{"title":"Editorial: Moral distress and its variations","authors":"David Ring","doi":"10.58616/001c.93000","DOIUrl":"https://doi.org/10.58616/001c.93000","url":null,"abstract":"","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 62","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140211057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The patient is a 57 year old male with peripheral vascular disease and a non-healing thumb wound. After radial artery catheterization (RAC), he developed pain and numbness in the radial-sided 3.5 fingers and pulse oximetry readings <80%. With a possible diagnosis of carpal tunnel syndrome due to increased pressure, the patient underwent a carpal tunnel release (CTR) one week after the catheterization and reported immediate pain relief. Unfortunately, his wound failed to heal, and his pain returned one week later. Another operation was performed to decompress the carpal tunnel; however, the pain worsened, and fingertip necrosis progressed, including the thumb, index, and middle fingers. An angiogram showed arterial calcifications, ruling out reperfusion of the hand. A trans-forearm amputation was performed. This case highlights overlapping symptoms of ischemia and median nerve compression as well as the risk of hand ischemia after RAC in those with circulatory compromise.
{"title":"Below Elbow Amputation Due to Ischemic Complications after Radial Artery Cannulation: A Case Report","authors":"Nathan Sarli, Sonal Kumar, Kassem Ghayyad","doi":"10.58616/001c.92532","DOIUrl":"https://doi.org/10.58616/001c.92532","url":null,"abstract":"The patient is a 57 year old male with peripheral vascular disease and a non-healing thumb wound. After radial artery catheterization (RAC), he developed pain and numbness in the radial-sided 3.5 fingers and pulse oximetry readings <80%. With a possible diagnosis of carpal tunnel syndrome due to increased pressure, the patient underwent a carpal tunnel release (CTR) one week after the catheterization and reported immediate pain relief. Unfortunately, his wound failed to heal, and his pain returned one week later. Another operation was performed to decompress the carpal tunnel; however, the pain worsened, and fingertip necrosis progressed, including the thumb, index, and middle fingers. An angiogram showed arterial calcifications, ruling out reperfusion of the hand. A trans-forearm amputation was performed. This case highlights overlapping symptoms of ischemia and median nerve compression as well as the risk of hand ischemia after RAC in those with circulatory compromise.","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review of the literature has summarized recent developments on cells implicated in the different phases of bone healing and their potential clinical applications including inflammatory phase (neutrophils, macrophages, mast cells), fibrovascular phase (endothelial cells and mesenchymal stem cells - MSCs), bone formation (osteoblasts, chondrocytes), and callus remodeling (osteoclasts). Some studies have confirmed the two well-known facts that alcohol intake and dexamethasone negatively affect bone healing. Other studies have shown that Aucubin, Bortezomib, and human umbilical cord MSCs (HUCMSCs)Wnt10b promote bone healing of bone fractures. However, more research is needed to confirm their actual utility in the clinical practice of bone fracture treatment.
