Repair of an Isolated Sternal Head Tear of the Myotendinous Junction of the Pectoralis Major Using Knotless Suture Anchors: Case Report and Literature Review.

Although considered a relatively uncommon sports injury, publications on pectoralis major (PM) injuries have increased in the last couple of decades. Knowledge of the complex anatomy of the PM muscle is important in diagnosing, understanding the complexity of the injury, and determining the suitable modality of management of these injuries. Despite the increase in publications, there is no consensus on the superiority of any proposed surgical management. We present a case of a recreational body builder who presented to our clinics with a rare pattern of isolated musculotendinous junction of the lower fibers of the PM muscle and proposed a new technique of surgical management of such injuries using knotless suture anchors and running locked suture pattern in different directions. We then conducted a comprehensive review of literature of these injuries and presented a review on the pathophysiology, the various patterns of these injuries, and the available described modalities of surgical management. Understanding the complex anatomy of the PM, the various pattens of injury, and the aid of an MRI read by an expert musculoskeletal radiologist is crucial before managing these injuries. We believe that acute surgical repair of musculotendinous junction injuries using running Krackow/Brunnell locked configuration and the use of knotless suture and anchors will provide adequate and practicable surgical repair of these injuries.

Giant Cell Tumor With Secondary Aneurysmal Bone Cyst in the Left Distal Humerus: A Case Report.

Giant cell tumor (GCT) is a common benign aggressive tumor that mostly occurs in the proximal tibia, distal radius, and distal femur but is rarely seen in the distal region of the humerus. It originally presents between the ages of 30 and 50 with suddenly occurring pain. Treatment is generally curettage adjuvant treatment if necessary and reconstruction if required. In our case report, we present the clinical and radiological findings, diagnosis, and management of a 33-year-old female patient with a giant cell tumor (GCT) accompanied by a secondary aneurysmal bone cyst (ABC) in the left distal humerus, where the patient experienced pain for many years without significant history of trauma. Upon clinical examination, the patient displayed tenderness over the medial side of the elbow but no noted swelling, redness, or hotness. She had a painless full range of motion, with an intact distal neurovascular examination. Imaging concluded GCT with secondary ABC. A biopsy confirmed the diagnosis, ruling out metastatic lesions. The patient underwent surgical intervention, with plate fixation, which yielded excellent outcomes.

Chronic Complex elbow fracture dislocation: Restoration of elbow function with ORIF and radial head replacement, a case report with long term follow up.

INTRODUCTION: The dislocation of the elbow joint to the posterior or postero-lateral region accompanied by fractures in the radial head or neck and coronoid process of the Ulna is known as a terrible triad injury of the elbow (TTI). IMPORTANCE: This injury presents as unique challenge for orthopedic surgeons due to elbow instability and stiffness, making the surgical intervention more difficult than usual. CASE PRESENTATION: A 47-year-old man suffered from polytrauma, including a pelvis fracture, a left humerus shaft fracture, and left ulna shaft fracture. An open reduction and internal fixation were administered as a treatment option. However, during a follow-up examination four months later, a missed fracture dislocation of the right elbow was discovered. CLINICAL DISCUSSION: The complex surgery required open reduction of the chronic dislocated joint, release of the triceps, resection of the radial head, replacement, bone grafting of the coronoid, reconstruction of the coronoid, and application of a spanning external fixation. The injury was complex, consisting of coronoid fractures, olecranon, a proximal third of the Ulna, and radial head malunion with heterotrophic ossification around the elbow joint. CONCLUSION: After seven years, our patient had a full range of motion in elbow flexion with 20-25 lags in extension. The Mayo Elbow Performance Score (MEPS) was 100 and Disabilities of Arm, Shoulder and Hand (DASH) score was 0.