1/24. Posterior interosseous nerve palsy following placement of the compass elbow hinge for acute instability: a case report.We describe a case of posterior interosseous nerve palsy that developed after application of a hinged elbow external fixation device. Our hypothesis that forearm pronation during ulnar half pin insertion may have been causative is supported by anatomic findings noted during subsequent cadaveric dissection. Based on our observations we recommend that the ulnar half pins required with this device be inserted with the forearm in supination.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/24. Os odontoideum with cerebellar infarction: a case report.STUDY DESIGN: A case report. OBJECTIVES: To report the case of a child with os odontoideum associated with cerebellar infarction and to discuss the correlation between atlantoaxial instability with os odontoideum and vertebrobasilar artery insufficiency. SUMMARY OF BACKGROUND DATA: knowledge of the influence of atlantoaxial instability on vertebrobasilar artery insufficiency remains limited despite the publication of several reports. methods: A 5-year-old boy with ataxic gait disturbance was hospitalized in the pediatric ward. magnetic resonance imaging revealed multiple cerebellar infarctions, and cerebral angiogram showed occlusions of several branches of the basilar artery and a winding of the left vertebral artery. Stress lateral radiographs of the cervical spine showed atlantoaxial instability with os odontoideum. Posterior C1-C2 transarticular screw fixation with iliac bone graft was applied to obtain firm stability and fusion. RESULTS: There was no damage to the vertebral arteries or spinal nerves in the perioperative period. Solid union of the grafted bone and rigid stability of the atlantoaxial joint were seen on lateral flexion-extension radiographs 1 year after the operation. There has been no sign of recurrent arterial insufficiency, and the patient has been free from cerebellar dysfunction to date. CONCLUSIONS: Atlantoaxial instability may cause insufficiency of the vertebral artery as well as spinal cord injury. More attention should be paid to the possible relation between atlantoaxial instability and vertebrobasilar artery insufficiency.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
3/24. Hypoplasia of bilateral humeral trochlea associated with bilateral ulnar nerve palsy.We document a case of bilateral ulnar nerve palsy that developed in an 27-year-old Japanese man who had bilateral hypoplasia of the humeral trochlea. Surgical management produced good results regarding the ulnar nerve palsy. The pathogenesis of the nerve paresis in this particular condition is discussed. There have been no reports outside japan. Whether this deformity occurs only in persons of Japanese extraction or is simply overlooked by foreign surgeons is an interesting question.- - - - - - - - - - ranking = 1.4keywords = nerve (Clic here for more details about this article) |
4/24. Occipital neuralgia secondary to hypermobile posterior arch of atlas. Case report.The authors report on the management of occipital neuralgia secondary to an abnormality of the atlas in which the posterior arch was separated by a fibrous band from the lateral masses, resulting in C-2 nerve root compression. The causes and treatments of occipital neuralgia as well as the development of the atlas are reviewed.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
5/24. Complications of thermal capsulorrhaphy of the shoulder.BACKGROUND: The purpose of this study was to evaluate the rate of recurrence and the prevalence of complications related to the use of thermal energy for the treatment of glenohumeral instability. methods: A survey was conducted of all members of the American shoulder and elbow Surgeons, the arthroscopy association of north america, and the American Orthopaedic Society for sports medicine. The survey focused on the rate of recurrence, the number of axillary nerve injuries, and the prevalence of capsular insufficiency seen in revision surgery after thermal capsulorrhaphy of the shoulder. RESULTS: Three hundred and seventy-nine surgeons responded to the survey. Of 236,015 shoulder procedures performed over the last five years, 14,277 (6%) involved the use of thermal energy (1,077 involved laser energy; 9,013, monopolar radiofrequency; and 4,187, bipolar radiofrequency) for the treatment of glenohumeral instability. The rates of recurrent instability after laser, monopolar radiofrequency, and bipolar radiofrequency capsulorrhaphy were 8.4%, 8.3%, and 7.1%, respectively. Of the patients with recurrent instability, 363 (twenty-one treated with laser energy, 220 treated with monopolar radiofrequency, and 122 treated with bipolar radiofrequency) required revision surgery. In this group of patients with revision surgery, seven (33%) of the twenty-one treated primarily with laser energy, thirty-nine (18%) of the 220 treated primarily with monopolar radiofrequency, and twenty-five (20%) of the 122 treated primarily with bipolar radiofrequency exhibited signs of capsular attenuation at the time of the revision. A total of 196 patients (1.4%) (three treated with laser energy; 133, with monopolar radiofrequency; and sixty, with bipolar radiofrequency) had a postoperative axillary neuropathy; 93% of the 196 had a sensory deficit only. Of these patients, 95% recovered completely, with the sensory deficits lasting an average of 2.3 months and the combined deficits, an average of four months. CONCLUSIONS: The use of thermal energy for the treatment of shoulder instability has promising short-term results. The rates of recurrent instability are low. However, when recurrent instability occurs, capsular insufficiency may be present. Axillary nerve injury was reported in 1.4% of the patients, in most of whom it resolved spontaneously.- - - - - - - - - - ranking = 0.4keywords = nerve (Clic here for more details about this article) |
