Complete talar extrusion is rare and usually associated with a high-energy mechanism of injury causing complete dissociation of the talus from the surrounding bony and soft-tissue structures with enough force to expel the talus out of the body. Treatment can be complicated by infection, osteonecrosis, posttraumatic osteoarthritis, and leg length discrepancy, which may require multiple subsequent surgeries for improved outcome and quality of life. Reimplantation of the native talus affords maintenance of joint height and favorable outcomes have been reported. Failed reimplantations have been successfully managed with arthrodesis with or without a bone allograft. We report a case of talar extrusion initially treated with a talus-shaped impregnated antibiotic spacer, followed by femoral head allograft and tibiocalcaneal fusion. This treatment resulted in radiographic evidence of bony fusion at 12 weeks without subsequent infection and good clinical outcome at 2-year follow-up.
Introduction/Purpose Surgical decompression of the ulnar nerve in the treatment of cubital tunnel syndrome is performed in close proximity to the first motor branch of the ulnar nerve to flexor carpi ulnaris (FCU). Understanding the variability of this branch is important for improving surgical interventions. The purpose of this study was to determine the location and anatomical variation of the first motor branch to flexor carpi ulnaris. Methods Embalmed cadavers were dissected to expose the ulnar nerve as it courses past the medial epicondyle of the humerus. Digital calipers were used to measure the distance between the point of origin of the first motor branch of the ulnar nerve to FCU and the most prominent aspect of the medial epicondyle. The length of the ulna was also measured and correlated with data from ulnar nerve measurements. Statistical significance was defined as a p‐value < 0.05. Outcomes Data was obtained from 113 cadaveric elbows. The location of the branch point was most consistently found (88.5% of specimens) distal to the medial epicondyle (average 19.42 mm, standard deviation 4.39, 95% confidence interval 18.54 – 20.29). In 11.5% of elbows, however, the branch point occurred proximal to the medial epicondyle (average 16.02 mm, standard deviation 4.53, 95% confidence interval 13.28 – 18.76 mm). The average distance was 18.42 mm distal to the medial epicondyle in females and 20.45 mm in males, with a statistically significant difference between genders (p‐value = 0.02). The correlation between the branch point of the first motor branch of the ulnar nerve to FCU and ulna body size was also explored. Conclusion This study has demonstrated that the first motor branch of the ulnar nerve is most consistently located 18.54 to 20.29 mm distal to the medial epicondyle. Males had a significantly greater distance from the origin of the first motor branch of the ulnar nerve to FCU from the medial epicondyle compared to females. No statistically significant correlation was found related to laterality. Additionally, the prevalence of the anatomical variant in which branching of the first motor nerve from the ulnar nerve occurs proximal to the medial epicondyle was estimated. Prior to this study, the prevalence of this variant had not been reported. Support or Funding Information The authors would like to thank Midwestern University for the use of the specimens in this study.
Cranial holders are used routinely in cranial and spinal surgery with rare reported complications, but frontalis palsy has not been reported as a complication of a Mayfield pin placement. Injury to the temporal nerve, a branch of the facial nerve that supplies the frontalis muscle, is possible because of its subcutaneous nature. A 78-year-old man presented after a fracture dislocation at C7-T1 following a ground level fall. He had progressive axial neck pain and clinical signs of C8 radiculopathy. The patient underwent elective C5-T2 fusion with an open reduction and internal fixation with the use of Mayfield skull immobilization. Postoperatively, he had right unilateral frontalis palsy. The patient was followed clinically for over 12 months and was treated conservatively without surgical intervention or nerve testing. He had spontaneous resolution of palsy with full recovery 2 months postoperatively. Proper placement of the Mayfield skull clamp is key to preventing complications. Knowledge of the landmarks for the temporal nerve assists in safe pin placement to avoid procedural morbidity. Frontalis palsy, if occurs, can be monitored for spontaneous resolution in the postoperative period.
Neglected rupture of the patellar tendon is rare, as this type of injury is typically disabling in the acute setting. We present a 31-year-old male patient who sustained a left patellar tendon rupture while playing basketball. The diagnosis of patellar tendon rupture was neglected by the patient and care was delayed by 8 months. The proximally retracted patella and distally detached patellar tendon were brought back to their anatomic positions and repaired surgically while avoiding the use of autograft or allograft tissue due to fat interposition maintaining the patellar tendon length. This case report contributes to the scarce literature on surgical management of neglected patellar tendon rupture and presents a unique radiologic appearance of a chronic patellar tendon rupture.
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