. They usually present with atypical pain. The diagnosis of osteoid osteoma is challenging and often missed. A high index of suspicion and appropriate investigations are essential in the diagnosis.
We conclude that the diagnosis of osteoid osteoma should be considered in case of wrist pain of unknown aetiology with cystic lesions in the carpal or metacarpal bones.
International Journal of Surgery Case Reports 10/2014; 5(12). DOI:10.1016/j.ijscr.2014.10.067
[Show abstract][Hide abstract] ABSTRACT: Bilateral spontaneous inter-trochanteric fractures of the proximal femur are rare. We report an unusual case of bilateral intertrochanteric fractures of the proximal femur in a 92 year old lady.
A 92 year old lady presented to us with one week history of pain in both hips and poor mobilisation. There was no history of mechanical fall. The initial plain films of the hips did not show any fractures and the diagnosis was made by MRI scans. She underwent bilateral fixation of the fractures with dynamic hip screws. After a period of rehabilitation she returned to the pre injury mobilisation status.
Bilateral spontaneous intertrochanteric fractures of the hip due to osteoporosis are not that common. These rare fractures are usually associated with major trauma, renal disease, osteoporosis, osteomalacia, long term corticosteroid treatment and epilepsy.
Early diagnosis with high index of suspicion and appropriate investigations are mandatory in the management of these fractures.
International Journal of Surgery Case Reports 03/2014; 5(5):246-248. DOI:10.1016/j.ijscr.2014.03.001
[Show abstract][Hide abstract] ABSTRACT: Background
Recurrent patella dislocation is a very disabling condition. The stability of patellofemoral joint depends on many general and local factors. It is believed that the Medial Patellofemoral Ligament (MPFL) is one of the major stabilisers of the patellofemoral joint in early knee flexion. Injury to the MPFL occurs in almost every patellar dislocation. This result in a significant increase in lateral patellofemoral joint tracking and contact pressures, which may affect long-term articular cartilage health. Therefore, in recent years MPFL reconstruction has become a popular surgical option in the treatment of patella instability. However there is still a growing debate regarding the correct surgical technique and post-operative rehabilitation. In addition, the long-term effect of MPFL reconstruction procedure on the patellofemoral joint is unknown. Recent research has emphasised the importance of anatomic femoral tunnel placement with the help of intraoperative radiograph. Mal-positioned femoral tunnels and over tensioned grafts during MPFL reconstruction have been reported to result in adverse outcomes such as joint stiffness, pain, recurrent instability and possibly early degenerative joint changes.
To review of our current knowledge of the anatomy, function and the surgical reconstruction of MPFL
We conducted cadaveric dissection to understand the anatomy of MPFL, its femoral and patellar attachments and its role in the functional stability of the patello-femoral joint. We also describe the surgical reconstruction of the MPFL using hamstring tendons, technique and accurate placements of femoral tunnel.
Our findings showed that the MPFL insert in an area midway between the adductor tubercle and medial epicondyle of the femur, dorsal to an extended line from the posterior cortex of the femur and attaches to the superomedial portion of the patella, and under the surface of the Vastus Medialis Obliquus tendon (VMO). The ideal graft for reconstruction is the gracilis tendon. The femoral tunnel entry point is behind the posterior cortex of the femur and above the Blumensaat's line.
We conclude that anatomic femoral attachment and minimal tension during reconstruction of MPFL is essential for a successful outcome.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to better quantify the role of delayed MRI scans in acute wrist injuries, and to assess the prevalence and distribution of multiple occult injuries of the wrist. A retrospective study was made of all patients who had been referred to the orthopaedic trauma clinic for a possible scaphoid fracture and with normal radiographs over a two year period. There were 110 patients. Patients were initially treated conservatively with a scaphoid cast or a futura splint for two weeks. This was then removed and the wrist examined and further radiographs taken. The patients with normal radiographs who had positive clinical findings for a scaphoid fracture at two weeks or persisting pain at six weeks had an MRI scan. MRI was performed with and without fat saturation sequences. A total of 110 wrists were analysed. Twenty-eight (25.4%) were reported as normal; 24 patients (21.8%) had occult bone fractures. Three (2.7%) had scaphoid fractures diagnosed by MRI scans. There were nine (8.1%) distal radius, two trapezium and five hook of hamate fractures. Bone bruising was seen in 12 (10.9%). Carpal degeneration was seen in ten and a TFC tear was noted in five (4.5%). Other findings were a ganglion in 14 (12.7%) and three (2.7%) had Kienbock's disease. The MRI scan is a useful tool in obtaining a definite diagnosis in acute wrist injuries. Among other findings, an occult scaphoid fracture was diagnosed on MRI in 2.7% of cases in this study. To conclude, in the majority of patients with persisting symptoms after two weeks following a wrist trauma, the cause of symptoms was pathology in other tissues in the wrist including soft tissues, other carpal bones and distal forearm.
