The goal of this study is to evaluate the incidence rate of iatrogenic injuries to the infrapatellar branch(es) of saphenous nerve during ACL reconstruction with four-strand hamstring tendon autograft. Retrospective review of 226 patients that underwent 230 arthroscopically assisted primary ACL reconstructions with four-strand hamstring tendon autograft, between March 2002 and December 2004. The patients were separated into two groups. In group 1 (116 knees) the tendon was harvested and tibia prepared through a 3-cm vertical surgical incision (between March 2002 and September 2003) and in group 2 (114 knees) through a 3-cm horizontal surgical incision (between October 2003 and December 2004). In group 1, we found 39.7% of the patients with disturbed sensitivity in the area of the infrapatellar branch(es) of the saphenous nerve distribution. In patients of group 2 the incidence of nerve injury was 14.9% (P<0.001). The horizontal surgical incision in harvesting hamstrings tendon autograft for ACL reconstruction was found to have less associated chance of iatrogenic injury to the infrapatellar branch(es) of the saphenous nerve. No technical ties were found in both incisions for graft harvest.

Despite the fact that anterior cruciate ligament reconstruction (ACLR) is a common procedure, no clear guideline regarding the timing of reconstruction has been established. We hypothesized that there is a point in post injury period, after which significant increase in meniscal tears occurs. The purpose of this study was to derive a guideline in order to reduce the rate of secondary meniscal tears in the ACL-deficient knee. A total of 451 patients were retrospectively studied and divided into six groups according to the time from injury to ACLR: (a) 105 patients had undergone ACLR within 1.5 months post injury, (b) 93 patients within 1.5-3 months, (c) 72 patients within fourth to sixth month, (d) 56 patients within seventh to twelfth month, (e) 45 patients within the second year and (f) 80 patients within the third to fifth year. The presence of meniscal tears was noted at the time of ACL reconstruction and then recorded and statistically analysed. Fifty-three (50.5%) patients from group a, 46 (49.5%) from group b, 39 (54.2%) from group c, 31 (68.9%) from group d, 28 (62.2%) from group e and 54 (67.5%) from group f had meniscal tear requiring treatment. The statistical analysis demonstrated that the earliest point of significantly higher incidence of meniscal tears was in patients undergoing ACLR more than 3 months post injury. Therefore, ACLR should be carried out within the first 3 months post injury in order to minimise the risk of secondary meniscal tears.

The hook plate is a simple device that can be created quite easily with readily available materials. We have extended the use of these plates to avulsion fracture fixation in the hand and found this to be a versatile technique. The risk of fragmenting the small fracture fragment is reduced because the hooks secure it and the plate is fixed in the bone. If done meticulously, joint congruence can be achieved. It has a biomechanical advantage over current methods of fracture fixation of small but important bone fragments in the hand.

Neurectomy is one of the treatments available to the surgeon treating patients with spasticity of the upper limb.Its popularity has increased in recent years.Accurate knowledge of the anatomical variations of the terminal branches to the muscles is required in order to achieve a successful outcome.Although the anatomy has been thoroughly studied, there are still controversies regarding the percentage of the nerve to be resected for a successful result, and also regarding the terminology that has been used in the literature to describe the procedure.The literature for neurectomies for the upper limb is reviewed and an agreement regarding terminology is proposed.Cite this article: EFORT Open Rev 2017;2:469-473. DOI: 10.1302/2058-5241.2.160074

| http://medcraveonline.com modalities. 2 Any non-operative treatment modality is considered to be reversible, 3 so it gives the treating healthcare professional the advantage to stop or modify it if the result is suboptimal.Operative treatment of Spasticity is indicated when the patient's function is impaired, when it causes significant pain to the patient, when it makes caring for the patient troublesome, or when it may lead to irreversible deformities of the skeletal system. 4 It is understandable that operative treatment is irreversible and the results of this treatment are permanent for the patient. 3 Operative treatment is expected to decrease, eliminate or redirect muscle forces, mobilize stiff joints, restore balance to joints or stabilize joints, but it is not expected to restore volitional control to muscles or increase muscle force generation. 5 Patients with Spasticity that involves the Upper Limb can be either functional or non-functional. 6 Thorough and detailed preoperative assessment is essential through a multidisciplinary setting where all health professionals who are treating the patient are involved. 6,7 In the functional patient the aim of any treatment modality is usually to improve function by restoring the balance between agonists and antagonists. In the non-functional patient the treatment usually aims to improve hygiene, sometimes improve pain, and to facilitate dressing and nursing. An important part of the decision making is preop assessment with the use of nerve blocks or Botulinum toxin. Botulinum toxin and nerve blocks can give a result which is very similar to the result after surgery. This can give the patient, the carers and the members of his/her family the opportunity to see the condition of the limb after surgery. 8