While proximal hamstring tears at the myotendinous junction are common sports-related injuries that are often successfully treated nonoperatively, complete avulsions from the origin on the ischial tuberosity are less common and better treated with surgical repair to prevent significant functional limitations and ongoing weakness. The diagnosis can be easily missed, leading patients to present several months after the initial injury. In addition, some patients decide on nonoperative management initially but later present requesting surgical intervention. The delayed cases are challenging due to often significant tendon retraction, making direct repair difficult if not impossible. Techniques using allograft and autograft reconstruction have been described for this clinical situation. This Technical Note describes the use of 2 Achilles tendon allografts fixed via 5 suture anchors to reconstruct a chronic complete avulsion injury of the proximal hamstring with >5-cm retraction.A cute strains of the hamstring muscle group are
BACKGROUND Os odontoideum is typically treated with instrumented fusion through a posterior cervical approach. When this approach fails, limited options for revision are available. Occipitocervical fusion and transoral anterior fusions have been utilized in the past but are associated with high morbidity and complications. OBSERVATIONS Here the authors report a case of os odontoideum that was treated with an anterior cervical extraoral approach after failed posterior instrumented fusion. They discuss the challenges that can be encountered with the failure of fusion and the limited options when it comes to approach and fixation of os odontoideum. LESSONS To the authors’ knowledge and based on a review of the literature, this case represents the first use of an anterior extraoral prevascular approach to the high cervical spine to address os odontoideum. They demonstrate that this approach can be utilized as a reasonable alternative to transoral surgery and should be considered in cases where additional or alternative fixation is desired without the morbidity and complications associated with occipitocervical fusion or a transoral approach, especially in a younger patient population.
Background: Use of radial and ulnar access has increased due to its perceived benefits over femoral access. Ulnar artery catheterization can place patients at risk of significant complications, including pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve injury, and critical hand ischemia. The purpose of this study was to describe complications specific to ulnar artery catheterization. Methods: After obtaining institutional review board approval, a retrospective review was performed on all patients who underwent ulnar artery catheterization at our institution between 2019 and 2021. Complications were assessed, and complication rates were compared with previously published studies on ulnar artery catheterization for coronary angiography (percutaneous coronary intervention). Results: A total of 41 patients were available for review with a mean age of 59 years. Of these, 17 patients (41%) sustained complications in the immediate postprocedural period. These complications included hematoma (12 patients, 29%), pseudoaneurysm (1 patient, 2%), ulnar artery thrombosis (1 patient, 2%), ulnar neuropathy (3 patients, 7%), arterial damage requiring repair (2 patients, 5%), transient ischemia (3 patients, 7%), and compartment syndrome (2 patients, 5%). Three of these patients (7%) required operative intervention, and several were admitted to the hospital for an additional period of observation. Conclusions: This series highlights the significant risks associated with ulnar artery catheterization for percutaneous procedures. Complications include pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve damage, and critical hand ischemia. Several of these patients required urgent or emergent surgical intervention, with some patients experiencing ongoing ulnar nerve symptoms.
INTRODUCTION: The purpose of this study was to evaluate the accuracy of pelvic exam when compared to ultrasound measurements and pathology weight depending on BMI. To our knowledge, there are limited studies evaluating the effect of BMI on accuracy of bimanual examination and a more recent investigation is long overdue. METHODS: This was a retrospective chart review of patients over the age of 18 undergoing hysterectomy for benign indications between July 2010 and July 2015. Bimanual examination and ultrasound measurements of the uterus prior to surgery were compared to pathology weight and then their accuracy was compared based on BMI. Concordance correlation coefficients were used to estimate accuracy of these measurements. Bland-Altman plots were used to compare the weights from clinical exam and ultrasound to the actual pathology weight. RESULTS: 981 records were reviewed, of those 364 met inclusion criteria. Average weight of the uterus was 454.04 gm (+/-475.27). Average age and BMI of women undergoing hysterectomy was 45.5 years (+/-7.5) and 31.65 (+/- 7.09) respectively. Overall concordance between the three different methods of estimating uterine size ranged from 0.73 to 0.82. Concordance did not differ significantly between different BMI categories. CONCLUSION: The findings of pelvic exam are similar to ultrasound measurements when compared to pathology weight regardless of BMI whenever the uterine size can be estimated. These results suggest that if uterine size can be assessed, ultrasound may not be necessary for preoperative evaluation.
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