A 60-year-old man developed severe neuropathic pain and foot-drop in his left leg following resurfacing arthroplasty of the left hip. The pain was refractory to all analgesics for 16 months. At exploration, a PDS suture was found passing through the sciatic nerve at several points over 6 cm and terminating in a large knot. After release of the suture and neurolysis there was dramatic and rapid improvement of the neuropathic pain and of motor function.

This case represents the human equivalent of previously described nerve ligation in an animal model of neuropathic pain. It emphasises that when neuropathic pain is present after an operation, the nerve related to the symptoms must be inspected, and that removal of a suture or irritant may lead to relief of pain, even after many months.

The purpose of this study was to evaluate the long-term results of isolated closed Mason type-II and III fractures treated by internal fixation or by radial head resection.

METHODS: A long-term retrospective study was undertaken of eighty-seven patients with a Mason type-II and type-III isolated closed fracture of the radial head. Fifty of them were treated by radial head resection, two by excision of the fracture’s fragment and thirty-five of them by internal fixation. The average length of follow-up was 92.25 months. The patients were divided into two homogeneous groups, of which group 1 was made up of fifty-two patients treated by capitellectomy and by excision of the fracture’s fragment, and group 2 was made up of thirty-five patients treated by osteosynthesis.

The patients were submitted to clinical and radiographic evaluation. The subjective outcome was assessed with the DASH questionnaire (Disabilities of Arm-Shoulder-Hand); elbow pain on loading and at rest (VAS scale); and tenderness, loss of strength, and range of motion of the affected elbow. The uninjured arm served as the control. Flexion and extension of the elbow and the wrist, pronation and supination of the forearm, and the angle of the extended/flexed elbow were measured with a goniometer. Grip strength of the hand was evaluated with the Jamar vigorimeter. The radiographic evaluation included antero-posterior and lateral projections of the elbow and antero-posterior of the wrist.

RESULTS: The previously injured elbows in group 1 had an average loss of flexion of 14.61° and an average loss of extension of 8.65° compared with the uninjured, and there was less pronation of the forearm on the injured side (4.81°) and less supination (9.04°). Instead the injured elbows in group 2 had an average loss of flexion of 3.71° compared with the uninjured and an average loss of extension of 2°, which is minimal, and there was a further minimal loss of pronation of 1° and loss of supination of 0.86°.

In group 1, the definate average DASH value was 21.26, much higher than the value of 2.81 found in group 2. The VAS average value was also superior in the group 1 (3.87) compared with group 2 (1.2).

We also evaluated, in direct manner, the instability of the injured elbow using the valgus-stress test, which revealed a slight instability (48%) and a moderate instability (35%) of group 1. No instability however was found in group 2.

With regard to radiographic analysis, radiographic signs of arthrosis were present in 90% of patients who had undergone capitellectomy, and in 16% of those who had undergone osteosynthesis.

CONCLUSION: The patients in whom the radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection.