Subacute Acromioclavicular Dislocation After Basal Coracoid Process Fracture: Indirect Reduction without Open Reduction and Internal Fixation: A Case Report.

CASE: A 55-year-old man presented with an isolated undisplaced basal coracoid process (CP) fracture after direct trauma over his right shoulder. One week later, he presented with pain and anatomical deformity over the acromioclavicular joint (ACJ). Shoulder x-rays and computerized tomography revealed a complete acromioclavicular (AC) dislocation and displaced CP fracture. Anatomical AC reduction and ipsilateral coracoid fracture reduction were obtained using fixation with a hook plate. At 12-month follow-up, the patient regained functionality and showed complete CP consolidation and anatomic alignment of the ACJ. CONCLUSION: Our alternative treatment of coracoid fracture associated with secondary subacute AC dislocation showed satisfactory functional results.

Tuberculous sternal osteomyelitis.

A 32-year-old female patient with systemic lupus erythematosus presented with 1 month of nocturnal subjective fevers, night sweats, poor appetite, malaise, 8-kg weight loss, and a 6-cm painful sternal mass. She had normal vital signs with a physical examination notable only for the presence of a fluctuating sternal mass. A computed tomographic scan of the thorax showed a 67 × 32 × 27-mm sternal mass associated with severe sternal osteomyelitis (Fig. 1); then a surgical drainage was performed, and abundant caseous material was removed, leaving a penrose drain (Fig. 2). Histologic examination of the bone tissue revealed extensive necrosis and granulomas with multinucleated giant cells. The bone, secretion, and soft tissue were negative for acid-fast bacillae on Ziehl-Neelsen stain; but culture grew Mycobacterioum tuberculosis, and she was started on 4 first-line antituberculosis medications, showing rapid symptomatic improvement, and was discharged 4 weeks after admission (Fig. 3).