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 NEWS
January/06/2007
Surgical treatment in
paraplegia survey:
Cross-anastamosis in paraplegia below D9 started to give
results. The last documented case operated 1 year ago in a patient from Israel came
to the clinic 3 weeks ago. ECS and EMG performed showed that there is
starting innervation of Th 11 and 12. The patient's lower limbs muscles
became bulky and he could contract the lower abdominal muscles and some
movements in the pelvic girdle. Crude sensation descended down to the
inguinal level both sides. If you are more interested in this topic,
click here!
March/08/2007
Tuberculosis of the
spine
In the last 2 years the incidence of
tuberculosis of the spinal column is becoming more frequent and having
different clinico-morphologic picture. This phenomenon is alarming sign
as the residual of the use of dirty bombs and several radioactive
materials in the surrounding dirty wars in the region. For demonstration
click here! and
here!
20-AUGUST-2007
SIEMENS Digital C-arm is implemented and
functioning in the Shmaisani hospital.
30-AUGUST-2007
The Inomed ISIS Highline neurophysiologic
navigation system start to work at the operating room.
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1.
03-JUNE-2007 MUHAMED SALAMEH MUHAMED
21 YEARS OLD CUT LEFT ULNAR NERVE AT THE DIVISION
WITH RAMI DORSALIS.
Anamnesis
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The patient came to the
clinic 27-May-2007 complaining of weak left hand
with analgesia of the ulnar distribution same
hand. |
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The patient got cut wound by
glass 2.5 years ago to the left forearm 4 cm
above the wrist at the ulnar nerve trajectory. |
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ECS done 22-May-2007
confirming complete non-function of the ulnar
nerve above the division of the ramus dorsalis. |
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On examination, there was
complete analgesia of the ulnar distribution
including the sensory branch of the ulnar nerve
to the dorsum of the hand with atrophy of the
interossii and the hypothenar mm. There is
painful neuroma at the wound site. |
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The ulnar nerve exposed above
and below the neuroma. It was completely cut
below the neuroma and the ramus dorsalis was
involved with neuroma. |
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The distal and proximal ends
of the nerve were cut sharply after
electrophysiological workup. The incision was
made 45 degrees oblique and with good fascicles
inside the epineurium. The gap was 3 cm length.
Using 6 zero prolen, anastamosis was performed
with 8 stitches with good adaptation under
microscopic facilities. |
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Closure of the wound and
back-slap with slight flexion of the wrist was
applied for three weeks.
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Comments:
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The dorsal branch was
sacrificed, because it has little clinical
significance and it was in bad condition, that
adequate reinnervation for it was less likely
and could deform the good alignment of the
direct anastamosis. |
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Neurophysiologic studies must
be performed during any such procedure in the
nerves, even if it was clinically clear that
complete cut of the nerve is present. |
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The long time of the injury,
play a negative role in the degree of recovery.
Time will give the answer in such a case. But,
considering the young age and the proximity of
the injury to the target organs play a positive
role in the outcome. |
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