{"title":"Recent developments on cells involved in bone repair and their potential clinical applications","authors":"E. C. Rodríguez-Merchán","doi":"10.58616/001c.90443","DOIUrl":"https://doi.org/10.58616/001c.90443","url":null,"abstract":"This review of the literature has summarized recent developments on cells implicated in the different phases of bone healing and their potential clinical applications including inflammatory phase (neutrophils, macrophages, mast cells), fibrovascular phase (endothelial cells and mesenchymal stem cells - MSCs), bone formation (osteoblasts, chondrocytes), and callus remodeling (osteoclasts). Some studies have confirmed the two well-known facts that alcohol intake and dexamethasone negatively affect bone healing. Other studies have shown that Aucubin, Bortezomib, and human umbilical cord MSCs (HUCMSCs)Wnt10b promote bone healing of bone fractures. However, more research is needed to confirm their actual utility in the clinical practice of bone fracture treatment.","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rahul Muchintala, Nathaniel Kern, Gaston Davis, Patrick Ioffreda, Santiago Rengifo, Mohammad Khak
This systematic review aims to comprehensively evaluate the current literature to determine whether local infiltration liposomal bupivacaine (LB) used in total hip arthroplasty (THA) results in reduced pain scores and opioid consumption compared to traditional local anesthetics. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Ovid Medline, PubMed, Scopus, and ScienceDirect databases. Articles were screened independently by two investigators based on inclusion criteria of 1) prospective randomized control trials or retrospective cohort studies, 2) conducted after the 2015 Food and Drug Administration (FDA) expansion of LB indication to local surgical infiltration, 3) compared LB as a periarticular injection to other local anesthetics used as a periarticular injection, and 4) available in English. Primary outcomes of pain scores and opioid consumption were reported. Secondary outcomes of interest included mobility, length of stay, costs, incidence of adverse events, and readmission rates. Bupivacaine costs $3 per dose, while LB costs $334 per dose. A total of seven articles were identified with the inclusion criteria. Four studies concluded that LB improves patient outcomes of pain scores and opioid consumption in patients receiving THA. Three studies found no benefit to using LB compared to their controls. Four studies found no significant reduction in the length of stay between the groups. There were no reported differences in the incidence of adverse events or total costs between the two groups. There are minimal benefits of reduced pain scores or opioid consumption when using LB opioid-sparing protocols compared to current protocols for patients undergoing THA. III
{"title":"Periarticular Injections with Liposomal Bupivacaine in Comparison with Traditional (Bupivacaine/Ropivacaine) Periarticular Injections in Total Hip Arthroplasty: A Systematic Review","authors":"Rahul Muchintala, Nathaniel Kern, Gaston Davis, Patrick Ioffreda, Santiago Rengifo, Mohammad Khak","doi":"10.58616/001c.90487","DOIUrl":"https://doi.org/10.58616/001c.90487","url":null,"abstract":"This systematic review aims to comprehensively evaluate the current literature to determine whether local infiltration liposomal bupivacaine (LB) used in total hip arthroplasty (THA) results in reduced pain scores and opioid consumption compared to traditional local anesthetics. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Ovid Medline, PubMed, Scopus, and ScienceDirect databases. Articles were screened independently by two investigators based on inclusion criteria of 1) prospective randomized control trials or retrospective cohort studies, 2) conducted after the 2015 Food and Drug Administration (FDA) expansion of LB indication to local surgical infiltration, 3) compared LB as a periarticular injection to other local anesthetics used as a periarticular injection, and 4) available in English. Primary outcomes of pain scores and opioid consumption were reported. Secondary outcomes of interest included mobility, length of stay, costs, incidence of adverse events, and readmission rates. Bupivacaine costs $3 per dose, while LB costs $334 per dose. A total of seven articles were identified with the inclusion criteria. Four studies concluded that LB improves patient outcomes of pain scores and opioid consumption in patients receiving THA. Three studies found no benefit to using LB compared to their controls. Four studies found no significant reduction in the length of stay between the groups. There were no reported differences in the incidence of adverse events or total costs between the two groups. There are minimal benefits of reduced pain scores or opioid consumption when using LB opioid-sparing protocols compared to current protocols for patients undergoing THA. III","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Payton M. Boere, Levi J. Buchan, Kerri-Anne Ciesielka, Jacob E. Tulipan, Michael Rivlin, Asif M. Ilyas
