IntroductionCalcific myonecrosis is a rare condition in which muscle in a limb compartment undergoes necrosis and becomes peripherally calcified with central liquefaction. The patient usually presents with a slowly progressive enlarged mass that sometimes can be misdiagnosed as soft tissue sarcoma. Most of the reported cases showed that the disease occurs often after trauma or compartment syndrome. However, the case of calcific myonecrosis following snake bite is rarely reported.Case presentationA 66-year-old Thai woman presented with a gradually progressive enlarged mass over a period of 10 years in her left leg. She had a history of untreated compartment syndrome after she was bitten by a snake (Malayan pit viper) in her left leg when she was 14-years old. At presentation, a plain X-ray showed a large soft tissue mass at the anterior compartment of her left leg. A sheet-like mass with an enlarged central cavity combined with peripheral calcification and cortical erosion of her tibia were observed. A biopsy was performed and the result was negative for neoplastic cells. During a 5-year follow-up, the mass progressively enlarged and then became infected and finally broke through the skin. She was treated by excision of the mass and administration of antibiotics. The wound completed healed at 1 month postsurgery. There was no wound complication or disease recurrence at 1 year postoperation.ConclusionsThe diagnosis of calcific myonecrosis was done by history taking and radiographic interpretation. In an asymptomatic patient the management should be observation and clinical follow-up. A biopsy should be avoided due to the high rate of postoperative infection. Treatment of choice in a symptomatic condition is mass excision.
Background: Mini-open carpal tunnel release has become increasingly popular for the treatment of carpal tunnel surgery. The main advantages are shortening recovery time and return-to-work time. However, the risk of neurovascular injury still remains worrisome.
Identification of the radial nerve is important during the posterior approach to a humerus fracture. During this procedure, the patient can be placed in the prone or lateral decubitus position depending on the surgeon’s preference. The distance from the radial nerve to the osseous structures will be different in each position. The purpose of this study was to identify the safety zones of the various patient and elbow flexion positions. The distances from the olecranon to the center of the radial groove and intermuscular septum and lateral epicondyle to the lateral intermuscular septum were measured using a digital Vernier caliper. The measurements were performed with the cadavers in the lateral decubitus and prone positions with different elbow flexions. The distance from where the radial nerve crossed the posterior aspect of the humerus measured from the upper part of the olecranon to the center of the radial nerve in both positions with different elbow flexion angles varied from a mean maximum distance of 130.00 mm with the elbow in full extension in the prone position to the shortest distance of 121.01 mm with elbow flexion of 120 degree in the lateral decubitus position. The mean distance of the radial nerve from the upper olecranon to the lateral intermuscular septum varied from 107.13 mm to 102.22 mm. The distance from the lateral epicondyle to the lateral edge of the radial nerve varied from 119.92 mm to 125.38 mm. There was very little change in the measurements and no important different distances of radial nerve location until the elbow was flexed to 120 degrees, which was not significant as this flexion is rarely used.
There are various skin suture techniques for wound closure following carpal tunnel release, and well-performed suturing will result in low post-operative scar tenderness. The aim of this study was to compare the Donati suture technique and running subcuticular technique in terms of surgical scar, post-operative pain and functional outcome in open carpal tunnel release.
One-hundred forty-two patients were randomized using a computer-generated random number table into two groups receiving either running subcuticular suturing or Donati suturing after surgical intervention. We evaluated postoperative scarring using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Boston Carpal Tunnel Questionnaire after surgical decompression for carpal tunnel syndrome at 2, 6, and 12 weeks. Continuous data are reported as mean ± SD while normally distributed or as median (interquartile range) when the distribution was skewed.
Lower scores at 2 weeks were given by the patients receiving the running subcuticular suture technique than the Donati suture technique (15.3 ± 4.8 vs 17 ± 4.6, respectively, P < 0.05) while the observer scores were not significantly different (15.6 ± 5.8 vs 16.7 ± 5.2, respectively, P = 0.15). At both 6 and 12 weeks post-surgical decompression both patient and observer scores were not significantly different. There were no differences between the groups in terms of VNRS pain scores and functional Boston Carpal Tunnel Scores at all time points.
This randomized controlled trial found that although scarring assessments were slightly better in the earliest period following wound closure after surgical decompression in carpal tunnel syndrome using the running subcuticular suture, the final results at 3 months postoperative were not significantly different.
The study was registered at https://www.thaiclinicaltrials.org/ (TCTR20191204002).
Objective: The Chinese finger trap is a device used to aid in reduction of fractures, especially in distal end of radius fractures. The stainless steel finger trap is widely used but often causes fingers pain. We adapted a bamboo finger trap to reduce pain and also provide a lower cost alternative.Material and Methods: This was a cross-over study in healthy volunteers comparing bamboo and stainless-steel finger traps. Each participant underwent two tests, one with the stainless steel finger trap and another with the bamboo finger trap. For each trial, the participant lay supine on a bed, and the finger trap was attached to the index and middle fingers of the participant, with the arm suspended by a metal loop at the top of the trap to the elbow level of the patient on the bed. Weights were incrementally added to a weight bag suspended by a strap over the patient’s upper arm at one pound per minute until a maximum weight of 20 lbs. and the participant was asked to rate the degree of discomfort with the increasing weights using a visual analogue score (VAS)Results: Thirty volunteers were tested, all of whom were tested with both the bamboo and stainless steel traction devices. One patient developed a superficial skin injury while the stainless steel device was being applied. Overall, the bamboo finger trap group had lower VAS scores than the stainless steel group in the first fifteen minutes (p-value< 0.001).Conclusion: The bamboo finger trap is an effective alternative to the stainless steel finger trap, causing less pain.
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