PURPOSE: Cubital tunnel syndrome is a well-described entity with many reported etiologies and anatomical compression sites. Accessory ossicles of either traumatic or congenital origin might occur around the elbow joint. Only one case reporting such ossicles compressing the ulnar nerve exists in previous literature. We aim to present this entity with a detailed description of the patient history and treatment. CASE REPORT: We report a case of 30-year-old female presenting with classical signs of cubital tunnel syndrome-positive Wartenberg's and Froment's signs, hypoesthesia in the fourth and fifth finger with decreased finger duction strength but without gross hypotrophy of interosseous and hypothenar muscles. Tinel's sign was positive over the ulnar sulcus and an accessory ossicle was found on the elbow radiograph within the ulnar sulcus. The first signs of calcification in this patient were reported 6 years prior in a follow-up after the dislocation of her elbow joint following a bike accident. The EMG confirmed ulnar nerve neuropathy in the elbow area. The ossicle was extirpated, the ulnar nerve was decompressed in the ulnar sulcus in a standard manner and the symptoms quickly resolved. The patient has been regularly visiting our outpatient clinic for the next 12 years without any complaints considering her elbow and the ulnar nerve. CONCLUSION: This is a rare case of cubital tunnel syndrome caused by an accessory ossicle of traumatic origin. Simple bone extirpation with ulnar nerve release followed by anterior subcutaneous transposition is the recommended method of treatment. No report of congenital accessory bones causing ulnar nerve compression in the elbow exists in the literature.
Background: Eagle’s syndrome (ES) is a term describing a group of symptoms associated with the elongation of the styloid process (SP) of the temporal bone or with ossification of the stylohyoid ligament. Clinically, it manifests through pain in the orofacial and pharyngeal regions, similar to that experienced by patients with temporomandibular joint disease. The presented paper aims to assess the evaluation of the success of surgical treatment and the complications associated with such treatment. Methods: Our retrospective study includes nine patients with ES treated in our Department Oral and Maxillofacial Surgery in years 2019–2023 (median age of 47 years) – all patients affected with this disease out of 2,716 patients examined at our department due to a temporomandibular joint disease. Eight of these patients underwent a surgical resection of the SP. The success and complications in these patients are evaluated in this study. Results: In seven patients, the problems disappeared or at least diminished, which is consistent with data from the literature. Postoperative complications such as deficit of the marginal branch of the facial nerve (n. VII), limited sticking the tongue out (n. XII), and velopharyngeal insufficiency (n. IX) occurred in three patients. Conclusion: The wide spectrum of clinical manifestations makes ES a condition that should be considered in the differential diagnosis of temporomandibular joint disorders, post-traumatic conditions, or complicated eruption of wisdom teeth or their extraction. ES can be treated conservatively or (mostly) surgically. Surgical treatment can be relatively successful and effective, but it is necessary to respect the anatomical placement of the SP, which can be associated with the development of complications, especially in cases with extremely long SP.
OBJECTIVES: To recommend appropriate immobilization after the initial reduction of acetabular displaced fractures in order to minimize the risk of heterotopic ossification formation. DESIGN: Retrospective study of patients treated in our surgical department during the years 2005-2018. MATERIALS AND METHODS: There were 94 patients included in statistical analysis. The factors of injury severity, course of surgery and hospitalization and incidence of complications were recorded. The functional and X-ray results were evaluated at least one year after surgery. RESULTS: The patients were divided into the two groups according to the type of fixation after closed reduction, the external fixation (EF) and the skeletal traction (ST) group. According to the type of fracture there were 33 patients with central displacement and 61 patients with posterior displacement. Ossification grade III. And IV. Occur in 20% of our sample. There was greater incidence of Brooker grade III. And IV. Ossification in the ST group, but statistically insignificant, p = 0.57. There was no statistically significant difference in the occurrence of ossifications regarding the severity of the head injury, p = 0.11, or to the severity of the injury p = 0.54. The combination of posterior displacement and ST results in higher risk for ossifications, specifically in our group at 11.48% compared to the combination of posterior displacement and EF where it is 8.2%. CONCLUSION: Skeletal traction for posterior displaced acetabular fracture appears to be a more risky procedure for the development of ossifications than external fixation.
