Aneurysmal bone cyst of the orbit: a case report and review of literature

Aneurysmal bone cyst is a benign fibroosseous lesion which rarely occurs in the orbit. We report on a 7-year-old girl with aneurysmal bone cyst of the orbit who presented with painless proptosis and diplopia. Optic nerve compression resulted in field loss and delayed visual evoked potentials. Radiological and histological features are discussed. The lesion was excised via a frontal craniotomy and the orbital roof reconstructed with a prefabricated titanium plate. Post-operatively a rapid resolution of the proptosis and diplopia followed. Previous reported cases of this rare entity in the orbit are also reviewed.

Universal Total Wrist Implant: experience with a carpal component fixed with three screws

The Universal Wrist Implant was used to treat 31 patients (37 wrists), who had symptoms indicating pancarpal arthritis of the wrist, diagnosed as total wrist arthroplasty. Their mean age was 58.1 years. Follow-up ranged from 48 to 120 months with a mean of 79.4 months (6.7 years). The carpal component of the Universal Total Wrist is fixed to the carpus by titanium screws. Unlike other total wrist prostheses, the primary fixation of the carpal component is in the capitate and not in the third metacarpal. Intercarpal fusion provides a solid bony support for the carpal plate and results in improved longevity. Articular surface of the radial component is inclined 20 degrees, similar to the articular surface of the radius. Components can be inserted with or without cement. In three patients, the prosthesis had to be removed due to infection and persistent dislocation. Of the remaining 34 wrists, 30 (88%) achieved excellent pain relief. Complications occurred in 12 cases (32%). Of these 12 complications 9 (75%) resolved with appropriate treatment. The most common complication with this nonconstrained prosthesis was dislocation. The Universal Total Wrist Implant provides a predictable option to preserve motion and relieve pain when managing wrist joint arthritis.

Epidemiology of aplastic anaemia in the state of Sabah, Malaysia

Aplastic anaemia is a rare disease which is more prevalent in the Far East. In Malaysia, it appears to be unusually common in the state of Sabah. A retrospective analysis of all cases of aplastic anaemia diagnosed between January 1993 and March 1996 was undertaken. The criteria of the International Aplastic Anaemia and Agranulocytosis Study (IAAAS) was used. In this 39 month period, 31 cases were confirmed by marrow trephine biopsy to be aplastic anaemia. The male-to-female ratio was 3.4. Median age of diagnosis was 23 years. There were 24 patients (77%) who were from the Kadazan-Dusun ethnic group, which forms 18% of the population of Sabah. The incidence of aplastic anaemia in Sabah appears to be higher than that reported elsewhere in the Far East, at 4.8 per million population per year. Peak incidence is in the elderly group at 8.6 per million followed by a second peak in young people aged 15 to 24 (7.9 per million). The aplastic anaemia to total acute leukaemia ratio is 0.37. The marked male preponderance and apparent susceptibility of the Kadazan-Dusun people are also notable. A further prospective study to address the true incidence of aplastic anaemia and possible aetiologic factors accounting for these observations is necessary.

Sacral chordoma--a case report

Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life.

Clinicopathologic studies of thymic carcinoids in multiple endocrine neoplasia type 1

Thymic carcinoid is part of the multiple endocrine neoplasia type 1 (MEN1) syndrome occurring predominantly in male patients who were heavy smokers, presenting most commonly in middle age. In contrast with metastatic midgut carcinoids, MEN1-related thymic carcinoid is not associated with carcinoid syndrome, nor is it associated with Cushing syndrome, in contrast with sporadic thymic carcinoids. Local invasion and metastasis are common. Prognosis is poor because of late detection, lack of effective treatment, and the aggressive nature of the tumor. All patients with thymic carcinoids should be investigated for MEN1, including thorough clinical evaluation and family studies. Anterior mediastinal lesions in MEN1 male patients should be considered thymic carcinoids until proven otherwise. All male MEN1 patients and asymptomatic gene carriers should be warned of the risk of thymic carcinoids and the possible link to smoking. Computed tomography (CT) of the chest is recommended on first screening for MEN1 in male patients more than 25 years of age, followed by yearly chest X-rays and chest CT every 3 years. Prophylactic thymectomy should be carried out during subtotal or total parathyroidectomy on MEN1 patients.

