The Palmar Cutaneous Branch of the Median Nerve: A Detailed Morphometric Study

Damage to the palmar cutaneous branch of the median nerve (PCBMN) is a potential complication of surgery at the volar aspect of the wrist. The aim of this study was to determine the relationships of the PCBMN to both surface and bony landmarks using reliable methods. Ten pairs of forearms from cadavers aged 73 to 98 years were dissected. The PCBMN was identified and its course and relationships documented. The situation of the PCBMN was quantified relative to the distal wrist crease, bistyloid line, scaphoid tubercle, radial styloid process and flexor carpi radialis tendon. A PCBMN was identified on 90% of sides. The PCBMN arose from the radial aspect of the median nerve 52.4 (SD 31.0) mm from the bistyloid line and entered the transverse carpal ligament 10.9 (SD 9.5) mm proximal to the bistyloid line. At the level of the distal wrist crease the PCBMN was located 0.6 to 7.5 mm (mean 4.5;SD 1.9 mm) from the ulnar aspect of the flexor carpi radialis tendon. The inter- and intra-observer reliability of the measurement methods ranged from ICC 0.96 to 1.00. Detailed morphometric data of the PCBMN relative to bony landmarks contribute to knowledge of the spatial relationships of the PCBMN to inform the precision of surgical incisions.

Obturator Dislocation of the Hip at Yopougon/Abidjan Teaching Hospital

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.

Unusual Posterior Traumatic Hip Dislocations at Yopougon/Abidjan Teaching Hospital

Traumatic dislocation of the hip is quite rare and accounts for 2% - 5% of all dislocations. We report on a case of a bilateral posterior hip dislocation associated with symmetric acetabular fracture and two cases of infracotyloid dislocation. The report included 2 men and one woman. The mean age of patients was 33 years. All dislocations followed a road traffic accident. Non-operative closed reduction was achieved within 19 hours of admission. The average follow-up time was 15 months. The hips were stable, mobile, and painless;and there was no radiographic sign of avascular necrosis of the femoral head.

Constructing the toolbox:Patient-specific genetic factors of altered fracture healing

The multifaceted sequence of events that follow fracture repair can be further complicated when considering risk factors for impaired union,present in a large and growing percentage of the population.Risk factors such as diabetes,substance abuse,and poor nutrition affect both the young and old,and have been shown to dramatically impair the body’s natural healing processes.To this end,biotherapeutic interventions such as ultrasound,electrical simulation,growth factor treatment(BMP-2,BMP-7,PDGF-BB,FGF-2)have been evaluated in preclinical models and in some cases are used widely for patients with established non-union or risk/indication or impaired healing(i.e.ultrasound,BMP-2,etc.).Despite the promise of these interventions,they have been shown to be reliant on patient compliance and can produce adverse side effects such as heterotopic ossification.Gene and cell therapy approaches have attempted to apply controlled regimens of these factors and have produced promising results.However,there are safety and efficacy concerns that may limit the translation of these approaches.In addition,none of the above mentioned approaches consider genetic variation between individual patients.Several clinical and preclinical studies have demonstrated a genetic component to fracture repair and that SNPs and genetic background variation play major roles in the determination of healing outcomes.Despite this,there is a need for preclinical data to dissect the mechanism underlying the influence of specific gene loci on the processes of fracture healing,which will be paramount in the future of patient-centered interventions for fracture repair.