A Posterior Interosseous Nerve Syndrome Associated With Spontaneous Rupture of the Extensor Pollicis Longus Tendon

Posterior interosseous nerve entrapment syndrome and spontaneous rupture of the extensor pollicis longus tendon are rare conditions. The authors describe the bizarre combination of a spontaneous rupture of the extensor pollicis longus tendon in a 82-year-old lady with a posterior interosseous nerve syndrome. As far as the authors know, this is the first description of such an association in the literature. Surgical exploration revealed compression of the posterior interosseous nerve at the proximal portion of the supinator muscle and at Henry's leash. The nerve was freed, and the tendon of the extensor index proprius was transferred to the extensor pollicis longus. Six months after the procedure, the patient had resumed her daily activities, showing a good functional result.

Tinea Capitis no Adulto. Um Diagnóstico a Considerar?

A tinea capitis, uma infecção por fungos dermatófitos do couro cabeludo, é uma patologia rara no adulto, mesmo em áreas geográficas onde a doença é prevalente. Nestes casos está muitas vezes, mas não exclusivamente, associada a imunodepressão e habitualmente surge por exposição ao agente infeccioso em contactantes próximos. São fundamentais uma história clínica e um exame objectivo minuciosos que permitam equacionar a tinha do couro cabeludo como hipótese diagnóstica e proceder à colheita de amostras para exame micológico. Esta metodologia pode evitar a realização de exames complementares exaustivos ou a prescrição de tratamentos inadequados. Os autores descrevem três casos de tinea capitis em mulheres adultas – dois casos de infecção por Microsporum audouinii e um caso por Trichophyton soudanense. É apresentado o registo iconográfico dos casos e é efectuada breve revisão da literatura.

Salvage Flexor Hallucis Longus Transfer for a Failed Achilles Repair: Endoscopic Technique

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.

Avaliação do Tratamento Cirúrgico da Artrose Trapeziometacárpica

The authors describe their experience, from July 1995 to December 1996, in the management of patients suffering from trapeziometacarpal degenerative arthrosis. Dell's classification is used for disease staging. The results of two different techniques are compared: 1) distal tenotomy of supranumerary insertions of abductor pollicis longus; and 2) trapeziectomy with tendon interposition arthroplasty and ligamentoplasty using the flexor carpi radialis.

Morphometric Analysis of the Extensor Tendons of the Hallux and Potential Implications for Tendon Grafting

Although several tendon sources are available for reconstructive surgical procedures, all have one or more shortcomings. The aim of this work was to evaluate if the extensor tendons of the hallux showed anatomical characteristics that could make them an additional source for tendon grafting procedures.The authors performed a detailed morphometric analysis of the extensor tendons of the hallux in 26 lower limbs in order to evaluate the putative association of anatomical variants with hallux valgus, and to attempt to assess the feasibility of using part of the extensor apparatus of the hallux as a source of tendon for grafting procedures.An accessory extensor hallucis longus ten-don was found in 92.3% of cases. The extensor hallucis brevis tendon length was 10.5 ± 0.6 cm; its width was 0.5 ± 0.1 cm, and its thickness varied between 1-2 mm, making it a potentially good candidate as a source of ten-don grafts. Several anatomical variations were observed, namely the fusion of the tendons of the extensor hallucis brevis and the accessory extensor hallucis longus muscles in the distal part of the foot.This new therapeutic option, if implemented, would possibly increase the supply of autogenous donor tissue for reconstructive procedures, thereby enhancing the reconstructive surgeon’s armamentarium.

A Rare Variant of the Ulnar Artery with Important Clinical Implications: a Case Report

BACKGROUND: Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. CASE PRESENTATION: During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. CONCLUSION: As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

Dois Casos de Quérion por Trichophyton Mentagrophytes

Introdução: O Quérion é uma forma rara e infl amatória de tinea capitis causada por fungos dermatófi tos. O diagnóstico é difi cultado pela demora no exame cultural e possibilidade de várias etiologias no diagnóstico diferencial. O tratamento é prolongado e implica o recurso a antifúngicos sistémicos. Novos fármacos têm sido considerados após a descontinuação da griseofulvina em Portugal. Casos clínicos: Apresentamos duas crianças com lesões dolorosas do couro cabeludo com reação infl amatória exuberante, exsudativa e alopécia local acompanhadas de febre. O exame bacteriológico foi negativo e o micológico revelou Trichophyton mentagrophytes. Foram medicados com fl ucloxacilina endovenosa, antifúngicos orais (griseofulvina e itraconazol), corticoide e antifúngico tópicos. A resposta foi favorável com evolução lenta para a cura com área de alopécia residual. Conclusão: Estes casos destacam -se pela sua raridade e ilustram a exuberância das manifestações clínicas desta entidade. O diagnóstico precoce, a identificação e tratamento da fonte de contágio e as medidas de higiene e vigilância sanitária são primordiais para o controlo da infecção.