[Show abstract][Hide abstract] ABSTRACT: Conservative management has been the mainstay of treatment for simple extra-articular distal radius fractures. Several factors, such as quality of definitive casting, have been implicated in the risk of fracture re-displacement during follow-up. Objective assessments of the quality of casting using various indices have been documented in literature, although overall evidence remains scant, and only one study in the literature discusses the use of the three-point index (3-PI) in adults. Currently, no independent study assessing the 3-PI in adults has been documented. This retrospective study aimed to assess the 3-PI in terms of (1) predicting fracture re-displacement and (2) evaluating its practicality in everyday clinical use. We had 54 patients (47 female, 7 female), out of which 35 patients had a 3-PI greater than the suggested cutoff value of 0.8; of these, 22 went on to re-displace. The remaining 19 patients had a 3-PI below the cutoff and 14 went on to re-displace. No statistical significance was found for the 3-PI as a predictor for fracture re-displacement, although inter-observer reliability was high; its impact on clinic times (in calculating the 3-PI) remained low.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the deep infection rates in patients who underwent a total hip replacement after having had a prior diagnostic steroid injection into the same hip. We identified and reviewed the case notes, relevant radiographs and microbiology reports of all patients who underwent a total hip replacement after a diagnostic steroid hip injection in our unit from 1 January 2007 to 31 April 2009. There were 40 patients. (10 males and 30 females) Their mean age was 68.4 (52-82) years. The mean time interval from the injection to the joint replacement was 6.2 (2-23) months. The mean follow-up was 23.2 (11-37) months. None of the patients in the study group developed a deep infection during this followup period. Diagnostic intra articular steroid and local anaesthetic injection prior to total hip replacement appears to be safe.
[Show abstract][Hide abstract] ABSTRACT: The Galeazzi fracture-dislocation was originally described by Sir Astley Cooper in 1822 but was named after Italian surgeon Ricardo Galeazzi in 1934. It is an injury classified as a radial shaft fracture with associated dislocation of the distal radioulnar joint and disruption of the forearm axis joint. The associated distal radioulnar joint injury may be purely ligamentous in nature, tearing the triangular fibrocartilaginous complex, or involve bony tissue (that is, ulnar styloid avulsions) or both. We report this case because of the rare association of posterior dislocation of the elbow along with Galeazzi fracture-dislocation. To the best of our knowledge, this has not been previously reported in the English literature.
A 26-year-old Caucasian man presented to our department after a fall from a motorbike. He sustained a closed, isolated Galeazzi fracture-dislocation of the right forearm and no associated elbow injuries, and this necessitated open reduction and internal fixation of the radius. Post-operative radiographs films were satisfactory. However, clinical and radiological evidence of ipsilateral elbow dislocation was noted at a five-week follow-up, subsequently requiring open reduction of the joint and collateral ligament repair. Our patient was noted to have full elbow and forearm function at three months.
Although the Galeazzi fracture-dislocation has been classically described as involving only the distal radioulnar joint, traumatic forces can be transmitted to the elbow via the interosseous membrane of the forearm. This can lead to instability of the elbow joint. Therefore, we recommend that, in every case of forearm fracture, both elbow and wrist joints be assessed clinically as well as radiologically for subluxation or dislocation.
Journal of Medical Case Reports 12/2011; 5(1):589. DOI:10.1186/1752-1947-5-589
[Show abstract][Hide abstract] ABSTRACT: Bilateral quadriceps tendon rupture is not common in the absence of systemic disease. Patients with chronic systemic diseases such as uremia and systemic lupus erythematosus and patients who are being treated with systemic steroids or local steroid injections are more prone to tendon rupture. The tendon can rupture spontaneously or as a result of trauma. We report an unusual case of simultaneous bilateral traumatic quadriceps tendon rupture in a patient with psoriasis who was being treated with topical steroid preparations.
