Long-term results of replantation of the proximal forearm following avulsion amputation

This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of successful replantation of an avulsed proximal forearm and its acceptance on the part of patients. After a minimum follow-up of 3 years (average, 4.7 years), muscular and sensory recovery was evaluated with the Medical Research Council scale, and global function according to the demerit score system of Chen (China Med 5:392-397, 1967). Subjective evaluation and patient satisfaction were investigated by means of a questionnaire. One patient was classified as grade 2, 4 patients as grade 3, and 5 patients as grade 4 according to Chen (China Med 5:392-397, 1967). However, in spite of the poor objective results, patient satisfaction was obtained in 90% of cases, and the replanted extremity was considered of help for common activities of daily living. In conclusion, replantation of an avulsed proximal forearm should be considered only in patients who are strongly motivated to maintain body integrity, and who are aware of the expected functional limitations.     

Rehabilitation of a patient following hand replantation after near-complete distal forearm amputation

Study designCase report.IntroductionReports of comprehensive rehabilitation following hand replantation are limited.Purpose of the studyTo describe hand therapy of a patient following hand replantation.MethodsRight hand dominant 55 year-old male assessed 9 days following left hand replantation to treat distal forearm amputation. Patient presented with dorsal blocking orthotic. Initial status: AROM digits and thumb 0–20° extension, 0–40° flexion; absent light touch sensation; 0–1/5 hand strength. Patient underwent 70 hand therapy sessions over 13 months focusing on A/PROM, therapeutic exercise, neuromuscular re-education, and modalities to address functional limitations.ResultsHand therapy discharge status: AROM digits and thumb form composite fist, thumb opposition to digit 3, light touch sensation (monofilament) 4.03 (digits 2, 4) and 4.17 (digits 1, 3, 5); 3− to 4−/5 hand strength.DiscussionHand therapy allowed for near complete functional return of the hand following replantation.ConclusionComprehensive Hand therapy aided restoration of adequate sensation and strength for functional use of the replanted hand.Level of evidence4     

Spondylitis following vertebroplasty. Case report and review of the literature

We report the observation of a 76-year-old female who was treated with percutaneous vertebroplasty for an L3 osteoporotic compression fracture. Fifteen days after this procedure, a cauda equina syndrome occurred. The neuroimaging studies showed worsening of the compression fracture and the appearance of a posterior wall displacement. Blood test results showed a moderate inflammatory syndrome resembling lymphangitides complicating a venous arm perfusion. Therapeutic options consisted of a combined surgical approach associating an anterior approach with implantation of a corporeal prosthesis and a posterior osteosynthesis. At the postoperative period, the patient presented hyperthermia peaks and Staphylococcus aureus grew on three consecutive hemocultures. MRI evaluation demonstrated septic pseudarthrosis, the corporeal prosthesis was removed in a second combined approach, and it was replaced with an iliac crest graft, with posterior debridement. A three-month course of antibiotics was given. The follow-up was good with overall recovery of the deficit and disappearance of the fever. This case report emphasizes the importance of suspecting postprocedure spondylitis when in the follow-up neuroimaging of a vertebroplasty, an increasing compression fracture is noted even though the clinical picture of sepsis is not apparent.     

Successful repair of post-infarction heart rupture. Case report and review of the literature

Left ventricular rupture secondary to acute myocardial infarction (AMI) if untreated, is invariably fatal. Successful surgical correction reported in the reviewed literature amounts to twenty cases. This is the case presentation of a 53 year old Caucasian woman admitted urgently to our Institution 6 hours after acute chest pain with a presumptive diagnosis of intrapericardial aortic rupture secondary to acute ascending aortic dissection. A cross-sectional echocardiogram demonstrated a posterior left ventricular rupture secondary to myocardial infarction. Emergency repair was carried out with the aid of cardiopulmonary bypass (CPB) and the patient was discharged after an uneventful recovery. However, five months later she was reoperated on for resection of a large pseudoaneurysm presumably secondary to incomplete resection of nonviable myocardium at the first operation. The patient made an uneventful recovery and remains asymptomatic and well. On the basis of this experience and review of the literature the authors propose a more aggressive approach in an attempt to improve the salvage rate of this not so rare complication of AMI.     