- MeSH
- acetabulum zranění chirurgie MeSH
- externí fixátory * škodlivé účinky MeSH
- fixace fraktur škodlivé účinky MeSH
- heterotopická osifikace * epidemiologie etiologie prevence a kontrola MeSH
- lidé MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- ankylóza diagnóza etiologie komplikace MeSH
- chřipka lidská * komplikace MeSH
- heterotopická osifikace * diagnóza etiologie terapie MeSH
- kyčelní kloub diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- umělé dýchání škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY In certain patients after treated pelvic fractures, heterotopic ossifications can be observed in the area of the pubic bone, which protrude ventrally, and often also laterally and distally into surrounding soft tissues of the groin or even medially into the proximal thigh. These ossifications are shaped like sharp spikes of various lengths, which is why the authors refer to them as "spicules". In some patients, these ossifications are also associated with pain. The aim of this study was to provide an overview of the morphology of heterotopic ossifications of the anterior segment of the pelvis and to discuss the etiology of their origin, and further to determine the incidence, risk factors and clinical significance of these "spike-like" ossifications. MATERIAL AND METHODS X-ray images of patients treated for pelvic injuries between 2009 and 2018, in whom radiological documentation was available at least 12 months after the injury or surgery were evaluated. Patients with acetabular fractures or combined pelvic and acetabular injuries were not included in the study. Possible risk factors studied included gender, severity of injury, type of fracture according to the AO / ASIF classification, concomitant bladder injury, method of treatment and type of osteosynthesis of the anterior segment of the pelvis. The categorial data concerning risk factors for the observed "spicule" type ossifications was statistically evaluated using the chi-square test at the 5% level of significance. RESULTS The studied group consisted of 218 patients (121 women, 97 men) aged 13 to 92 years of age (mean age was 54 years, median age was 55 years). Heterotopic "spicule" type ossifications occurred in 21 patients (4 females, 17 males) aged 18 to 76 years (mean 39 years, median 41 years). Significant risk factors in the observed ossification group included male sex (p = 0.0004), severity of trauma (predominance of "spicules" was seen in multiple trauma patients, (p = 0.0024), unstable pelvic injury according to AO / ASIF classification (predominance of "spicules" in type B and C fractures over type A fractures, (p = 0.0013), concomitant bladder injury (p = 0.0009) and in patients undergoing surgical treatment of the fracture (p < 0.0001), where all the observed spicules were seen in patients undergoing anterior pelvic segment osteosynthesis. A statistically significant difference was also evident when comparing the osteosynthetic material used in the anterior segment (a increased incidence of ossifications was seen in patients undergoing plate fixation compared to patients in whom pubic screws were used, p = 0.0050). DISCUSSION Heterotopic ossifications are described as relatively common consequences of pelvic fractures, but are not considered a major problem because they usually do not produce any clinical correlations. The causes of post-traumatic and postoperative ossifications in the pelvic area include the effects of high energy traumas, extensive surgical procedures, prolonged artificial lung ventilation, and post-infectious states after complications of surgical treatment. CONCLUSIONS The study identified risk factors for heterotopic "spicule" type ossifications. The identified risk factors include male sex, severity of injury, unstable type of fracture, concomitant bladder injury, surgical treatment, and the use of massive implants. Only the effect of bladder injuries can be partially influenced by performing less invasive surgical techniques during combined pelvic and bladder injuries. Key words: pelvic fracture, pelvic injury, complications, heterotopic ossifications, multiple trauma, unstable pelvic trauma, urinary bladder injury.
