Polychlorinated biphenyls (PCBs) are widespread environmental contaminants, and co-planar PCBs can induce oxidative stress and activation of pro-inflammatory signaling cascades which are associated with atherosclerosis. The majority of the toxicological effects elicited by co-planar PCB exposure are associated to activation of the aryl hydrocarbon receptor (AHR) and subsequent induction of responsive genes. Previous studies from our group have shown that quercetin, a nutritionally relevant flavonoid can significantly reduce PCB77 induction of oxidative stress and expression of the AHR responsive gene cytochrome P450 1A1 (CYP1A1). We also have evidence that membrane domains called caveolae may regulate PCB-induced inflammatory parameters. Thus, we hypothesized that quercetin can modulate PCB-induced endothelial inflammationassociated with caveolae. To test this hypothesis, endothelial cells were exposed to co-planar PCBs in combination with quercetin, and expression of pro-inflammatory genes was analyzed by real time PCR. Quercetin co-treatment significantly blocked both PCB77 and PCB126 induction of CYP1A1, vascular cell adhesion molecule 1 (VCAM-1), E-selectin and P-selectin. Exposure to PCB77 also induced caveolin-1 protein expression, which was reduced by cotreatment with quercetin. Our results suggest that inflammatory pathways induced by co-planar PCBs can be down-regulated by the dietary flavonoid quercetin through mechanisms associated with functional caveolae.

Tibial eminence avulsion fractures are relatively rare injuries, most frequently occurring in skeletally immature patients. Screws or suture fixation can be used, with each offering different potential advantages. The purpose of this retrospective study was to evaluate the clinical outcomes of a suture fixation technique for displaced tibial eminence avulsion fractures using the Rotator Cuff Guide (RCG; Acufex Microsurgical, Mansfield, Massachusetts). In a 12-year period from 1998 to 2010, a total of 17 tibial avulsion fractures were treated using the RCG for suture fixation. Outcomes evaluated included pain at final assessment and findings from Lachman, drawer, pivot shift, flexion, extension, and varus/valgus stress tests. Demographic data, fracture type, mechanism of injury, and postoperative activity were obtained for 17 patients (16 males and 1 female) who underwent surgery during the study period. Average patient age was 16.8 years (range, 13-37 years). Average follow-up was 25 months (range, 2 months to 13 years). Postoperatively, all fractures in all patients were radiographically healed, and all patients had stable Lachman and negative pivot shift tests. Two patients had 3° of extension loss, and 1 patient lost greater than 10° of knee flexion. The length of follow-up was broad. Further limitations include a small sample size and suture versus T-Fix (Acufex Microsurgical, Mansfield, Massachusetts) fixation methods. This technique offers a simplified, reliable method of suture fixation that provides few long-term complications and predictable results. Patients can expect to return to preinjury levels of activity, with the majority of patients achieving full range of motion.

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Background: The etiology of recurrent carpal tunnel syndrome (CTS) is unclear, and outcomes following secondary surgery in this demographic have been poorer than primary surgery. Fibrosis and hypertrophy have been identified in the flexor tenosynovium in these patients. The authors use flexor tenosynovectomy (FTS) for recurrent CTS after primary carpal tunnel release and present a review of these patients. Methods: A retrospective chart review was performed of 108 cases of FTS for recurrent CTS from 1995 to 2015 by 4 attending surgeons at one institution. Demographic information, symptoms, and outcomes were among the data recorded. A phone survey was conducted on available patients where the shortened version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and satisfaction were assessed. Results: Average office follow-up was 12 months. Average age was 57.5 years. A total of 104 (96%) reported symptom improvement and 48 (44%) reported complete symptom resolution. Forty patients were available for long-term follow-up at an average 6.75 years postoperatively via phone interview. Average QuickDASH score was 31.2 in these patients. Thirty-six (90%) of 40 patients were initially satisfied at last office visit, and 31 (78%) of 40 were satisfied at average 6.9 years, a maintenance of satisfaction of 86%. Satisfied patients were older (58 years) than unsatisfied patients (51 years). Conclusion: Both long-term satisfaction and QuickDASH scores in our cohort are consistent with or better than published results from nerve-shielding procedures. The authors believe a decrease in both carpal tunnel volume and potential adhesions of fibrotic or inflammatory synovium contributes to the benefits of this procedure. This remains our procedure of choice for recurrent CTS.

Limb-threatening vascular compromise from an isolated closed clavicle fracture is exceedingly rare. We report a case of a posteriorly angulated, closed clavicle fracture segment causing right upper-extremity ischemia, numbness, and paresis caused by entrapment of the clavicle between the first and second ribs.