Nerve Transfer With Entubulated Nerve Allograft Transfers to Treat Recalcitrant Lower Extremity Neuromas

Neuroma formation in the lower extremity can be debilitating to patients, especially when the neuromas are recurrent. The results of an advanced nerve reconstruction technique consisting of nerve transfer combined with nerve allograft and entubulation was evaluated in 4 patients with severe, debilitating, lower extremity neuromas. At a mean follow-up period of 26 months, the mean visual analog scale had improved from 9.5 preoperatively to 1.25 postoperatively (p < .05). These data suggest that techniques using a nerve allograft with a nerve conduit could be of great assistance in successfully managing debilitating neuromas of the lower extremity. Thus, further in-depth evaluation of these techniques is warranted.     

Tube enterostomy after small bowel resection

Ostomy formation can be technically difficult when mesenteric shortening and thickening are present. In addition, the high output that follows a small bowel ostomy can be debilitating in the elderly patient or the patient with underlying medical illness. We describe a technique to avoid these difficulties.     

Intrathecal local anesthetic infusion as a treatment for complex regional pain syndrome in a child

Diagnosis and treatment of complex regional pain syndrome in children is one of the most challenging clinical pain problems encountered in the chronic pain setting. Despite the intense and debilitating nature of the pain, referral to appropriate specialists often comes too late, thereby prolonging an already arduous (and controversial) course of treatment and risking long-term disability. On the contrary, full recovery can be expected with early diagnosis and prompt treatment. The following case study describes a novel and successful use of intrathecal catheter administration of ropivacaine in a child with early, rapidly progressing, and debilitating complex regional pain syndrome.     

Cicatricial pemphigoid: a diagnostic problem for the urologist

We describe a case of cicatricial pemphigoid, which is a chronic bullous disorder that predominantly involves mucous membranes. It can sometimes present to the urologist, with erosions, blisters or ulcers on the male or female genitalia, and can pose a diagnostic problem. The response to medical therapy can be rewarding. However, this can be a chronic debilitating and mutilating disease, and the differential diagnosis should be considered in such cases.     

Obstetric post-dural puncture headache

Post-dural puncture headache (PDPH) is a recognized complication of inadvertent dural puncture (DP) during epidural insertion or the intentional dural puncture following spinal anaesthesia. The resulting headache can be debilitating.     

Fractures of the proximal phalanx of the hallux: the use of plates with displaced multifragment fractures.

Fractures of the proximal phalanx of the hallux are a common injury. Due to the important biomechanical function of the first ray, these injuries must be treated properly. Incorrectly treated, a fracture of the hallux can be debilitating. These injuries will be discussed, and several illustrative cases will be presented with the use of plate fixation.     

Surgical management of complex spinal deformity

Surgical treatment of complex cervical spinal deformities can be challenging operations. Patients often present with debilitating conditions ranging from generalized decreased quality of life to quadriplegia. Surgical treatment can be divided into anterior, posterior, or combined procedures. A thorough understanding of anatomy, pathology, and treatment options is necessary. This article focuses on the surgical treatment of complex spinal deformity.     

Chronic medial elbow instability

Chronic medial elbow instability can be a debilitating problem for the throwing athlete. It affects non-throwers much less commonly regarding activities of daily living. Instability can occur as a result of repetitive microtrauma over a long period of time or as a result of a single traumatic event. If left untreated, the resulting sequelae can lead to chronic pain, ulnar neuritis, and inability to compete/work.     

Early and late complications of orbital fractures

Complications, unfortunately, arise as a result of traumatic or iatrogenic injuries. The sequelae can range from the most insignificant to the most debilitating. The most common complications noted in the diagnosis and treatment of orbital fractures are outlined as well as discussed as appropriate to their appearance during the healing process. With better understanding and better management, complications can be prevented.     

Neglected ruptures of the Achilles tendon

Neglected Achilles tendon ruptures, although uncommon, are debilitating injuries. The optimal management is surgical. Many different techniques can be used to repair or reconstruct the rupture, including tendo-Achilles advancement or flap reconstruction; local tendon transfer; and autologous, autograft, or synthetic implantation. Comparison of different techniques is difficult.     