- MeSH
- acetabulum MeSH
- fraktury kostí * komplikace chirurgie MeSH
- fraktury kyčle * MeSH
- heterotopická osifikace * diagnóza etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pánev MeSH
- pánevní kosti * MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Heterotopic ossification is a frequent and a well-known complication after elective primary total hip arthroplasty. Prophylaxis is crucial since once the ossification is mature, the only treatment option is its surgical removal during revision hip surgery. There are pre-, peri- and postoperative prophylactic modalities. Ranking among the perioperative possibilities is the application of tranexamic acid in blood control management. The aim of our study is to prove the positive side effect of tranexamic acid application on reducing the heterotopic ossification ratio. MATERIAL AND METHODS A cohort of 401 total hip replacements was assessed retrospectively in the period from 2012 to 2016. Particular degrees were stratified based on the Brooker classification, sex, laterality and type of implant fixation. The average follow-up period is 6.10 years (range 40 m to 113 m). The hips treated in 2012 are taken as reference and the hips treated in 2016 are exposed to tranexamic acid protocol. Other secondary prophylactic modalities (pharmacological prophylaxis or radiotherapy), tertiary modalities (revision surgery) and trauma patients were excluded from the study. The acquired data were then statistically assessed. RESULTS Tranexamic acid protocol significantly reduces the incidence of heterotopic ossification after elective primary total hip replacement. In our cohort of 401 hips, the overall incidence of HO is 40.6%. The difference between the control group - 49.7% and the exposed group - 30.2% is statistically significant. More importantly, the clinically relevant types (III and IV) were also significantly reduced (12.7% vs. 4.2%). Other associated parameters such as uncemented implant, female sex and right-sided surgery further reduced the incidence of ossifications. DISCUSSION Identification of the risk patient, risk factors and subsequent care to maintain the range of motion, analgesia or potential removal of ossifications remain to be the priority in managing heterotopic ossifications after THA. Preoperative options to reduce the incidence of this complication are limited. Moreover, both the pharmacological prophylaxis and radiotherapy are associated with major complications and strict patient compliance is fundamental. Inclusion of simple tranexamic acid protocol in surgery management significantly reduces the risk of heterotopic ossification. CONCLUSIONS Development and maturation of heterotopic ossification is still intensively explored, but the main biochemical pathways are still unclear. Therefore, there is no causal treatment option nowadays. Individualisation of prophylactic treatment modalities leads to reduction in ossification development. It has been proven that one of these effective modalities is the tranexamic acid application before and after the procedure. This reduction is statistically significant and clinically relevant. Key words: tranexamic acid, total hip replacement, heterotopic ossification, prophylaxis, fixation type.
- MeSH
- heterotopická osifikace * epidemiologie etiologie prevence a kontrola MeSH
- incidence MeSH
- kyselina tranexamová * terapeutické užití MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- pooperační komplikace prevence a kontrola MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This case presents the utility of ultrasound examination in diagnostics, providing accurate therapy and follow-up of entrapment syndrome of the ulnar nerve, caused by heterotopic ossification. The heterotopic ossifications were in this case presumably linked to a long-term working with a vibration sander.
- MeSH
- heterotopická osifikace komplikace MeSH
- lidé MeSH
- senioři MeSH
- syndrom kubitálního tunelu diagnostické zobrazování etiologie MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- dopisy MeSH
- kazuistiky MeSH
INTRODUCTION: Sagittal craniosynostosis associated with midline cephalhematoma is a rare finding. Despite the controversy regarding its etiopathogenesis, this condition represents a clear indication for surgery. CASE REPORT: We present a case of a 10-week-old boy with an ossified midline vertex cephalhematoma and sagittal craniosynostosis. The child underwent a cephalhematoma excision and minimally invasive non-endoscopic narrow vertex craniectomy, with calvarial vault remodeling followed by 2 weeks use of a cranial orthosis. On 5-month follow-up, mesocephaly was achieved. CONCLUSION: Our case is well documented with native CT, 3D CT, intraoperative pictures, and 3D head scan imaging. We described our minimally invasive non-endoscopic technique that led to a rapid cranial vault remodeling with reduction of cranial orthosis need. A review of literature focused on surgical techniques is included.
- MeSH
- epidurální hematom komplikace patologie chirurgie MeSH
- heterotopická osifikace patologie MeSH
- kojenec MeSH
- kraniosynostózy komplikace patologie chirurgie MeSH
- lidé MeSH
- porodní poranění novorozence patologie chirurgie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- heterotopická osifikace etiologie klasifikace prevence a kontrola terapie MeSH
- lidé MeSH
- muskuloskeletální nemoci * patofyziologie terapie MeSH
- nemoci svalů etiologie patofyziologie terapie MeSH
- osteoporóza diagnóza terapie MeSH
- poranění míchy * komplikace MeSH
- svalová atrofie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dítě MeSH
- fasciitida * diagnóza patologie MeSH
- heterotopická osifikace diagnóza chirurgie patologie MeSH
- hybridizace in situ fluorescenční metody MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- plazmocelulární granulom * diagnóza chirurgie patologie MeSH
- prsty ruky patologie MeSH
- výsledek terapie MeSH
- zápěstí patologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