Surgical simulation is a growing form of education in medical training, but it remains unclear how simulation compares to traditional lecture or apprenticeship models of teaching when translating procedural knowledge to surgical performance. This study aimed to assess the effectiveness of translating procedural knowledge to surgical skill when trained by the surgical simulation app “Touch Surgery (TS),” recorded video lecture, or in-person teaching of the trigger finger release (TFR) surgery. The study also aimed to identify the learners’ preferred teaching modality. Twenty-seven first- and second-year medical students were recruited to participate. They were randomly assigned to one of three cohorts (n=9) as designated by a different TFR surgery learning modality: surgical simulation through TS (cohort “SS”), video demonstration (cohort “VIDEO”), or live teaching by a board-certified orthopaedic hand surgeon (cohort “LIVE”). Each participant completed their modality three times. They then completed an assessment of the procedural steps before performing the TFR surgery on a cadaver. Outcome measures included procedural test scores and cadaveric performance, evaluated using a surgery-specific detailed checklist, a global rating scale (GRS) of soft surgical skills, and a pass/fail assessment. Participants graded their modality’s usefulness using a 5-point Likert scale. There was no statistically significant difference in TFR procedural assessment scores (P=0.123) or cadaveric surgical performance between groups when evaluated by the surgery-specific step checklist (P=0.549), GRS (P=0.567), and pass/fail assessment (P=0.874). Students in the LIVE cohort rated their modality as their first-choice training tool (P=0.009); however, those in the SS cohort rated their modality as easiest to use, follow, and understand (P=0.010). All educational modalities should be considered in surgical training. This study demonstrates that students can perform cognitively and technically similar learning from virtual or live formats; however, they preferred live teaching. III
{"title":"Assessment of Surgical Training Modality Efficacy in Medical Students – A Comparison of Surgical Simulation, Video Demonstration, and Live Instruction","authors":"Payton M. Boere, Levi J. Buchan, Kerri-Anne Ciesielka, Jacob E. Tulipan, Michael Rivlin, Asif M. Ilyas","doi":"10.58616/001c.88828","DOIUrl":"https://doi.org/10.58616/001c.88828","url":null,"abstract":"Surgical simulation is a growing form of education in medical training, but it remains unclear how simulation compares to traditional lecture or apprenticeship models of teaching when translating procedural knowledge to surgical performance. This study aimed to assess the effectiveness of translating procedural knowledge to surgical skill when trained by the surgical simulation app “Touch Surgery (TS),” recorded video lecture, or in-person teaching of the trigger finger release (TFR) surgery. The study also aimed to identify the learners’ preferred teaching modality. Twenty-seven first- and second-year medical students were recruited to participate. They were randomly assigned to one of three cohorts (n=9) as designated by a different TFR surgery learning modality: surgical simulation through TS (cohort “SS”), video demonstration (cohort “VIDEO”), or live teaching by a board-certified orthopaedic hand surgeon (cohort “LIVE”). Each participant completed their modality three times. They then completed an assessment of the procedural steps before performing the TFR surgery on a cadaver. Outcome measures included procedural test scores and cadaveric performance, evaluated using a surgery-specific detailed checklist, a global rating scale (GRS) of soft surgical skills, and a pass/fail assessment. Participants graded their modality’s usefulness using a 5-point Likert scale. There was no statistically significant difference in TFR procedural assessment scores (P=0.123) or cadaveric surgical performance between groups when evaluated by the surgery-specific step checklist (P=0.549), GRS (P=0.567), and pass/fail assessment (P=0.874). Students in the LIVE cohort rated their modality as their first-choice training tool (P=0.009); however, those in the SS cohort rated their modality as easiest to use, follow, and understand (P=0.010). All educational modalities should be considered in surgical training. This study demonstrates that students can perform cognitively and technically similar learning from virtual or live formats; however, they preferred live teaching. III","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 74","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140211129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the last several decades, total wrist arthroplasty design and outcomes have significantly improved. The development of modern wrist arthroplasty began in the 1960s with a silicone spacer implant, which has progressively evolved to the metal-on polyethylene modular implants utilized today. Modern implants have been shown to have high patient satisfaction and increased 5-10 year survivorship; however, the overall utilization of total wrist arthroplasty has decreased in the United States since 2001. This could be due to several reasons, including improved modern therapies for rheumatoid arthritis preventing end-stage wrist disease, reliable outcomes with arthrodesis, and the high complication and revision rates of early total wrist implants. This review will discuss the design evolution of total wrist implants, which can be divided into four distinct generations. This review also presents the most recent outcome, complication, and survivorship results for the modern 4th generation of total wrist implants.
