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Microsurgery is a term used to describe the surgical techniques that require an operating microscope and the necessary specialized instrumentation, the three "Ms" of Microsurgery (microscope, microinstruments and microsutures). Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively smaller blood vessels and nerves that have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Currently, with obtained experience, microsurgical techniques are used by several surgical specialties such as general surgery, ophthalmology, orthopaedics, gynecology, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery and more. This article highlights the most important innovations and milestones in the history of microsurgery through the ages that allowed the inauguration and establishment of microsurgical techniques in the field of surgery. [ABSTRACT FROM AUTHOR]

Congenital anomalies of the limbs have been observed since ancient human civilizations, capturing the imagination of ancient physicians and people. The knowledge of the era could not possibly theorize on the biologic aspects of these anomalies; however, from the very beginning of civilization the spiritual status of people attempted to find a logical explanation for the existence of such cases. The next logical step of the spiritual and religious system of the ancients was to correlate these anomalies with the Gods and to attribute them to a different level of existence in order to rationalize their existence. In these settings, the mythology and religious beliefs of ancient civilizations comprised several creatures that were related to the observed congenital anomalies in humans. The purpose of this historic review is to summarize the depiction of congenital anomalies of the limbs in mythology and antiquity, to present several mythological creatures with resemblance to humans with congenital anomalies of the limbs, to present the atmosphere of the era concerning the congenital anomalies, and to theorize on the anomaly and medical explanation upon which such creatures were depicted. Our aim is to put historic information in one place, creating a comprehensive review that the curious reader would find interesting and enjoyable. [ABSTRACT FROM AUTHOR]

The brachial plexus is the complex network of nerves, extending from the neck to the axilla, which supplies motor, sensory, and sympathetic fibers to the upper extremity. Typically, it is formed by the union of the ventral primary rami of the spinal nerves, C5–C8 & T1, the so-called “roots” of the brachial plexus. By examining the neural architecture of the brachial plexus, the most constant arrangement of nerve fibers can be delineated, and the most predominate variations in the neural architecture defined. A thorough understanding of the neuroanatomy of the brachial plexus, with an appreciation of the possible anatomic variations that may occur is necessary for effective clinical practice. [ABSTRACT FROM AUTHOR]

Intramedullary nailing has become a popular and effective procedure for the treatment of most fractures of the tibial diaphysis. However, distal interlocking screw placement under fluoroscopic control is responsible for the majority of the radiation exposure and a significant loss of surgical time in the entire nailing procedure. To limit fluoroscopy use, during distal interlocking screw placement, Orthofix® has developed a distal targeting device which compensates for the inevitable deformation of the nail in the sagittal plane during its insertion. This prospective clinical study evaluates the efficacy of this distal targeting device for distal locking. One hundred and fifteen fresh tibial fractures in the same number of patients with a mean age of 37.5 years (17–85 years) were treated with operative stabilization using the Orthofix tibial nailing system. The mean duration of the operation was 38 min (20–55 min). A mean of four intra-operative plain X-rays (2–6 X-rays) were used in 103 cases to confirm guide wire placement, final nail insertion and accuracy of screws placement. The mean duration of the use of the image intensifier utilized in the remaining 12 fractures was 5 s (3–8 s). The distal targeting device failed in 12 (5.2%) distal locking screws. This study demonstrates that distal locking can be performed easily and successfully with minimal exposure to radiation, once the surgeon develops a reasonable experience with the use of this distal targeting device. [ABSTRACT FROM AUTHOR]

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Isolated dislocation of the carpal scaphoid is an extremely rare injury. The authors report herein a case of a 28-year-old man managed with open reduction and Kirschner wire fixation. The aim of this study is to comprehensively present this unusual injury along with its treatment and to attempt to merge the available experience in the literature in a suggested algorithm that will guide the surgeon confronted with this rare problem to treat it promptly and effectively. [ABSTRACT FROM AUTHOR]

Background: Infections of the musculoskeletal system are tuberculous in nature in 1–5% of cases. The sacroiliac joint is involved in 3–9.7%. We describe the case of a 32-year-old man with tuberculous sacroiliitis presented as a growing mass on the lateral aspect of his right proximal and mid-thigh. Open biopsy, histology, cultures and PCR established the diagnosis of tuberculosis. Results: After surgical drainage of the abscess, the patient was administrated a triple antibiotic regimen for 12 months. Seven years postoperatively, the patient is disease-free with no functional limitation. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection. [ABSTRACT FROM AUTHOR]

The literature cites numerous studies involving the analysis of movement patterns in anterior cruciate ligament deficient (ACLD) patients. Although several in vivo biomechanical studies have shown that ACLD patients develop protective mechanisms against degenerative diseases, it seems that these adaptations fail to protect the knee from future pathology. Some authors state that ACLD patients adapt to the injury by avoiding quadriceps contraction during gait when the knee is near full extension. However, others have found increased hamstrings and decreased gastrocnemius activity, which normally contribute to the stability of the knee. It seems that further in vivo biomechanical investigation is required to understand the mechanisms of pathological knee joint motions and develop rehabilitation programs, which would delay the progress of developing long-term degenerative diseases. [ABSTRACT FROM AUTHOR]

In reporting on the preliminary results of our series of 76 patients, this paper aims to identify potentially complicating aspects of endoscopic carpal tunnel release (ECTR) using the two-portal Chow technique, and to recommend solutions, based on our early experience, which enhance the ease and safety of this minimally invasive technique. Of the first 24 patients, 16 cases required conversion to an open procedure. Based on these initial cases, we developed certain modifications of the Chow technique which precluded any need for open conversion in the 60 remaining cases. During a follow-up interval ranging from 4 to 24 months, there was no recurrence of carpal tunnel symptoms, and the average time to resumption of work activity was 14 days. The complication rate was 5% and included one case of transient hypesthesia, one case of extended hematoma, and one hypersensitive scar. All complications resolved at subsequent follow-up. In our experience, correct positioning of the hand, proper injection of local anesthetic, use of magnifying loupes, and correct use of instruments are essential for a safe and successful procedure. [ABSTRACT FROM AUTHOR]