Deep brain stimulation as an effective treatment option for post-midbrain infarction-related tremor as it presents with Benedikt syndrome

Benedikt syndrome is a rare but debilitating constellation of symptoms that manifests from infarction of the red nucleus, cerebral peduncle, oculomotor fascicles, and lower oculomotor nucleus. Clinically, it presents as ipsilateral cranial nerve III palsy, contralateral hemiataxia with intention tremor, contralateral hemiparesis, and hyperactive tendon reflexes. Commonly, the tremor upon purposeful movement proves to be the most debilitating manifestation of the infarction with significant impact on the patient's ability to perform activities of daily living and, therefore, quality of life. The authors report the successful management of this debilitating post-midbrain infarction tremor with the insertion of a deep brain stimulator with targets in the contralateral lenticular fasciculus.     

Traitement de la rectite radique par plasma argon

Chronic radiation proctitis can manifest as debilitating and repeated rectal bleeding with anemia. Argon plasma coagulation (APC) is now recommended as a first-line treatment because the procedure is often successful, easy, and safe. Precautions must be taken before treatment (colonic preparation, anticoagulant therapy management) and during the procedure (no contact between applicator and tissue, adapted gas flow rate and power settings). Many sessions can be required to obtain efficacy.     

Nonsurgical management of infection-related renal calculi

Struvite calculi can be a debilitating affliction for which the cure is mainly surgical. If left untreated, infection-related calculi can cause failure to thrive, anemia, chronic renal insufficiency, renal failure and death. There has been much research aimed at non-surgical intervention and prevention of these calculi especially in this "non-invasive" era. The historic and current non-surgical treatment modalities of struvite calculi are discussed.     

Anatomy, function, and pathophysiology of the posterior tibial tendon.

The posterior tibial tendon is vital for the structure and function of the foot and ankle. Dysfunction of the tendon can be debilitating and devastating. In recent years, much attention had been directed toward the diagnosis and treatment of PTTD. To properly diagnose and devise an appropriate treatment regimen, the anatomy, function, and pathophysiology associated with PTTD need to be thoroughly understood.     

Bipartite patella fracture

Bipartite patella fracture is an uncommon injury that has rarely been described in the literature. It can be quite debilitating in the competitive athlete and is often overlooked by the treating physician. A bone scan can be helpful in confirming the diagnosis, and appropriate treatment often results in a successful outcome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp 215–217     

Vertebral fracture management

Osteoporosis-related acute vertebral fragility fracture is a debilitating condition that can cause significant morbidity in elderly patients. Appropriate treatment requires a multimodal approach by spine care providers. Initial management should be directed at achieving adequate pain control to facilitate early mobilization. In patients refractory to nonoperative treatment, vertebral augmentation may be utilized. Back extensor exercises, postural training, and active orthoses can help not only with symptom control but also reduce the progression of kyphosis. Appropriate treatment of osteoporosis should be initiated as soon as possible to minimize the risk of future fracture.     

Fractures of the forefoot

Fractures of the forefoot are common injuries of various causes. Although not crippling, forefoot fractures can be debilitating if they go undiagnosed or are mistreated. Whenever patients complain of foot pain with ambulation or difficulty ambulating, radiographs should be taken as part of a standard routine to assess for bony pathology. This article discusses the classification and treatment of metatarsal fractures, digital and sesamoid fractures, and open fractures about the forefoot.     

Minimally invasive subcutaneous fasciotomy for chronic exertional compartment syndrome of the lower extremity

Chronic exertional compartment syndrome of the lower extremity can be debilitating in the active population. Open fasciotomy typically provides a cure or significant improvement in up to 90% of patients, provided that the compartments are adequately released. Cosmetic deformity from the surgery may be a major concern, especially in the young female athlete. A technique for minimally invasive subcutaneous fasciotomy is described that allows adequate compartment release and a favorable cosmetic result.     

Multicentric extra-abdominal desmoid tumours.

Despite their classification as benign, desmoid tumours are difficult to diagnose and manage. They are prone to recurrence and resection can be debilitating. Rarely, synchronous or metachronous multicentric desmoid tumours occur and may require further excision. Therefore, early detection of recurrence and multicentric tumours is vital. We present a case of metachronous desmoid tumours, and review the literature to propose a treatment pathway.     

Tophaceous gout in a patient with rheumatoid arthritis

Chronic gout and rheumatoid arthritis are common medical manifestations with debilitating effects on patients. However, these conditions are not typically identified concomitantly and can be hard to distinguish from one another. We report a rare case of a 50-year-old white woman with a history of chronic gout and rheumatoid arthritis who presented with intradermal tophaceous gout. Physical examination and laboratory results are described.