6/24. Awake tracheal intubation through the intubating laryngeal mask airway in a patient with halo traction.PURPOSE: To report a case of awake tracheal intubation through the intubating laryngeal mask airway (ILMA) in a patient with halo traction. Clinical features: A 16-yr-old, 40 kg, boy with atlanto-occipital instability and halo traction was scheduled for surgery under general anesthesia. The head of the patient was fixed in a position of flexion and extension was impossible. Cranial magnetic resonance imaging revealed that pharyngeal and laryngeal axes were aligned, but that the oral axis was in an extreme divergent plane. The tongue and oropharynx were anesthetized with 10% lidocaine spray and bilateral superior laryngeal nerve blockade was performed. Under sedation, awake orotracheal intubation via ILMA was successful. Fibreoptic bronchoscopy has been recommended for awake tracheal intubation in such patients. Other techniques, such as use of the Bullard laryngoscope have been described also but awake tracheal intubation through the ILMA in patients with a halo device in situ has seldom been reported in the medical literature. CONCLUSION: airway management of patients with cervical spine instability includes adequate preoperative evaluation of the airway and choosing the appropriate intubation technique. We suggest that the ILMA may be an adequate alternative for awake tracheal intubation in patients with an unstable cervical spine and cervical immobilization with a halo device.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
7/24. Lesion of the common peroneal nerve during arthroscopy.Arthroscopic knee surgery has been well accepted worldwide and has become an important part of orthopaedic surgery. The use of arthroscopy has reduced the duration of hospitalization, overall costs, and time required for the patient to return to sports activities or work. However, because of the closed nature of the procedure and proximity of neurovascular structures to instruments, substantial risk of injuries exists. Significant anatomic variability in the nerve course has not been reported in previous literature as a cause of a knee arthroscopy complication. We present a case of complete transection of an unusually located common peroneal nerve during a knee arthroscopy for lateral meniscal repair in a 22-year-old football player.- - - - - - - - - - ranking = 1.2keywords = nerve (Clic here for more details about this article) |
8/24. The sequelae of osteomyelitis of the proximal ulna occurring in early childhood.Three patients presented with upper limb problems caused by the loss of the proximal ulnar shaft due to osteomyelitis which occurred in early childhood. The three patients had several features in common: instability of the elbow, dislocation of the radial head and shortness and bowing of the forearm, but hand and wrist function were largely unaffected. One patient had evidence of impaired function of the posterior interosseous nerve, presumably a traction injury. The treatment of these problems is discussed. In one patient, a child who had a functioning ulno-humeral joint, successful reconstruction of the ulna using a vascularised fibular graft was possible.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
9/24. Circumferential cervical spine surgery in an 18-month-old female with traumatic disruption of the odontoid and C3 vertebrae. Case report and review of techniques. Case report and review of techniques.STUDY DESIGN: A case study of an 18-month-old female with craniovertebral instability and spinal cord compression requiring circumferential stabilization. A review of surgical techniques in upper cervical spine and craniovertebral stabilization for young children is provided. OBJECTIVES: To describe an interesting surgical approach in a young pediatric patient requiring circumferential stability at the craniovertebral junction. BACKGROUND DATA: Craniovertebral instability is problematic in the young pediatric population due to the inability to secure hardware for stabilization. We present an interesting case of spinal cord compression with craniovertebral instability in an 18-month-old female requiring circumferential cervical spine and craniovertebral stabilization. methods: The patient presented with acute onset quadriparesis after a fall. Radiographs demonstrated C2-C3 disruption with canal compromise. magnetic resonance imaging revealed signal changes of the spinal cord at C2-C3. Neurological examination revealed normal muscle volume with strength 1/5 in the upper extremities and 0/5 in the lower extremities. Respirations were normal with normal diaphragmatic function. cranial nerves were intact. RESULTS: Halo-traction attempted at 0.453 kg induced occipital-atlantal dislocation. The patient underwent anterior corpectomy of C3 and the base of C2 with autologous rib grafts placed from C2 to C4 and macropore as an anterior plating system. Posteriorly the patient had occiput-C3 fusion with a titanium rod and autologous rib grafts bilaterally. Postoperatively the patient regained normal neurological function with circumferential fusion after 4 months in a halo vest. CONCLUSIONS: This case demonstrates the ability to achieve circumferential stabilization in the young pediatric patient. Injuries at the odontoid synchondrosis can be difficult to treat and are only complicated by having to achieve a posterior fusion at the craniovertebral junction. We present a successful case of circumferential fusion and offer a surgical technique to achieve spinal cord decompression and fusion of the upper cervical spine and craniovertebral junction in the young pediatric population.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
10/24. Reconstruction of the medial patellofemoral ligament for painful patellar subluxation in distal torsional malalignment: a case report.Complex two-level rotational malalignment of the lower extremity can cause maltracking of the patella with anterior knee pain. Double derotation osteotomy would correct the underlying pathology. However, it carries a high risk of complications such as nerve and vessel damage. We report a case of rotational malalignment in the femur and the tibia associated with trochlear dysplasia, which causes painful patellar instability. The patient was successfully treated with reconstruction of the medial patellofemoral ligament and lateral release. Although the malrotation was not addressed, the position of the patella was corrected, and no dislocation occurred during a follow-up of 10 months.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
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