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Background Chronic groin neuralgia is a life-debilitating condition that plagues patients worldwide. While groin neuralgia is usually traced to iatrogenic causes (inguinal hernia repairs, vasectomy, and hysterectomy), there is a unique subset of patients that present with noniatrogenic groin neuralgia. The diagnosis and treatment of these patients present a particular challenge. Methods A total of 30 patients (current mean age, 46.5 [range: 19–72] years) who presented with noniatrogenic groin neuralgia and received neurectomies on the iliohypogastric, ilioinguinal, and genitofemoral nerves between 2008 and 2017 were identified. A retrospective review of preoperative and immediate postoperative pain scores was compared with prospectively collected current pain on a Likert's scale (0–10). Additionally, patients were asked to complete a Short Form (SF)-20 and identify current pain medications. A two-sided Wilcoxon–Mann–Whitney test was used to analyze the data. Results Of the 30 patients identified, 16 could participate (mean follow-up = 61 months). The average pain reduction for the entire group was 62.7%. When using an established 30% reduction pain as a marker for clinical significance, 12 successful and 4 unsuccessful patients had an average reduction of 81.1 and 7.68%, respectively (success rate of 75%). Patients with successful group showed a statistically significant increased social functioning (p = 0.012) and near-significant increase in mental health (p = 0.063). Improvements, albeit nonsignificant, in mean scaled scores for every other SF-20 quality of life (QoL) category were observed when comparing both groups. Conclusion Neurectomy is a potentially beneficial surgery that can assuage pain and improve quality of life for patients with noniatrogenic groin neuralgia.

Background:Most patellar dislocations occur in a lateral direction because of a summed lateral force vector and predisposing anatomic risk factors. Medial patellar instability is rare and is a well-recognized iatrogenic complication of an overly aggressive lateral retinacular release. Noniatrogenic medial patellar dislocations are rare. The management of these injuries is not well described.Purpose:To describe the experience of the International Patellofemoral Study Group with patients with noniatrogenic medial patellar dislocation.Study Design:Case series; Level of evidence, 4.Methods:Members of the International Patellofemoral Study Group (N = 64) were surveyed between October 2018 and April 2019. This group was chosen because of its wide referral base and interest in patellar instability. Specialists who had encountered a patient with medial patellar instability were sent a questionnaire inquiring about details of the case, including patient demographics, medical history, level of athletic competition, injury characteristics, and treatment. Cases were confirmed by physical examination records and, in some cases, with findings on advanced radiographic imaging.Results:The survey response rate was 73% (47/64). Three of the 47 specialists (6.4%) reported they had seen a case of noniatrogenic medial patellar dislocation, for a total of 6 cases. Four cases were described as recurrent medial dislocations in the setting of hypermobile Ehlers-Danlos syndrome; 2 were treated nonoperatively, 1 underwent lateral patellofemoral ligament reconstruction, and 1 underwent derotational osteotomies. Two medial-sided patellar dislocations in collegiate athletes were sports-related injuries that required surgical debridement but no ligamentous reconstruction. None of the patients had persistent or recurrent instability at the time of their most recent follow-up.Conclusion:Noniatrogenic medial patellar dislocations are extremely rare. This case review suggests that the treatment of first-time medial patellar instability in patients without known risk factors should follow the same principles as the treatment of lateral instability with no known risk factors, which is nonoperative management. For patients with documented risk factors and recurrence, surgery to address the risk factors may be appropriate.

Aim: Vascular trauma in children is uncommon. Considering the complexity of these injuries, we have tried to determine their demographic data, the different factors changing their outcome, the different modalities of management, and their outcomes. Patients and Methods: We reviewed the medical records of 52 pediatric patients of less than 15 years f age for about ten years (1996 to 2006) .The review was followed by physical examination done by two surgeons. Vascular injuries included blunt and penetrating injuries to the neck and extremities. Their management included conservative management, primary closure, end-to-end anastomosis, graft interpositioning, and fasciotomy. Results: The patients included 41 males and 11 females and their mean age was 9.7 years (ranging from 3 to 14 years). Males were signifi cantly more (78%) involved. Penetrating upper extremity injuries were the most common cause of vascular injury in the paediatric population (65% on the right side). The most common mechanism was cutting the hand by glass (most of them on the ulnar side). These vascular injuries per se did not cause any disability in the upper extremities. The outcome of these injuries depended more on simultaneous nervous injury and to a lesser extent, on tendon injury. There was no signifi cant long-term difference between ligation and anastomosis of the radial and ulnar arteries. Lower extremity vascular injuries had signifi cantly higher mortality and morbidity. Conclusion: As the reconstructive procedures to manage vascular injuries are technically diffi cult, we suggest conservative managements to be applied fi rst. Prompt surgical intervention is necessary if there are any critical signs of ischaemia or unsuccessful conservative management, Keywords: Anastomosis, graft interposition, noniatrogenic, pediatrics, vascular traumaAfrican Journal of Paediatric Surgery Vol. 6 (1) 2009: pp. 35-39