Sonography and MR imaging can allow effective diagnosis and delineation of a bifid median nerve in the wrist. This diagnosis is important to make before carpal tunnel release or other wrist surgeries are performed to avoid nerve injury. Furthermore, the sonographic size criteria for diagnosing carpal tunnel syndrome in nonbifid median nerves may not be accurate in evaluating bifid median nerves.

This article presents a new technique for diagnosing carpal tunnel syndrome using ultrasound. The ultrasound characteristics of the normal and abnormal median nerve are discussed in relation to carpal tunnel syndrome. The development of ultrasound as a new diagnostic modality for carpal tunnel syndrome is presented in a three-part study correlating the ultrasound measurements of the median nerve and electromyogram of the median nerve. A new algorithm for evaluating patients with carpal tunnel syndrome is presented.

PURPOSE: The purpose of this study was to evaluate the effect of a low-profile alternating pressure (AP) overlay system on hospital-acquired pressure injuries (HAPIs). DESIGN: Prospective case series with historical controls. SUBJECTS AND SETTING: The study setting was the operating room and critical care unit of an urban quaternary care hospital in the Midwestern United States. One hundred neurosurgery patients undergoing surgery for 2 hours or longer in supine position were included in the study (AP group). The outcomes for the AP group were compared to a historical control group of 292 patients. METHODS: A group of 100 patients were prospectively placed on the AP overlay during surgery. Participants were enrolled preoperatively and tracked by the research team during their hospital stay. Demographic data, details of the operation, and pressure injury risk factors were recorded. Following surgery, AP group patients were evaluated daily and continued on standard protocol for pressure injury prevention. The primary study outcome was HAPI rate during the perioperative period (up to 5 days postsurgery) for the AP group (plus standard of care) compared to the standard of care alone (historical control). Control group data were extracted from electronic health records for the prior 2 years. A written questionnaire was given to the care team that used the AP technology; items queried the degree of acceptance of the overlay by surgeons and the operating room and intensive care unit (ICU) staff. RESULTS: None of the patients in the AP group developed perioperative pressure injuries. Review of historical control group revealed a 6% perioperative pressure injury incidence (18 pressure injuries in a group of 292 patients). Responses on the written questionnaire indicated that the AP technology was well accepted by surgeons and the operating room and ICU staff. There were no adverse events. CONCLUSIONS: Study findings suggest that AP overlay system can safely and reliably be used during neurological surgeries. Findings further suggest that using the AP product may improve outcomes with respect to perioperative HAPIs, including patients deemed at high risk for pressure injury development. Further studies are underway to evaluate the use of this AP overlay system beyond the operating room for more comprehensive care.

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Autogenous bone grafting is the gold standard for reconstructing craniofacial defects. Mandibular defects are reliably reconstructed with free nonvascularized bone, such as from the posterior iliac crest (PIC). In light of improved imaging, including 3-dimensional computed tomography scanning, a more accurate defect estimation is possible. A strong understanding of bone graft available is necessary. The purpose of this study was an updated review of the dissection and quantification of the amount of bone that can be safely harvested. Bilateral bicortical osteotomy was performed on 55 cadavers to obtain 110 PIC bone grafts. Demographic factors and bicortical osteotomy measurements were recorded. Average osteotomy lengths, widths, and depths were 7.4, 5.5, and 1 cm, respectively. The average bicortical osteotomy volume was 40.6 cm. During the dissection, the authors identified 2 anatomical variants with respect to muscle insertion into the PIC. In variation 1, which occurred in 62% of dissections, the latissimus dorsi and thoracolumbar fascia did not originate from the PIC. When this occurred, the quadratus lumborum attached to the PIC. In variation 2, which occurred in 38% of dissections, the latissimus dorsi and thoracolumbar fascia originate from the PIC. By identifying the maximal bone volume obtainable from a PIC graft and noting 2 anatomical variants, this study allows for more accurate surgical planning and management.