{"title":"The Evolution & Outcomes of Total Wrist Arthroplasty: Current Concepts","authors":"Clay B. Townsend, Joseph Paladino, Asif M. Ilyas","doi":"10.58616/001c.74943","DOIUrl":"https://doi.org/10.58616/001c.74943","url":null,"abstract":"Over the last several decades, total wrist arthroplasty design and outcomes have significantly improved. The development of modern wrist arthroplasty began in the 1960s with a silicone spacer implant, which has progressively evolved to the metal-on polyethylene modular implants utilized today. Modern implants have been shown to have high patient satisfaction and increased 5-10 year survivorship; however, the overall utilization of total wrist arthroplasty has decreased in the United States since 2001. This could be due to several reasons, including improved modern therapies for rheumatoid arthritis preventing end-stage wrist disease, reliable outcomes with arthrodesis, and the high complication and revision rates of early total wrist implants. This review will discuss the design evolution of total wrist implants, which can be divided into four distinct generations. This review also presents the most recent outcome, complication, and survivorship results for the modern 4th generation of total wrist implants.","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 52","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hallux valgus is one of the most common foot pathologies. More than a hundred procedures have been described in treating hallux valgus deformity. Minimally invasive (MIS) hallux valgus surgery has a growing interest among foot and ankle surgeons due to its potential advantages over open surgeries, including smaller incisions, less postoperative pain, and improved cosmetics. Although MIS bunion surgery has been described in the past, early techniques were complicated by inadequate or poor fixation and complications related to the devices used for osteotomy. Recent technological advances and improved surgical techniques have led to a reemergence of MIS hallux valgus correction. 3rd generation MIS techniques have demonstrated promising results in short and midterm follow-up clinical studies. In this technique report, we aimed to describe preoperative evaluation, surgical technique, and postoperative management of MIS hallux valgus surgery.
足外翻是最常见的足部病症之一。在治疗足外翻畸形方面，已有上百种手术方法。与开放式手术相比，微创（MIS）拇外翻手术具有切口小、术后疼痛轻、美观等潜在优势，因此越来越受到足踝外科医生的关注。虽然 MIS 拇趾外翻手术在过去已有描述，但早期的技术因固定不足或不佳以及与截骨装置有关的并发症而变得复杂。近年来，技术的进步和手术技巧的改进使得 MIS 拇趾外翻矫正术再次兴起。第三代 MIS 技术在短期和中期的临床随访研究中显示出了良好的效果。在这份技术报告中，我们旨在描述 MIS 外翻矫正手术的术前评估、手术技巧和术后管理。
{"title":"Minimally Invasive Bunion Surgery for Hallux Valgus: A surgical Technique","authors":"Erdi Özdemir, Michael Aynardi","doi":"10.58616/001c.82177","DOIUrl":"https://doi.org/10.58616/001c.82177","url":null,"abstract":"Hallux valgus is one of the most common foot pathologies. More than a hundred procedures have been described in treating hallux valgus deformity. Minimally invasive (MIS) hallux valgus surgery has a growing interest among foot and ankle surgeons due to its potential advantages over open surgeries, including smaller incisions, less postoperative pain, and improved cosmetics. Although MIS bunion surgery has been described in the past, early techniques were complicated by inadequate or poor fixation and complications related to the devices used for osteotomy. Recent technological advances and improved surgical techniques have led to a reemergence of MIS hallux valgus correction. 3rd generation MIS techniques have demonstrated promising results in short and midterm follow-up clinical studies. In this technique report, we aimed to describe preoperative evaluation, surgical technique, and postoperative management of MIS hallux valgus surgery.","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 72","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140211048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kassem Ghayyad, Peyman Mirghaderi, Meysam Akbarzadeh, Maryam Salami, M. Ebrahimzadeh, Amir Kachooei
