Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation

Background@#The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. @*Methods@#The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12–33 months). An additional posterolateral portal and a 70º arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. @*Results@#Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0º for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. @*Conclusions@#Complete debridement using an additional posterolateral portal and 70º arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction: A Multicenter Retrospective Study

BACKGROUND: Although the instability severity index score (ISIS) is widely used to predict recurrence after arthroscopic anterior instability surgery, its reliability, especially on the weightings and cutoff values, is questionable. The goal of the current retrospective study was to investigate recurrence after arthroscopic capsulolabral reconstruction to evaluate whether each domain of the ISIS has the appropriate predictive power for recurrence by using logistic regression analyses with odds ratios (ORs). METHODS: This study included 120 consecutive patients who underwent arthroscopic capsulolabral reconstruction between 2004 and 2016. We retrospectively reviewed patients' preoperative history and radiographs, postoperative recurrence or sensation of instability, and risk factors related to the ISIS. The mean postoperative follow-up was 27.6 months (range, 12 to 96 months; median, 21 months). Twenty-six patients with recurrence or positive apprehension were classified as the recurrence group; 94 patients without any symptoms were classified as the non-recurrence group. Logistic regression analyses with ORs were used to verify the utility of each domain of the ISIS for predicting recurrence. RESULTS: The mean ISIS did not differ significantly between the recurrence and non-recurrence groups (4.3 ± 1.8 vs. 3.4 ± 2.1 points; p = 0.063). Among the domains of ISIS, factors related to bone defects, the presence of a Hill-Sachs lesion and glenoid bone loss had the lowest ORs (0.77 and 0.38, respectively). CONCLUSIONS: Not all ISIS domains accurately predicted recurrence after arthroscopic capsulolabral reconstruction. The ISIS may not be a proper reference for determining Latarjet procedure in patients with anterior shoulder instability.

Comparative Results of Acetabular Both Column Fracture According to the Fixation Method

PURPOSE: We wanted to compare the clinical and radiological results of surgical treatment of acetabular both column fracture according to the fixation method. MATERIALS AND METHODS: Between 1986 and 2008, 55 patients who underwent surgical treatment for acetabular both column fracture were clinically and radiologically evaluated after a minimum follow-up of one year. Of 55 patients, 29 cases were operated with a cerclage wire or cable (group I) and 26 cases were operated with a plate and screw (group II). The surgical approach, the intra- and post-operative complications and the reduction quality were compared between the two groups. The clinical and radiological results were analyzed according to the criteria reported by Matta. RESULTS: There were 14 (48.3%)/20 (76.9%) cases of anatomical reduction, 12 (41.4%)/6 (23.1%) cases of imperfect reduction, 1/0 case of poor reduction and 2/0 cases of surgical secondary incongruence, respectively. Thirty three patients of 34 anatomically reduced patients showed excellent clinical results and the anterior and posterior combined approach was frequent in group I. There were no differences between the two groups for the complications, although intraoperative complication was more frequent in group II and postoperative complication was more frequent in group I. CONCLUSION: The clinical and radiological results of surgical treatment in patients with both column fracture were satisfactory in both groups. However, the concerns related to the surgical approach and complications will require a randomized prospective study.

A Case of Soft Tissue Recurrence after Wide Resection of Giant Cell Tumor in the Distal Femur

Giant cell tumor of the long bones is a relatively common neoplasm in young age patients, and this tumor usually involves the metaphysis and epiphysis. Due to the high rates of recurrence and the occasional development of pulmonary metastasis, this tumor has a malignant manifestation and it requires long term follow-up observation. Most local recurrences of giant cell tumor after surgery occur in the long bone that was previously curetted; however, the recurrence of tumor in the soft tissue around the long bones is known to be rare. We describe here a case of giant cell tumor that recurred in the soft tissue around the knee after wide resection of the distal femur and we discuss this case along with reviewing the related literature.

Clavicle Midshaft Fracture with Acromioclavicular Joint Dislocation: A Case Report

Clavicle fracture or acromioclavicular joint dislocation is common injury in the upper extremity. But ipsilateral clavicle midshaft fracture with acromioclavicular joint dislocation is a extremely rare. Seven cases has been reported in the English literature, but it has never been reported in Korea. We report a case of clavicle midshaft fracture with acromioclavicular joint dislocation caused by motor vehicle accident and describe its presumed mechanism, diagnosis, treatment with a review of literature.