Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.

According to our preliminary results, the oppressive force of Nuss bars interferes with IMA patency and thereby compromises future usability in coronary artery bypass grafting (CABG). We recommend that patients undergoing CABG following the Nuss procedure undergo preoperative evaluation of IMA patency. This study will be continued to include a larger number of patients including follow-up CTA one year after removal of the bar.

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Dislocation of the pisiform bone is rare and hence its optimal management strategy has not been specified. We present a case of traumatic dislocation of the pisiform bone, which was treated with open reduction.A 16-year-old right-handed male was referred to our department after he fell onto his outstretched right hand with maximal dorsiflexion during a soccer game. The main complaint was pain at the ulnar side of his right wrist. Physical examination showed tenderness and swelling of the ulnar border of the right wrist with limited range of motion, particularly flexion and radial deviation. Radiographs demonstrated a fracture of the triquetrum and a distal dislocation of the pisiform bone in the right wrist.Additional computed tomography (CT) scan was performed to gain more information about the configuration of the fracture and dislocation (►Fig. 1A). The triquetrum bone only showed an avulsion fragment on the volar side with widening of the joint space between triquetrum and hamate bone, with diastasis to the avulsion fracture fragment.As initial closed reduction of the pisiform bone under anesthesia was unsuccessful, an open approach was performed. To achieve this open approach, an incision over Guyon's canal was made. After opening Guyon's canal and retraction of the neurovascular bundle, a small tear on the radial side next to the pisiform bone was seen. By using a Howard Bone File (Hu-Friedy, Chicago, United States), open reduction of the pisiform bone was achieved through the small tear. The pisiform bone proved stable during provocation without crepitation. Anatomical realignment of the wrist and the avulsion fragments was evaluated by radiographs and a CT scan (►Fig. 1B), and the widening of the joint space was absent.The wrist was immobilized with a cast for 6 weeks. Two months after the trauma, the patient had a full return of grip strength and function of the wrist and was able to perform his daily activities as before.Dislocation of the pisiform bone is a relatively rare injury associated with hyperextension traction of the flexor carpi ulnaris (FCU), tearing the pisohamate and/or pisometacarpal ligament. The FCU is the most powerful muscle in the wrist, and the pisiform acts as a sesamoid, mechanically enhancing the action of the FCU.1 As a consequence, the pull of the FCU as well as the forced wrist hyperextension associated with a fall onto the outstretched hand cause a significant traction to displace the pisiform bone and associated ligament injury or avulsion fractures. Depending on the intensity of the trauma, the thin capsule of the pisotriquetral joint, as well as the FCU tendon's distal continuation or the pisohamate and pisometacarpal ligaments, can disrupt.2 The direction of displacement of the pisiform bone is a result of the damaged structures.Various treatment options have been described in the literature for dislocation of the pisiform bone, varying widely from conservative treatment without even splinting to excision of the pisiform bone. 3Immediate closed reduction of the pisiform ...

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