Arthroscopic management of trapeziometacarpal joint arthritis of the thumb

Open partial trapeziectomy and interpositional arthroplasty have proven to be effective in ameliorating the symptoms of carpometacarpal joint arthritis of the thumb. Surgical technique of arthroscopic partial resection of the trapezium and interpositional arthroplasty is described. Thirty-three interpositional arthroplasties were carried out arthroscopically. Autogenous tendon graft. Gortex (WL Gore & Associates, Inc. Flagstaff, AZ) and fascia lata allograft were used as interpositional material; 87.8% of patients got relief from pain. Average postoperative pinch strength was 11 lbs. No ligament reconstruction was required because the capsule was left intact. The procedures were done on an outpatient basis and all patients were discharged the same day. There were no complications associated with radial sensory nerve.

Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb

Partial excision including the articular surface of the trapezium and interpositional arthroplasty using one half of the flexor carpi radialis tendon was done in 36 hands. The joint capsule was reattached to the trapezium and the thumb immobilized for 4 weeks post-operatively. No ligament reconstruction was done. 30 hands (83.6%) had complete relief of pain. The average post-operative pinch strength was 11 lb. Three patients who complained of weakness of pinch had hyperextension of the MP joint. Correction of MP hyperextension is recommended to improve pinch strength. The outcome of this operation is comparable to any of the techniques described in the literature. The technique is simple and easy to perform. Since the capsule is closed the operation is truly an interpositional arthroplasty.

Endoscopic carpal tunnel release: preliminary report

The surgical technique of endoscopic carpal tunnel release using the Concept Carpal Tunnel Relief Kit (Linvatec, Largo, FL) is described. This is a single-portal technique and can be performed with any standard (4-mm) arthroscope available in the operating room. The results of the first 100 cases treated by the author are reported. Ninety-four percent of the patients achieved relief of symptoms. No permanent neurological or vascular injury occurred in this series. The grip strength returned to preoperative level in 3-4 weeks in the majority of patients. Subjective evaluation showed a greater degree of patient satisfaction when compared with results of the open technique.

Endoscopic carpal tunnel release--current status

Endoscopic carpal tunnel release is one of the most controversial topics in hand surgery today. Many surgeons have reservations in doing carpal tunnel release endoscopically because its merits and demerits have not been clearly defined. This article describes the various techniques now available to perform endoscopic carpal tunnel release. The anatomic basis for a single-portal technique using the Concept Carpal Tunnel Release Kit is described in detail. The results of 100 postoperative cases indicate that endoscopic carpal tunnel release was superior to the open technique in regard to postoperative morbidity and patient satisfaction in 92% of this patient group.

Endoscopic carpal tunnel release: a single-portal technique

A safe single-portal technique for performing endoscopic carpal tunnel release is described. The procedure can be done using equipment already available in any standard operating room. Evaluation of 100 cases done by the author using this method has shown encouraging results.

Correction of rotary malunion of the fingers by metacarpal rotational osteotomy

Metacarpal rotational osteotomy was performed in 12 patients to correct rotary malunion following fractures of the phalanges and metacarpals. All but one patient obtained excellent correction of their preoperative deformities. The procedure is simple and gives predictable results.

Polytypism in a decagonal quasicrystalline Al–Co phase

A decagonal quasicrystalline phase has been produced in rapidly solidified binary Al–14 to 25 at.% Co and ternary Al–20 at.% Co–5 at.% Si alloys. Observation of periodicity along one of the directions in the electron diffraction patterns has confirmed the decagonal nature of the phase. Variations in periodicity ranging from 4 to 16 Å suggest that a polytypism-like phenomenon occurs in these phases. By in situ hot-stage electron microscopy, it can be shown that one polytype transforms into another. Reasons for the formation and transformation of polytypes in decagonal quasicrystalline phases are discussed.

Recurrent osteoblastoma of the carpal hamate

A case of recurrent osteoblastoma of the hamate is reported. Curettage and bone grafting is usually followed by recurrence. Wide excision of the tumor is the treatment of choice if anatomically feasible.

Total wrist replacement using the modified Volz prosthesis

Eighteen total wrist arthroplasties in sixteen patients were done using the modified Volz prosthesis. The length of follow-up ranged from twenty-four to sixty-six months, with a mean of forty months. A 100-point scoring system was used to evaluate the outcome. Muscle imbalance developed in five wrists, the carpal component became loose in three wrists, and two prostheses dislocated. In five patients six arthroplasties (33 per cent) were considered to have failed because one reoperation or more was required for loosening of the components in two wrists, dislocation in two wrists, and muscle imbalance in two wrists. Of the remaining twelve arthroplasties (eleven patients) eight (45 per cent) had an excellent result; two (11 per cent), a good; and two (11 per cent), a poor result. The over-all rate of complications was 44 per cent. Patients who had significant preoperative deformity did poorly postoperatively. The surgeon should be prepared to perform other types of arthroplasty or an arthrodesis if the extensor tendons are structurally inadequate, as this may lead to progressive flexion deformity postoperatively.