Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain: Outcome after arthroscopic resection.

BACKGROUND: Shoulder pain in general and acromioclavicular joint (ACJ) pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA). The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases. MATERIALS AND METHODS: Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years). All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI). Arthroscopic ACJ excision arthroplasty was performed in all patients. RESULTS: At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10. CONCLUSION: Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury.

Syndecan-2 is a key regulator of transforming growth factor beta 2/Smad2-mediated adhesion in fibrosarcoma cells.

Fibrosarcoma is a rare malignant tumor originating from fibroblasts. Transforming growth factor beta 2 (TGFß2) has been established to regulate processes correlated to fibrosarcoma tumorigenesis. In this study, we investigated the possible participation of syndecan-2 (SDC-2), a cell membrane heparan sulfate (HS) proteoglycan on these TGFß2 functions. Our results demonstrate that the inhibition of SDC-2 expression by short interfering RNA (siSDC2) abolished TGFß2-dependent HT1080 cell adhesion (P ≤ 0.01). In parallel, the downregulation of SDC-2 significantly inhibited TGFß2-induced Smad2 phosphorylation (P ≤ 0.01). The immunoflourescence signal of TGF receptor III as well as its protein expression was decreased in SDC-2-deficient cells. The enhancement of adhesion molecules integrin ß1 (P ≤ 0.01) and focal adhesion kinase expression, induced by TGFß2 treatment (P ≤ 0.001), was markedly inhibited in SDC-2-defficient cells (P ≤ 0.01). Conclusively, the obtained data suggest that SDC-2 modulates TGFß2 transcriptional regulation via Smad signaling to facilitate fibrosarcoma cell adhesion.

Lateral mass screw complications: analysis of 1662 screws.

STUDY DESIGN: Retrospective, consecutive patient series. OBJECTIVE: To quantify the risks and the complications associated with screw fixation devices of the cervical spine. SUMMARY OF BACKGROUND DATA: The usefulness of lateral mass internal fixation has been well documented in the clinical setting. However, there is a paucity of studies examining the complications associated with these devices in a degenerative clinical setting. METHODS: From 1999 to 2007, 225 consecutive patients underwent posterior cervical fixation using a screw-plate and polyaxial screw-rod implant systems. There were 105 women and 120 men (age range: 45 to 84 y; mean, 68 y). In all patients, the surgical indication was cervical spondylosis with myelopathy. Mean follow-up interval was 18 months (range: 12 to 72 mo). Screw position was evaluated by computed tomography scanning postoperatively in all patients. Clinical and radiographic outcome was assessed at each visit after surgery. RESULTS: Intraoperative complications include fracture of lateral mass in 27 screws placement and nerve irritation in 3 bicortical screws. Early complications include hematoma formation in 2 cases and C5 root palsy in 5 cases after spinal canal decompression. Late complications include pseudarthrosis in 6 cases and screw pull-out in 3 cases. There were no cases of spinal cord or vertebral artery injury, infections, deaths, or adjacent segment disease. All patients had radiographic union, and no patient developed mechanical implant failure requiring removal of instrumentation. Reoperation was required in 14 (6.2%) cases because of nerve injury, hematoma formation, pseudarthrosis, and screw pull-out. CONCLUSIONS: Our clinical findings indicate that lateral mass fixation can be used safely with minimal complications and low rate of morbidity for cervical myelopathy treatment.

Thoracolumbar burst fractures: a systematic review of management.

The management of thoracolumbar burst fractures remains challenging. Ideally, it should effectively correct the deformity, induce neurological recovery, allow early mobilization and return to work, and be associated with minimal risk of complication. This article reviews the related studies reporting their clinical data for the management of thoracolumbar burst fractures, discusses the most suitable approach in cases such as these, highlights specific treatment recommendations, and proposes a treatment algorithm. Using PubMed and Scopus databases to search the term thoracolumbar burst fractures, abstracts and original articles in English investigating the treatment of thoracolumbar burst fractures were searched and analyzed.

Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report.

INTRODUCTION: Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. CASE PRESENTATION: We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. CONCLUSION: The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.

Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty.

BACKGROUND: In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function.The combination of fluoroscopic guided radiofrequency ablation (RFA) and kyphoplasty may fulfill these criteria. METHODS: We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic hepatocellular carcinoma, and a 71-year-old man with a Th12 and L1 pathological fracture from multiple myeloma. RESULTS: The choice of patients was carried out according to the classification of Tomita. Visual analog score (VAS) and Oswestry disability index (ODI) were used for the evaluation of the functional outcomes. The treatment was successful in all patients and no complications were reported. The mean follow-up was 6 months. Marked pain relief and functional restoration was observed. CONCLUSION: In our experience the treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty is safe and effective for immediate pain relief in painful spinal lesions in neurologically intact patients.

Spontaneous and enormous, chronic expanding hematoma of the lumbar region: a case report.

BACKGROUND: Chronic expanding haematoma (CEH) is a very infrequent event with imprecise developmental mechanism and is rarely reported in literature. CASE PRESENTATION: We present a case of enormous and spontaneous chronic haematoma of the back, expanded from the lower thoracic area to the sacral area, in a young patient without any history of trauma or chronic coagulopathy. CONCLUSION: The MRI scan is very useful in preoperative diagnosis, however only the histopathological examination is able to perform the differential diagnosis with soft tissue tumors. Careful surgical treatment is important to minimize the haematoma recurrence.

Intra-articular calcaneal fracture: closed reduction and balloon-assisted augmentation with calcium phosphate cement: a case report.

INTRODUCTION: For decades, open reduction and internal fixation was the surgical treatment of choice for intra-articular calcaneal fractures, either with or without any augmentation. Delayed weight bearing and wound-related complications are still unresolved. Aiming at a minimally invasive therapy with accelerated mobilization, we applied closed reduction and balloon-assisted augmentation with calcium phosphate cement. CASE PRESENTATION: A 45-years-old Greek man with intra-articular calcaneal fracture was treated with closed reduction and balloon assisted augmentation with calcium phosphate cement. Follow-up was performed using the Maryland foot score, plain radiographs and multidirectional computerized tomography. Early full weight-bearing was performed at the end of the first week postoperatively. There was no need for secondary reconstructive procedures at the 2 year follow-up. The patient had minimal problems regarding the pain, subtalar motion and peroneal impingement. There was no significant further collapse of the subtalar calcaneal articular surface radiologically. CONCLUSION: The closed reduction and balloon assisted augmentation with calcium phosphate cement of intra-articular calcaneal fractures is a minimally invasive surgical procedure which led to early full weight bearing, good functional patient outcomes and a low complication rate.