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We report the case of a middle-age lady who presented following minor trauma, with dominant-sided anterior elbow pain and swelling of 6 months in duration. She was assessed clinically, and underwent investigations, which confirmed features consistent with giant cell tumour (GCT) of distal biceps tendon sheath. She underwent uneventful en-bloc excisional surgery. She did not have radiotherapy. She is now 5 years postoperatively asymptomatic, with full function, and with no signs of recurrence.
RESUMEN
BACKGROUND: To determine the short-term effects following corticosteroid injection into the shoulder. METHODS: Type-specific shoulder injection was administered, followed by physiotherapy 7 days to 10 days later. One hundred and sixteen adult patients were prospectively followed-up. The primary outcome was a visual analogue score (VAS) for pain. Scores were recorded immediately before injection, 30 minutes after, daily until day 7 and then at 6 weeks. Post injection pain was defined as an increase of 2 or more points in the VAS score after the injection. The secondary outcome was determined at 6 months as successful discharge or progression onto surgery. RESULTS: The VAS showed a significant reduction from the pre-injection score for all patients at day 1 and was maintained until week 6. Forty-one (35.3%) patients experienced post-injection pain. The mean duration of symptoms was 3.9 days. At 6 months, 81 (69.8%) patients were discharged successfully and, at a mean of 23.2 months, did not require re-referral; 29 (25%) had surgery; and six (5.2%) were referred for a spinal opinion. CONCLUSIONS: One in three patients developed delayed post-injection pain. Flare phenomenon had no determinate effect on outcome. Patients' pain response by 6 weeks is predictive of final outcome at 6 months and may help clinicians plan further treatment without delay.
RESUMEN
BACKGROUND: Tension-band wiring is a popular method of internal fixation for simple olecranon fractures. Although fracture union rates and clinical outcomes are good, up to 80% of patients require removal because of prominent/symptomatic metalwork. The current literature remains unclear as to the best orientation of the longitudinal wires to minimize hardware failure. The aim of this study was to determine the surgically modifiable factors related to spontaneous wire pullout. METHODS: A retrospective review of hospital theater records over a period of 6 years was performed to identify all olecranon tension-band wire procedures. Preoperative radiographs were used to confirm and classify the fracture. Intraoperative and postoperative radiographs were analyzed for a number of wire-associated variables: wire length within the ulna, medullary/cortical position, parallelism of wires, proximal wire prominence, wire angle relative to the ulna, distance from the articular surface, fracture gap, and subsequent pullout. RESULTS: A total of 182 wires were analyzed. The mean age was 52.5 years, and the mean radiographic follow-up period was 7.3 months. Intramedullary wires had a mean pullout of 5.5 mm compared with 2.4 mm for transcortical wires (P < .0001). A multiple regression model noted 7 independent variables affecting wire pullout: age, bent wires, medullary/transcortical wire positioning, proximal prominence, ulnar shaft angle, distance from the articular surface, and articular step. CONCLUSION: To minimize postoperative pullout of wires, we suggest anatomic reduction and transcortical wire orientation, without bending, in the subchondral bone close to the articular surface.