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Background: An under-recognized complication of gelatin-based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in the literature of intraoperative anaphylaxis secondary to locally applied haemostatic agents. Methods: An electronic search was performed on databases Medline, Embase, Pubmed and ProQuest. A total of 7671 articles were reviewed from title and abstract. After exclusion criteria and duplicates removed, 19 articles with 21 cases were included for analysis. Data extracted from each of the articles included patient demographics, haemostatic agent used, surgery type, known allergies and any objective evidence of hypersensitivity post anaphylactic episode, that is tryptase levels, IgE levels, skin prick testing. Results: Fifty-seven percent of cases involved patients <18 years of age; 57% of cases involved spinal surgery; 100% of cases displayed objective evidence of hypersensitivity (tryptase levels, bovine or porcine IgE levels, or skin prick testing). Thirty-three percent of patients had exposure preoperatively to a known agent causing anaphylaxis or allergy which would preclude the use of a gelatin-based haemostat. These products included vaccines, spam meats, red meat, Jell-O and CollaPlug. Gelatin-based haemostat agents included Floseal, Gelfoam, Surgiflo, fibrin glue, Avitene, haemofibrine sponge, topical bovine thrombin and thrombin-soaked gelatin. Conclusion: Increased awareness of allergy to gelatin-based haemostats for surgical and anaesthetic is imperative, with 33% of cases having a known contraindication to gelatinbased haemostat. This review highlights important aspects in the pre-operative patient history and post-event patient investigation that could assist anaesthetists and surgeons in the prevention of future events.

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Introduction: Ultrasound-guided percutaneous first annular pulley (A1) release is a non-surgical management for the treatment of trigger finger, also known as stenosing tenosynovitis. Trigger finger occurs secondary to inflammation and retinacular sheath hypertrophy with subsequent restriction of the flexor tendons. Trigger finger can have a marked functional impact, with current conservative measures including steroids and/or splinting, and surgical therapy involving open release. Methods: A population of 20 adult patients with ultrasound proven trigger finger underwent percutaneous release with refined technique. Patients with additional ultrasound proven tenosynovitis received steroid injection. Results: Of the 20 cases, 18 cases involved the fingers, 2 cases involved the thumb and 14 cases had additional tenosynovitis. All procedures involving the fingers were well tolerated with initial symptomatic and functional relief. At 1-week post-intervention, 2 finger cases without concurrent steroid injection represented with pain but not triggering. Cases which did not receive concurrent steroid injection described post-procedural pain requiring oral analgesia. One case involving the thumb was complicated by no relief with a mild radial digital nerve neuropraxia, with near complete resolution at 6 weeks. The second thumb case reported only partial relief of triggering. Conclusion: US-guided percutaneous release of the A1 pulley is an effective procedure in achieving at least short-term resolution of trigger finger. It is best reserved for fingers due to the challenging anatomy of the thumb.

The objective findings of phalangeal T2-weighted hyperintense and T1weighted hypointense bone marrow signal on MRI without features of seronegative arthropathy or osteomyelitis may assist clinicians in making a diagnosis in the appropriate clinical context.

Introduction Soft tissue foreign bodies are a common presentation to emergency departments and primary care. They have variable presentations and associated morbidity depending on their acuity, location, functional impairment and neurovascular involvement. Traditional removal has utilised blind technique or surgical exploration. Their removal can be difficult secondary to induration, inflammation, granulation and scar tissue. Ultrasonography has emerged as a minimally invasive and inexpensive method of examination and retrieval. This article entails ultrasound‐guided foreign body extraction with associated pearls of experience. Methods From March 2017 to August 2020, a fellowship trained interventional radiologist and a fellowship trained musculoskeletal radiologist performed 52 foreign body extractions under ultrasound guidance at a single institution. Results 52 foreign body extractions occurred over 3‐year time period with a 95% success rate. The most common location of foreign body was the finger (62%) and feet/toes (17%). Foreign bodies identified include wood (31%), plant‐based material (29%), metal (17%), glass (17%) and synthetic material (6%). Two unsuccessful cases were secondary to delayed presentation with significant foreign body reaction and the 2nd due to patient psychiatric issues. There were no identified complications. Conclusion Ultrasonography‐guided foreign body extraction is a minimally invasive, efficient and targeted technique for foreign body removal.

The expanding scope of interventional musculoskeletal procedures has resulted in increased pressure on general radiologists. The confidence of general radiologists in performing ultrasound-guided musculoskeletal procedures varies with their clinical exposure. This didactic review provides a methodologically and clinically oriented approach to enhancing user understanding and confidence in performing ultrasound-guided musculoskeletal procedures. The body of the text is accompanied by figures depicting the procedural approach, injection site, and labeled ultrasonography images. This paper aims to provide a teaching and bedside aid for education on and the execution of musculoskeletal procedures to ensure the provision of quality health care.