Peroneal neuropathy following successful bariatric surgery. Case report and review of the literature

Peroneal neuropathy has been observed in starvation, anorexia, and other situations of extreme weight loss. The authors report a case in which sequential bilateral peroneal neuropathies developed after successful bariatric surgery resulting in a weight loss of 114 lbs over 12 months. The diagnosis was confirmed using nerve conduction studies and electromyography. Clinical improvement occurred with decompressive surgery at the level of the knee.     

SCIWORA-syndrome. Case report and review of the literature

The SCIWORA-syndrome was firstly described by Pang and Wilberger in 1982 [11]. It is characterized by a neurological injury without radiological appearance. Since the standardized use of MRI in spinal cord diagnosis, the number of the "real" SCIWORA-syndromes decreases.By the case report of a 14 years old boy falling down from a wall of 2 meters height with a complete paraplegia from Th12 without radiographic abnormality (even in MRI) we will give a short review of the literature.     

Successful replantation of nose by microsurgical technique, and review of literature

We present a case of total amputation of a major portion of the nose of a 10-year-old boy, which was successfully replanted by microsurgical technique. A 489-year review of the literature revealed the rarity of successful nasal replacement following amputation.     

Haemolytic uraemic syndrome following bone marrow transplantation. Case report and review of the literature

Thrombotic microangiopathy (TMA) can be a late complicationof bone marrow transplantation (BMT). A patient is describedin whom the haemolytic uraemic syndrome developed 10 monthsafter BMT and who died of E. coli sepsis while on maintenancehaemodialysis. The literature is reviewed, regarding clinicalpresentation, incidence, pathogenesis and therapy. TMA can beobserved, after an interval of 3–12 months, in about 6–26%of patients following BMT. Reported cases vary considerablyin clinical severity, from mild presentations to severe TMAwith high mortality rates despite intensive therapy. Importantpathogenetic roles are ascribed to the conditioning total bodyirradiation and the use of cyclosporin A, but other factorsmay be involved as well. Next to supportive therapy, plasmaexchange and the use of ACE inhibitors may be of value in treatingBMT-associated TMA.     

Iatrogenic vascular injuries following lumbar disc surgery. Case report and review of the literature

Iatrogenic vascular injuries are unusual complications of lumbar disc surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma whether artery or vein are injured or both. Diagnosis is suspected when early signs of retroperitoneal hemorrhage appear, but may often be delayed for weeks or years because formation of a pseudoaneurysm or an arteriovenous fistula which may be of gradual onset and produce only a few symptoms at the onset. Prompt diagnosis and aggressive treatment can hope to improve current mortality of more than 50%. A case of venous and arterial injury is reported, successfully operated on with an original technique of ilio-caval patching to avoid caval ligation. A review of the literature shows the predisposing factors and complex anatomy of such injuries, the clinical picture and the management of the emergency.     

Thoracic splenosis. Case report and literature review

Thoracic splenosis is the autotransplantation of splenic tissue into the thoracic cavity after thoracoabdominal trauma. We report a case of thoracic splenosis in a 35-year-old woman who had had a thoracoabdominal gunshot wound 12 years earlier. A review of the literature revealed 15 cases already reported. All patients had an asymptomatic thoracic lesion discovered on a plain chest film 9 to 32 years (mean 16) after the initial accident. In 13 cases an operation was necessary to establish the diagnosis. In two cases technetium 99m and indium 111 scans established the diagnosis.     

Dialysis-associated spondyloarthropathy. Case report and literature review

Hemodialysis has considerably prolonged the life of patients suffering from terminal renal failure. However, long-term hemodialysis leads to new bone complications and spinal disorders such as destructive spondyloarthropathy (DSA). At the present time DSA is reported in 8% to 18% of the dialysed patients. Diagnosis is based on severe narrowing of the intervertebral disk, erosions and geodes of the adjacent vertebral plates simulating infectious spondylitis. Lesions progressively involve posterior joints and may lead to severe destruction of the spine. The pathogenesis of this syndrome is still unknown. Several factors have been implicated, including microcrystal deposition, amyloidosis, inflammatory and foreign body reactions and suggest that the pathogenesis of erosive spondyloarthropathies of hemodialysed patients is multifactorial. Spinal instability inducing myelopathy and radiculopathy were observed in 8% of the cases. Treatment must be accorded to the natural disease course and to the quality of the bone. We report the case of a chronic dialysed patient with destructive spondyloarthropathy involving the cervical and thoracic spine. Pathogenesis, radiological datas and therapeutic approach are discussed.