Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.

Reconstruction with interference screw of ruptured distal biceps brachii tendon at level of insertion into radial tuberosity: a case report

Distal biceps tendon rupture is a relatively rare injury. The incidence of distal biceps rupture is 1.2 cases per 100,000 patients per year, with the average age is 47 years old and the majority is male patient with dominant extremity. A 43 years old male presented with pain of the left elbow and weakness to flex and supinate the forearm following gymnastic activity. He heard pop sound on his left elbow during lifting dumbbell and followed by a sudden pain on his arm and weakness to flex and supinate the elbow. The USG examination were performed and confirmed there was a rupture on the distal biceps tendon at the level of insertion. Durante operation confirmed a complete rupture of distal biceps tendon. A Henry approach incision is performed to expose radial tuberosity, and the ruptured tendon was reconstructed by anchored into the tuberosity of radius with bioabsorbable screw. After closing the incision, patient is immobilized by cast in 60 to 90o elbow flexion and neutral pronosupination. Distal biceps tendon rupture can be successfully repaired by single anterior approach using anatomical anchor on radial tuberosity, so that can avoid posterior approach and associated proximal radioulnar synostosis risk while conserving interosseous membrane.

Functional outcome after total hip replacement following 30 years neglected posterior hip dislocation: a rare case report

Neglected traumatic dislocations of the hip is one of disabling condition in lower extremity which are seldom found in adults. However, in developing countries, neglected-unreduced traumatic dislocations are not uncommon. Total hip replacement (THR) still remains a recommendation for the treatment of neglected hip dislocation which occurs more than 3 months. A 45- years-old female came to the outpatient clinic complaining pain on her right hip with history of trauma 30 years before, but instead of seeking medical treatment, she went to bonesetter instead. On physical examination, there is 5 cm leg length discrepancy, and the patient walked with limping gait. Conventional x-ray confirmed persistent dislocation of the right hip. A soft tissue release procedure and femoral neck osteotomy with skeletal traction was done before, followed by delayed THR two months after. The patient’s functional status was improved, and the HHS score increased from 48 to 87. The patient had no pain or significant complaints, except for a finding of mild residual Trendelenburg gait.