Surgeon perception is not reliable at preventing and detecting screw stripping at clinical torque levels in synthetic cancellous bone. Less aggressive insertion or standardized methods of insertion may improve the stability of nonlocking screw and plate constructs.

Neurofibromatosis type 1 is a congenital condition affecting neurons and connective tissue integrity including vasculature. On extremely rare occasions these patients present with venous aneurysms affecting the internal jugular vein. If they become large enough there presents a risk of rupture, thrombosis, embolization or compression of adjacent structures. In these circumstances, or when the patient becomes symptomatic, surgical exploration is warranted. We present a case of one of the largest aneurysms in the literature and one of only five associated with Neurofibromatosis type 1. A 63-year-old female who initially presented for a Hinchey III diverticulitis requiring laparotomy developed an incidentally discovered left neck swelling prior to discharge. After nonspecific clinical exam findings, imaging identified a thrombosed internal jugular vein aneurysm. Due to the risks associated with the particularly large size of our patient’s aneurysm, our patient underwent surgical exploration with ligation and excision. Although several techniques have been reported, for similar presentations, we recommend this technique.

Upper extremity arterial disease is relatively uncommon compared with lower extremity disease, but presents a unique diagnostic challenge for physicians and technologists. It affects approximately 5–10% of the population. The most common causes of upper extremity arterial disease are atherosclerosis and embolic disease. Some common symptoms of upper arterial disease include dysesthesia, paresthesia, pallor, cold intolerance, ulceration, pain, or weakness in one or both extremities. The vascular system plays a vital role in the delivering of nutrients and clearing metabolic waste products from the peripheral tissues and also helps maintain an individual's systemic core temperature. In a majority of patients, the deep and superficial palmar arches provide the dominant blood supply to the hand. The arches are a continuation of the radial and ulnar arteries. These arches are typically connected in approximately 80% of patients. In order to accurately diagnose upper extremity arterial disease, a noninvasive upper extremity physiologic examination is of importance to determine treatment options for patients. The physiologic examination includes upper extremity segmental pressures known as wrist-brachial index, Doppler waveforms; digital evaluations include photoplethysmography and pressures of the digits known as the digital-brachial index. Physiologic tests are indirect examinations. The upper extremity arterial physiologic examination is always completed bilaterally in order to determine if the disease is present in one or both extremities and also assists in the diagnosis of disease severity. The vascular physiologic examination should focus on the symptoms presented by the patient during the history. However, a complete vascular examination is appropriate given the diffuse nature of the atherosclerotic disease process.