Stress Fracture of the Trapezoid in a Professional Tennis Player

Background: Repetitive microtrauma can lead to trapezoid and second metacarpal stress fractures in racket sport players. Nontraumatic trapezoid stress fractures are rare and difficult to diagnose. To our knowledge, only 3 cases had been reported as of May 2023. We report the fourth case of a nontraumatic sports-related trapezoid stress fracture and only the second case in a tennis player. Case Report: A 29-year-old professional and right hand-dominant male tennis player presented with right hand and wrist pain for 3 weeks. He complained of dorsal wrist tenderness proximal to the base of the second metacarpal that was exacerbated by extension of the index finger. Initial radiographs were normal, but magnetic resonance imaging of the wrist showed a stress fracture of the trapezoid bone and base of the second metacarpal. The patient was treated conservatively with a wrist brace, cessation of sports activities, and modification of his training routine. The patient was asymptomatic at 1-year follow-up. Conclusion: This case highlights the relationship between trapezoid and second metacarpal stress fractures in athletes. A high index of suspicion for trapezoid stress fractures should be maintained and included in every differential diagnosis for athletes, especially racket sport players presenting with wrist pain. To avoid future injuries, clinicians should not only treat the fracture but also address the risk factors predisposing to this injury.

Osteoid Osteoma of the Distal Phalanx: A Rare Condition

Osteoid osteoma of the distal phalanges in the hand is rare and difficult to diagnose. We report a case of a 37-year-old Caucasian female patient who presented with a mass on the distal phalanx of the index finger. The patient was suffering from intermittent nocturnal pain for more than 18 months along with thickening, localized swelling, and clubbing of the distal phalanx of the right index finger. Radiographs revealed a lytic lesion of the distal phalanx of the right index finger with surrounding sclerosis. An MRI showed an intramedullary lesion with infiltration of the bone marrow, cortex, and surrounding tissue with focal sclerosis and elements of enhancements. A presumptive diagnosis of osteoid osteoma was made and surgical removal of the lesion by curettage and bone grafting was the treatment of choice. The curetted specimen was sent to pathology and the diagnosis of osteoid osteoma was confirmed. The patient was asymptomatic at six months postoperatively. Osteoid osteoma should be included in every differential diagnosis for patients presenting with atypical features of the distal phalanx of the hand.

Nerve transfers in the upper extremity: A review

Injury of the brachial plexus and peripheral nerve often result in significant upper extremity dysfunction and disability. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries. These transfers require an intimate knowledge of nerve topography, a technically demanding Intraneural dissection and require extensive physical therapy for retraining. In this review, we present a summary of the most widely accepted nerve transfers in the upper extremity described in the current literature.

Breast island flaps

Breast reconstruction has been performed using neighboring skin flaps and more recently by using myocutaneous flaps. Nowadays, more conservative techniques have been proposed. Quadrantectomy combined with chemotherapy and radiotherapy offers similar survival time after treatment when compared with a more radical procedure. Techniques used by plastic surgeons for partial or total breast reconstruction have become inadequate for patients with mild breast resections. In effect, surgeons have been qualified for extensive resections, but not for small reconstructions. Lesions left after quadrantectomy become, in many situations, a difficult problem to solve aesthetically, due to the positioning of the defect in different quadrants. I describe here a new procedure that uses a breast tissue flap with its pedicle on the costal cage. Breast island flaps, also called "plug flaps," were created specifically after quadrantectomy or other types of partial breast resection, for an easier reconstruction. The anatomical basis of breast island flaps was studied in cadavers. The surgical technique and results are described and illustrated in clinical cases.

Face-lift: the importance of redefining facial contours through facial liposuction

The remodeling of facial fat through fine liposuction is an indispensable element to be incorporated into the current concept of facial rejuvenation surgery. The authors describe their own system for remodeling facial fat through fine liposuction in 6 patients. The main technical aspects of this technique are discussed as well as its late results.