This retrospective comparative study compared the short to mid-term outcomes of arthroscopic Bankart repair and open Latarjet procedures in patients with recurrent anterior shoulder instability. Patients who underwent either arthroscopic Bankart repair or open Latarjet procedures between 2008 and 2020, with at least one year of follow-up, were included. Arthroscopic Bankart repairs were performed on shoulders with minimal glenoid bone loss (<15%), and the Latarjet procedure was performed if the preoperative computed tomography (CT) scan showed a 15% bone loss on the glenoid side or 30-40% humeral head bone loss. Their surgery results and patient-reported outcome measures (PROMs) were assessed using the Oxford Shoulder Score (OSS) and Shoulder Pain and Disability Index (SPADI). 133 patients were analyzed in Latarjet (n = 67) and Bankart groups (n = 66). Before surgery, the two groups of patients were similar regarding surgery side, hand dominance, education level, occupation difficulty level, and smoking (P>0.05). However, Latarjet’s patients were younger (32 vs. 35, P=0.04), had a higher proportion of males (96% vs. 82%, P=0.01), and had a significantly shorter follow-up period (3.2 vs. 6.4 years, P<0.001) than the Bankart group. There was no significant difference between the Latarjet and Bankart groups regarding the follow-up’s OSS score (37 vs. 36; P=0.94) and SPADI score (22 vs. 24, P=0.80). Dislocation was observed in only one patient (1.5%) in the Latarjet group (P=1.0). Subluxation was observed in 5 patients (7.5%) of the Latarjet group and three patients (4.5%) of the Bankart group (P=0.4). The overall instability rate was similar (P>0.05). Our findings suggest that both arthroscopic Bankart repair and open Latarjet are reliable techniques in short to mid-term follow-up based on the glenoid bone loss cut-off of 15%. Therapeutic Level III
{"title":"Arthroscopic Bankart versus Open Latarjet; Short-to-Mid-Term Outcomes of Recurrence and Patient-Reported Outcomes in Patients with Recurrent Anterior Shoulder Dislocation","authors":"Kassem Ghayyad, Peyman Mirghaderi, Meysam Akbarzadeh, Maryam Salami, M. Ebrahimzadeh, Amir Kachooei","doi":"10.58616/001c.90553","DOIUrl":"https://doi.org/10.58616/001c.90553","url":null,"abstract":"This retrospective comparative study compared the short to mid-term outcomes of arthroscopic Bankart repair and open Latarjet procedures in patients with recurrent anterior shoulder instability. Patients who underwent either arthroscopic Bankart repair or open Latarjet procedures between 2008 and 2020, with at least one year of follow-up, were included. Arthroscopic Bankart repairs were performed on shoulders with minimal glenoid bone loss (<15%), and the Latarjet procedure was performed if the preoperative computed tomography (CT) scan showed a 15% bone loss on the glenoid side or 30-40% humeral head bone loss. Their surgery results and patient-reported outcome measures (PROMs) were assessed using the Oxford Shoulder Score (OSS) and Shoulder Pain and Disability Index (SPADI). 133 patients were analyzed in Latarjet (n = 67) and Bankart groups (n = 66). Before surgery, the two groups of patients were similar regarding surgery side, hand dominance, education level, occupation difficulty level, and smoking (P>0.05). However, Latarjet’s patients were younger (32 vs. 35, P=0.04), had a higher proportion of males (96% vs. 82%, P=0.01), and had a significantly shorter follow-up period (3.2 vs. 6.4 years, P<0.001) than the Bankart group. There was no significant difference between the Latarjet and Bankart groups regarding the follow-up’s OSS score (37 vs. 36; P=0.94) and SPADI score (22 vs. 24, P=0.80). Dislocation was observed in only one patient (1.5%) in the Latarjet group (P=1.0). Subluxation was observed in 5 patients (7.5%) of the Latarjet group and three patients (4.5%) of the Bankart group (P=0.4). The overall instability rate was similar (P>0.05). Our findings suggest that both arthroscopic Bankart repair and open Latarjet are reliable techniques in short to mid-term follow-up based on the glenoid bone loss cut-off of 15%. Therapeutic Level III","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 58","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Closed rupture of the biceps brachii muscle belly should be considered in patients who experience arm pain and weakness after a forceful extension of the elbow against a fixed point of compression in the mid-arm. A delayed or missed diagnosis may portend inferior outcomes. Magnetic resonance imaging (MRI) can confirm the diagnosis but may not fully define the lesion. Therefore, the treating physician should be fully prepared to encounter a greater magnitude of muscular injury than that defined by the MRI. In young, active patients, early surgical repair can be considered to optimize the strength and cosmetic appearance of the limb. The repair technique should consist of a self-grasping suture technique, which may need to be augmented by fascial flaps or allograft tissue.
