OKOJ

OKOJ, Volume 5, No. 5


Cubital Tunnel Syndrome and Treatment With In Situ Release and Medial Epicondylectomy

Cubital tunnel syndrome (CTS) is a common compressive neuropathy. Compression of the ulnar nerve at the elbow causes pain and other symptoms in the patient's hand and forearm. It is second in incidence only to carpal tunnel syndrome or compression of the median nerve at the wrist. Cubital tunnel syndrome usually develops insidiously. Historically, the condition was first treated nonsurgically. If medical management was unsuccessful, the patient underwent surgical release of the ulnar nerve at the elbow. This procedure produced varying results with regard to resolution of symptoms, and its complications included ulnar nerve paralysis, which seldom resolved. Anterior subcutaneous transposition was used to treat posttraumatic ulnar nerve compression with only nominal success. There are several newer surgical techniques that appear to provide favorable outcomes for patients with cubital tunnel syndrome when nonsurgical management fails to provide relief. Nonetheless, no single treatment appears to be superior. This topic reviews the anatomy, pathophysiology, clinical presentation, and diagnosis of cubital tunnel syndrome, and provides a focused discussion of the rationale and technique of the authors' preferred surgical treatment, in situ ulnar nerve release with medial epicondylectomy, reflecting the authors' belief that unlike carpal tunnel syndrome, cubital tunnel syndrome is primarily a strain problem on the ulnar nerve, not merely a compression problem. Video of in situ release and medial epicondylectomy is provided.

    • Keywords:
    • McGowan classification of cubital tunnel syndrome

    • in situ decompression

    • tardy ulnar palsy

    • posttraumatic ulnar neuritis

    • Subspecialty:
    • Hand and Wrist

Giant Cell Tumor of Bone

Giant cell tumor (GCT) of bone is a relatively rare tumor characterized by the presence of multinucleated giant cells. Although usually regarded as benign, GCT of bone is locally aggressive and prone to local recurrence if inadequately treated. Metastasis to the lung and malignant transformation can also occur. GCT of bone has a distinctive histologic and radiographic appearance, and its diagnosis is usually not difficult; however, because histologic interpretation is not always reliable, diagnosis should be the end result of the integration of clinical, radiographic, and histologic information. Recommended treatment options for GCT of bone include thorough curettage and high-speed burring of the lesion followed by an adjuvant therapy, such as phenol, liquid nitrogen, or argon-beam coagulation. The recurrence rate of GCT of bone ranges from 3% to 25%, depending on which treatment option is employed; therefore, long-term follow-up of patients is necessary.

    • Keywords:
    • multicentric GCT

    • multifocal GCT

    • osteoclastoma

    • multinucleated giant cells

    • osteoclast-like giant cells

    • cryosurgery

    • cryotherapy

    • argon-beam coagulation

    • thermal coagulation

    • serial embolization

    • Subspecialty:
    • Musculoskeletal Oncology

Pediatric Forearm Fractures

Fractures of the radius and/or ulna are the most common long bone injuries in children. These injuries can result from simple trips and falls on an outstretched arm, but they occur most frequently as a result of higher-energy mechanisms. Fractures are classified by location, completeness, angular and rotational deformity, and fragment displacement. Most pediatric forearm fractures can and should be treated nonsurgically, with closed reduction, immobilization, and close follow-up. Surgical intervention is required for open fractures, and when acceptable reduction and alignment cannot be maintained or achieved with conservative management. Fixation may be performed percutaneously using Kirschner wires or flexible intramedullary nails, or through an open approach using plates and screws.

    • Keywords:
    • both-bone forearm fracture

    • middle third forearm fracture

    • proximal third forearm fracture

    • distal third forearm fracture

    • greenstick fracture

    • metaphyseal forearm fracture

    • diaphyseal forearm fracture

    • torus fracture

    • buckle fracture

    • broken arm

    • broken forearm

    • Galeazzi fracture

    • Monteggia fracture

    • physeal fracture

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Reconstruction for Complications of Calcaneal Fractures

Calcaneal fractures constitute approximately 60% of all major tarsal injuries. Complications of calcaneal fractures can occur in either the acute or late stages of treatment. Acute complications include swelling, fracture blisters, and compartment syndrome. Late complications include posttraumatic arthrosis, malunion with loss of calcaneal height and length, widening of the calcaneus with calcaneofibular abutment, heel pad trauma, and sural neuritis. Nonsurgical management of calcaneal malunions includes the use of nonsteroidal anti-inflammatory drugs, intra-articular steroid injections, and/or prescription footwear. Surgery is indicated for patients with persistent pain and disability after conservative treatments have been exhausted. Various surgical procedures are described in this article, including medial/lateral calcaneal displacement osteotomy for varus or valgus malalignment greater than 10°, lateral wall exostectomy for peroneal tendon impingement and calcaneofibular abutment, and distraction bone block subtalar arthrodesis for significant anterior impingement secondary to loss of talar declination.

    • Keywords:
    • calcaneus fracture

    • intra-articular calcaneus fracture

    • extra-articular calcaneus fracture

    • joint-depression calcaneus fracture

    • tongue-type calcaneus fracture

    • heel fracture

    • broken heel

    • broken foot

    • distraction bone block subtalar arthrodesis

    • lateral wall decompression

    • calcaneal displacement osteotomy

    • Subspecialty:
    • Trauma

    • Foot and Ankle

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