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Objectives: To our knowledge, no cases have been reported so far regarding the treatment of proximal humerus fracture with intramedullary nail fixation via the Neviaser portal. This study aimed at evaluating the results of intramedullary nail fixation via the Neviaser portal for proximal humerus fracture. Methods: Four patients with 2-part proximal humerus fracture, who underwent the intramedullary nail fixation via the Neviaser portal, were included in this study. All the patients were females, and the mean age was 78.8 years. We evaluated their clinical and radiographic findings retrospectively. Results: The mean follow-up period was 12 months. All the patients achieved a bone-union without severe complications, such as deep wound infections or any neurological deficits. At the final follow-up, mean shoulder flexion, abduction, and external rotation were 123.5 , 118 , and 36 , respectively. Mean visual analog pain scale (VAS) score at the final follow-up was 21/100. Complications related to the implants were observed in two patients. In one patient, protrusion of the proximal tip of the nail occurred from the entry point, and this caused secondary subacromial impingement. In the other patient, insertion of the end-cap from the Neviaser portal was not possible, and this resulted in the failure of fixation postoperatively. Conclusion: The Neviaser portal may be suitable for the insertion of an intramedullary nail, because it facilitates to make an entry-point at the top of the humeral head. However, the problems related to the use of the present instruments still remain and need to be improved.

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Flexor tendon rupture in the wrist of patients with rheumatoid arthritis is a rare complication, and there is no standard treatment for the wrist joint. Here, we present the case of a rupture of the flexor digitorum profundus of the left index finger owing to a rheumatoid wrist. Plain radiography and computed tomography showed carpal collapse, especially lunate, and arthrosis between the capitate and lunate. For stability and mobility of the wrist and index finger, resection of the lunate and radiotriquetral (RT) arthrodesis using the distal ulna as a bone graft and arthrodesis of the distal interphalangeal joint of the index finger were performed. At 2 years postoperatively, her wrist was painless and stable on radiography without recurrence of tendon rupture, and the arc of motion of the dorsal-palmar flexion of the wrist joint was 125°. RT arthrodesis could be a surgical choice of “mobile” partial wrist arthrodesis.

Summary: Persistent median artery thrombosis mimicking carpal tunnel syndrome is rare. Here, we report the pathological, ultrasonography, and intraoperative findings of a case of persistent median artery thrombosis mimicking carpal tunnel syndrome. A 34-year-old man reported to our clinic with a complaint of numbness in his left thumb, index finger, and middle finger, which are innervated by the left median nerve. He also reported that he felt pain in his left wrist and distal forearm while working. Although findings of the usual provocative tests and nerve conduction studies were normal, ultrasonography revealed arterial thrombosis at the carpal tunnel level, whereas magnetic imaging showed persistent median artery thrombosis in the carpal tunnel. Three months after surgical resection of the thrombosed section of the artery, the patient fully recovered with no residual pain or limitations in the use of the affected arm. His patient-reported outcomes improved as well. It is important to investigate the existence of persistent median artery thrombosis if a patient presents with atypical symptoms of carpal tunnel syndrome. Ultrasonography is useful for the diagnosis of persistent median artery thrombosis. Surgical resection of a thrombosed persistent median artery in patients with carpal tunnel syndrome yields good results.