{"title":"Closed Midsubstance Rupture of the Biceps Brachii and Brachialis: A Case Report","authors":"Lilah Fones, Daniel Nemrov, Rick Tosti","doi":"10.58616/001c.92563","DOIUrl":"https://doi.org/10.58616/001c.92563","url":null,"abstract":"Closed rupture of the biceps brachii muscle belly should be considered in patients who experience arm pain and weakness after a forceful extension of the elbow against a fixed point of compression in the mid-arm. A delayed or missed diagnosis may portend inferior outcomes. Magnetic resonance imaging (MRI) can confirm the diagnosis but may not fully define the lesion. Therefore, the treating physician should be fully prepared to encounter a greater magnitude of muscular injury than that defined by the MRI. In young, active patients, early surgical repair can be considered to optimize the strength and cosmetic appearance of the limb. The repair technique should consist of a self-grasping suture technique, which may need to be augmented by fascial flaps or allograft tissue.","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nerve wraps have been used to potentially decrease perineural scarring and to create a local environment conducive to nerve healing, but no consensus exists on the indications for their use. The primary purpose of this study is to assess the operative indications for using the porcine extracellular matrix (PEM) nerve wrap in the upper extremities at a single center. A retrospective review of all patients that underwent PEM nerve wrapping over eight years by hand and upper extremity surgeons at a single orthopaedic practice yielded 104 procedures in 102 patients for analysis. The most common indication for surgery was for nerve wrapping of acute traumatic nerve injuries in 57 patients (55%), most frequently involving lacerations of the hand and forearm. Neurolysis and nerve wrapping for cases of chronic nerve compression with perineural scarring and fibrosis was the second most common indication, involving 41 patients (39%), most frequently for revision carpal and cubital tunnel release surgery. Six patients (5.8%) underwent mass removal or contracture release involving neurolysis with nerve wrapping. Three patients (2.9%) required reoperation, two in the acute group and one in the chronic group. However, there were no cases of nerve wrap rejection or extrusion. PEM nerve wrapping was used for various nerve injuries, from acute lacerations to recalcitrant chronic compression and mass excision. Further studies are necessary to determine whether patient outcomes are improved with the PEM nerve wrap. Level 4
{"title":"Use of Nerve Wraps in the Upper Extremity","authors":"Lilah Fones, Maura DePascal, Asif M. Ilyas","doi":"10.58616/001c.90454","DOIUrl":"https://doi.org/10.58616/001c.90454","url":null,"abstract":"Nerve wraps have been used to potentially decrease perineural scarring and to create a local environment conducive to nerve healing, but no consensus exists on the indications for their use. The primary purpose of this study is to assess the operative indications for using the porcine extracellular matrix (PEM) nerve wrap in the upper extremities at a single center. A retrospective review of all patients that underwent PEM nerve wrapping over eight years by hand and upper extremity surgeons at a single orthopaedic practice yielded 104 procedures in 102 patients for analysis. The most common indication for surgery was for nerve wrapping of acute traumatic nerve injuries in 57 patients (55%), most frequently involving lacerations of the hand and forearm. Neurolysis and nerve wrapping for cases of chronic nerve compression with perineural scarring and fibrosis was the second most common indication, involving 41 patients (39%), most frequently for revision carpal and cubital tunnel release surgery. Six patients (5.8%) underwent mass removal or contracture release involving neurolysis with nerve wrapping. Three patients (2.9%) required reoperation, two in the acute group and one in the chronic group. However, there were no cases of nerve wrap rejection or extrusion. PEM nerve wrapping was used for various nerve injuries, from acute lacerations to recalcitrant chronic compression and mass excision. Further studies are necessary to determine whether patient outcomes are improved with the PEM nerve wrap. Level 4","PeriodicalId":512202,"journal":{"name":"SurgiColl","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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