David M. Klein

Delayed onset of posterior interosseous nerve palsy after distal biceps tendon repair

R upture of the distal biceps brachii is a relatively uncommon injury. Despite its rarity, many treatment methods have been described. Most common is the anatomic restoration of the biceps tendon to the tuberosity. Early reports of iatrogenic radial nerve injury with this technique made surgeons rethink their surgical approach to this problem.4,6,9 In fact, some authors have advocated suturing the biceps brachii to the brachialis, thereby avoiding the risk of nerve injury.4, 9 In 1985, however, Morrey et aLlo found that when the biceps was attached to the brachialis, there was nearly normal strength in elbow flexion but approximately a 50% loss in the strength of forearm supination. This and other studies suggest that the biceps brachii tendon should be reattached anatomically.3, lo, l1 Consequently, since 1961 most surgeons have used the two-incision technique of Boyd-Anderson* in an attempt to achieve anatomic repair while avoiding iatrogenic radial nerve injury. Good results have been reported with this technique. It too, however, has its own complications.5 This case report illustrates yet another unreported complication.

Pasteurella multocida brain abscess following perforating cranial dog bite

1. Krieg EG: Heterotopic pancreatic tissue producing pyloric obstruction, Ann Surg 113:364, 1941. 2. Nelson RS, and Scott NM: Heterotopic pancreatic tissue in the stomach, Gastroenterology 34:452, 1958. ~3. Dolan RV, ReMine WH, and Dockerty MB: The fate of heterotopic pancreatic tissue, Arch Surg 109:762, 1974. 4. Eklof O, Lassrich A, Stanley P, and Chrispin AR: Ectopic pancreas, Pediatr Radiol 1:24, 1973. 5. Stone DD, Riddervold HO, and Keats TF: An unusual case of aberrant pancreas in the stomach, Am J Roentgenol Radium Ther Nucl Med 113:125, 197L 6. Martinez NS, Morloch CG, Dockerty MB, Waugh JM, and Weber HM: Heterotopic pancreatic tissue involving the stomach, Ann Surg 147:1, 1958. 7. Lukash WM, Johnson RB, and Bishop RP: Aberrant pancreas in the stomach: radiographic and gastroscopic findings, Gastrointest Endosc 16:148, 1970. 8. Collett RW: Prepyloric polypus in stomach of child diagnosed histologically as aberrant pancreatic tissue, Am J Dis Child 72:545, 1946. 9. Palmer ED: Aberrant pancreatic tumours, Medicine 30:83, 1951. 10. French WE: Pancreatic tissue in antral wall, Am J Surg 114:959, 1967.

Technique for internal fixation of capitellum and lateral trochlea fractures.

Summary: Internal fixation for fractures of the humeral capitellum is a technically challenging procedure. Controversy exists regarding the optimal surgical approach and fixation technique. The benefit of stable fixation of the capitellum fragment is early mobilization. Our preferred technique involves anatomic reduction of the capitellar fragment and fixation with headless screws placed from anterior to posterior. When possible, the surgical exposure employed preserves the lateral ulnar collateral ligament (LUCL) and minimizes disruption of the soft tissues posterior to the capitellum.

Immobilization of the Mallet Finger Effects on the extensor tendon

Since the mallet finger that is treated with isolated splinting of the distal interphalangeal (DIP) joint can be moved freely proximal to the DIP joint, we sought to determine whether such motion might cause a tendon gap that could explain the extensor lag that often follows treatment. Experiments were performed on 32 cadaveric fingers with open mallet finger lesions, immobilizing either the DIP joint alone or both the DIP and PIP joints, while repeatedly flexing and extending the more proximal finger and wrist joints. For each experiment, the gap in the extensor tendon was measured. Joint motion proximal to the DIP joint and retraction of the intrinsics did not cause a tendon gap in a finger with a mallet lesion, supporting the convention that only the DIP joint needs to be immobilized.

Recurrent intravascular papillary endothelial hyperplasia

We report a case of recurrent intravascular papillary endothelial hyperplasia.

Calcification in brainstem gliomas

Calcification in brainstem gliomas is an unusual histologic and radiologic finding. To date, radiologic evidence of calcification in these tumors has not been reported. The two patients described here had evidence of calcification on either computerized tomography (CT) or plain skull films. Increasing availability of CT scans may provide a more accurate estimate of the incidence of calcification in these tumors.

Anatomy and histology of the A5 pulley

Since the anatomy and actual existence of the A5 pulley have been variably reported in the literature, we sought to better define its macroscopic and microscopic structure. Thirty-one A5 pulleys were dissected from 32 fingers. The average proximal to distal length was 3.8 mm; the average width was 8.9 mm. The distal edge of the pulley was proximal to the distal interphalangeal joint, 7.7 mm from the profundus tendon insertion. On histologic study by light microscopy, 3 distinct layers were noted; fibrofatty tissue was noted in the outermost layer, hyaluronic acid-secreting cells were noted in the innermost layer, and connective tissue containing collagen bundles, fibrocytes, and interspersed elastin fibers was noted in the middle layer. The A5 pulley is a discrete structure, with measurements as noted as well as a histologic composition consistent with that reported for the other annular pulleys.

Spontaneous healing of a massive tibial cortical defect

This case report describes the spontaneous healing of a 20-cm massive tibial cortical defect. The defect was created during debridement of necrotic bone and soft tissue in a low-velocity gunshot wound of the tibia that became infected in a skeletally mature patient. The patient was treated in an external fixator and had a soleus flap to provide soft-tissue coverage. He had refused any surgical reconstructive options. Despite the absence of surgical reconstruction, his tibia healed, and he returned to full activity without any orthotic device 9 months after the original injury.

Sarcoid flexor tenosynovitis of the wrist: A case report

A case is presented where flexor tenosynovitis of the volar wrist is the presenting symptom of sarcoidosis in a 69-year-old man.

Local-advancement soft-tissue coverage in a child with ipsilateral grade IIIB open tibial and ankle fractures.

This case describes the successful treatment of a child with a vascular injury and two ipsilateral grade IIIB open lower leg fractures using two local-advancement soft-tissue techniques. Multiple relaxing skin incisions were used for closure of the wound associated with the patients midshaft tibial fracture, whereas a randomly patterned rotational fasciocutaneous flap was used for coverage of the wound associated with the patients medial malleolar fracture. These straightforward local-advancement soft-tissue coverage techniques allowed for treatment of a child with vascular injuries, ensuring the viability of the foot, while preventing distant donor site morbidity and functional sacrifice. Additionally, no special microsurgical or specialty training is necessary to achieve a similar result.