A 57-year-old Caucasian man with a known history of psoriasis, for which he was being treated with topical steroid preparations, presented to our hospital with clinical signs of bilateral quadriceps tendon rupture after he fell while walking down stairs. The diagnosis was confirmed by bilateral ultrasound scans of the thighs. The patient underwent surgery to repair both quadriceps tendons. Post-operatively, the patient was immobilized first in bilateral cylinder casts for six weeks, then in knee braces for the next four weeks. His knees were actively mobilized during physiotherapy.
Bilateral quadriceps tendon rupture is a rare occurrence in patients with psoriasis who are being treated with topical steroids.
Journal of Medical Case Reports 07/2011; 5:331. DOI:10.1186/1752-1947-5-331
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to assess the functional outcome of fragility fractures of the ankle treated with a fibular locking nail. A retrospective review of 24 patients with fragility fractures treated with a fibular locking nail from January 2005 to December 2007 was performed. The fibular nail used in our study was Biomet SST (stainless steel taper) small bone locking nail for the fibula. The Olerud and Molander scale was used to assess the functional outcome at the end of 1 year. The domains of the Olerud and Molander scale are pain, stiffness, swelling, stair climbing, running, jumping, squatting, support, and the activities of daily living. The patients were interviewed by telephone or the questionnaire was send by mail. Of the 24 patients, 2 were men and 22 were women. The left side was affected in 15 patients. The age group ranged from 71 to 91 years (average, 79). Of the fractures, 10 were lateral alveolus, 8 were bimalleolar, and 6 were trimalleolar fractures. All the patients were followed up at 6 weeks, 12 weeks, and after 6 months. The average period to fracture union was 8.7 weeks. No wound breakdown or any deep infections developed. The average Olerud and Molander scale score was 57 (range 30 to 65). The use of fibular locking nails to treat these difficult fracture are quite crucial to achieve early mobilization and also to maintain a good fracture position. In our study, the use of fibular nails was a very useful and successful method of treating fragility fractures with a very low risk of complications. It also helps to restore function and results in patient satisfaction.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 05/2011; 50(5):547-50. DOI:10.1053/j.jfas.2011.04.017 · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report an unusual case of complete rupture of the flexor pollicis longus tendon following volar locking plating for a distal radius fracture. We believe that the prominence of a distal locking screw head predisposed to the rupture of the tendon. We highlight that correctly attaching the distal locking screws to the plate is essential for obtaining the correct biomechanics of the device and preventing flexor tendon rupture.
European Journal of Trauma and Emergency Surgery 08/2010; 36(4):385-387. DOI:10.1007/s00068-009-9021-4 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We describe a posterior approach to the elbow joint based on anatomical studies of the blood supply to the triceps muscle, and observation of the musculotendinous insertion of triceps. These studies demonstrated that the triceps muscle is essentially supplied by end arteries. Any distal-proximal anastamoses from the collateral branches of the radial and ulnar arteries, occur at the small vessel level. The insertion of triceps is musculotendinous with an aponeurosis consisting of two laminae, one superficial and one deep, as well as direct muscle insertion into the olecranon. Our approach provides an excellent exposure of the distal humerus without the division of any fibers of triceps preventing any muscle necrosis and scarring. We formally dissect the two laminae of the triceps aponeurosis, and divide the deeper intramuscular aponeurosis 2 cm proximal to the olecranon. At closure, correct tensioning of the intramuscular aponeurosis allows for soft tissue balancing and optimum elbow function. We use this approach for total elbow replacement, open reduction and internal fixation of distal humerus fractures and in the open reduction of displaced supracondylar fractures in children. We have had no cases of a triceps tendon dehiscence in over 400 cases
European Journal of Orthopaedic Surgery & Traumatology 10/2009; 19(7):467-472. DOI:10.1007/s00590-009-0462-6 · 0.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of our study is to document the arthroscopic findings in resistant lateral elbow pain. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with lateral elbow pain resistant to conservative treatment. We found established degenerative changes involving articular cartilage in 68 patients (59%). In 60 of these 68 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with a normal appearance of the articular cartilage of the medial compartment. Primary lateral compartment arthritis is more common than previously thought, it mostly affects a young population and could easily be misdiagnosed as lateral epicondylitis.