Citations

Although fractures of the fifth metacarpal neck (boxer's fractures) are common, their treatment can be problematic. A description of a technique utilizing traction reduction is presented in this paper. The records and radiographs of 59 patients who underwent reduction using longitudinal traction and subsequent immobilization in a specially molded cast were retrospectively reviewed. On average, 80% of initial fracture angulation in the sagittal plane was corrected, and only 1° of this correction was lost at the discontinuation of casting (3–4 weeks). We have found this technique to be highly effective in the treatment of boxer's fractures. Advantages of this treatment include its efficacy, ease, and improved patient tolerance over other casting techniques.

Purpose The purpose of this study was to investigate the functional and clinical outcomes of a consecutive series of patients who underwent fibular collateral ligament (FCL) and posterolateral corner (PLC) reconstruction by use of a single Achilles tendon allograft construct. Methods Patients were identified through prospective sports medicine databases at 2 academic institutions. Only patients who had undergone FCL and PLC reconstruction (as opposed to repair) were included. All patients followed a standard postoperative rehabilitation protocol. Various patterns of combined ligament injuries were included and divided into 2 groups (2 ligament v multiligament). Functional and clinical outcomes were assessed by clinical examination, Lysholm scores, and International Knee Documentation Committee subjective scores. Statistical analysis was performed by use of Wilcoxon paired rank‐sum tests and multivariate regression. Results We identified 16 knees in 16 patients, with a minimum of 2 years' follow‐up. There were 13 men and 3 women. The mean age was 30 years (range, 19 to 61 years). The mean length of clinical follow‐up was 30 months (range, 24 to 75 months). The mean International Knee Documentation Committee subjective scores were 80 points and 80 points ( P = .79) in the 2‐ligament and multiligament groups, respectively, and the mean Lysholm scores were 90 points and 89 points ( P = .96), respectively. Age ( P = .41), gender ( P = .84), and interval between injury and surgery ( P = .72) did not affect the clinical and functional outcomes between the 2 groups. Arthrofibrosis requiring manipulation developed in 1 patient. Residual varus laxity (1+) was noted in 4 patients, none of whom displayed functional instability. No patient has required revision reconstruction to date. Conclusions We describe a novel technique that takes into account the main static PLC stabilizers (FCL, popliteofibular ligament, and posterolateral capsule) that has not been previously reported. Our series showed no significant differences in clinical and functional outcomes between 2‐ligament and multiligament PLC‐based reconstructions. However, given the heterogeneity and small sample size of our study group, it is difficult to draw qualitative conclusions. Level of Evidence Level IV, therapeutic case series.

Background and Purpose— Size of an unruptured intracranial aneurysm (UIA) may be an important risk factor for rupture. Accordingly, serial noninvasive imaging is commonly used to assess untreated UIA for enlargement. Few data exist regarding the frequency and predictors of enlargement. We obtained this information from a group of patients followed with serial MR angiography (MRA). Methods— We retrospectively identified 165 patients with 191 UIA followed with serial MRA. Fusiform aneurysms, UIA <2 mm, and UIA that were surgically or endovascularly treated before the first MRA were excluded. MRA was performed using 1.5-T and 3-T MRI. Maximal diameter was determined on MRA source images. Multivariate regression analysis was used to determine independent risk factors for growth. Results— Twenty aneurysms (10%) grew over a median follow-up period of 47 months. Frequency of enlargement was 6.9%, 25%, and 83% for aneurysms <8 mm, 8 to 12 mm, and ≥13 mm, respectively ( P <0.001 for trend). Of the variables we evaluated, original aneurysm diameter (OR, 1.28 per mm; 95% CI, 1.07 to 1.58) was the only independent predictor of enlargement. Aneurysms ≥8 mm in diameter were at highest risk for enlargement (OR, 7.25; 95% CI, 1.96 to 27.1). There was a trend toward increased risk of enlargement in patients with multiple aneurysms (OR, 2.50; 95% CI, 0.86 to 7.53). Conclusions— Over a median follow-up period of 47 months, 10% of UIA enlarged. Larger aneurysms had a significantly increased risk of enlargement. The likelihood of enlargement was highest in aneurysms with diameters ≥8 mm. However, a clinically significant proportion of small aneurysms grow, and this growth can be detected by serial MRA.

This cross-sectional study examines the relationship between parenting stress and concerns identified by developmental screening and their effects on parents' decisions to seek medical care for their children. A total of 182 parents completed both the Parenting Stress Index (PSI) and the Parents' Evaluation of Developmental Status (PEDS) when their children were admitted to a sick child care program that provides parents the option of requesting medical evaluations for their children with mild acute illnesses. Although 31.6% of parents (N = 62) requested medical evaluations, neither PSI nor PEDS scores were associated with these requests. However, PEDS scores indicating significant parental concerns about their child's development or behavior predicted clinically significant levels of parenting stress on the PSI (odds ratio 4.9; 95% confidence interval, 1.5-15.9; P = .007). Primary pediatric health care providers who routinely perform developmental screening need to consider this relationship when interpreting developmental screening results and offer supportive and referral services to families as needed.

Dr Brazis has written a review of the literature on the clinical manifestations of idiopathic intracranial hypertension, possible associated venous hypertension and intracranial dural venous sinus abnormalities, and a brief discussion of medical and surgical therapies. The preferred terminology for this condition is idiopathic intracranial hypertension, but pseudotumour cerebri is so engrained in the literature that it stubbornly remains (1). The manuscript covers the literature well, and the information reviewed serves as an excellent reference source for interested readers. Unfortunately, Dr Brazis has noted the conflicting expert opinions regarding success, failure and complications for each of the surgical procedures, and, as a result, his summary discussion is barren of any algorithm of management, or even recommendations in approaching these difficult patients.

To review the literature on the surgical treatment of idiopathic pseudotumour cerebri (PTC) [idiopathic intracranial hypertension (IIH)]. When medical therapy fails or when visual dysfunction deteriorates, surgical therapies for PTC should be considered. The main procedures performed include lumboperitoneal shunt (LPS), ventriculoperitoneal shunt (VPS) and optic nerve sheath fenestration (ONSF). Recently, venous sinus stenting procedures have been performed on selected patients with PTC, especially those with venous sinus occlusive disease. The literature is summarized and appraised in the form of a narrative review. It is evident that ONSF, LPS, VPS and, in selected cases, venous sinus stenting may improve vision and prevent deterioration of vision in patients with PTC. All of the procedures have their advantages and disadvantages and may fail with time no matter what procedure is used. Various authorities have vehemently advocated one or the other of these procedures. Until a prospective, randomized study comparing ONSF with LPS or VPS for PTC is performed, and until the role of venous sinus obstruction as the aetiology of PTC is better defined, the question of which surgical procedure is best for the treatment of PTC remains unanswered.

Spontaneous intracranial hypotension (SIH) was described nearly 70 years ago, and for years it was essentially equated with post dural puncture headaches (PDPH) (1). The interest in this entity substantially increased after the magnetic resonance imaging (MRI) abnormalities of this disorder were recognized in the early 1990s (2-6), and consequently many more patients were diagnosed than before and a far broader clinical spectrum of this disorder began to become apparent. It also came to be recognized that the overwhelming majority if not all cases of SIH result from spontaneous cerebrospinal (CSF) leaks and that the independent pathogenic parameter is loss of CSF volume (7).