Alternative Surgical Strategy for AxiaLIF Pseudarthrosis: A Series of Three Case Reports.

Study Design Retrospective case series. Objective The objective of this study is to describe an alternative technique to attain interbody lumbar fusion in the event of pseudarthrosis after axial lumbar interbody fusion (AxiaLIF) and to assess its safety. Methods Three patients who suffered from pseudarthrosis after AxiaLIF underwent revision surgery with a DEVEX cage (DePuy Synthes, Raynham, MA, United States) through an anterior approach. We report technical details as well as clinical and radiological results at 12 months follow-up. Results Preoperative symptoms resolved in all cases. There were no perioperative complications. One patient had a deep venous thrombosis at postoperative day 9. A decrease in visual analog scale score for pain was observed, from 8.67 preoperatively to 2 postoperatively at final follow-up. Radiographic workup after 12 months showed no sign of implant failure or loosening, and fusion was obtained in all cases. Conclusion Anterior fusion with a DEVEX cage in front of a TranS1 screw (TranS1 screw, Inc., Wilmington, North Carolina, United States) for AxiaLIF pseudarthrosis is safe and effective.

Spontaneous scapular spine fracture related to rotator cuff pathology: a report of two cases.

Spontaneous fractures of the scapula are rare, especially those involving the scapular spine. There are only a few case reports addressing this topic. Two cases are presented of spontaneous scapular spine fractures in patients with cuff-tear arthropathy. Treatment was conservative, resulting in a stiff shoulder in both patients. The combination of oral steroids and cuff-tear arthropathy seems to have caused a spontaneous scapular spine fracture in these patients. Considering the risk of operative intervention in the elderly patient conservative treatment seems a reasonable alternative.

Repair of gluteus medius muscle avulsion following transgluteal hip replacement.

During a transgluteal approach to the hip joint the anterior part of the gluteus medius and minimus muscles are detached and subsequently reattached to the greater trochanter. Avulsion or rupture of these muscles may result in weak abduction, pain and/or instability. 15 patients with these symptoms were treated, of whom 13 had muscle avulsion at surgery. Reinsertion of these muscles resulted in improvement of pain in 6 (55%) patients and improvement of walking ability in 9 (82%) patients. Reinsertion of avulsed gluteal muscles after transgluteal approaches to the hip may relieve pain and improve walking ability.

Pseudoaneurysm of the anterior tibial artery after ankle arthroscopy.

The formation of an arterial pseudoaneurysm as a complication of ankle arthroscopy is extremely rare, with a reported incidence of 0.008%. Pseudoaneurysm is especially unlikely after ankle arthroscopy by means of standard anteromedial and anterolateral portals. In this report, we describe a case of a pseudoaneurysm of the anterior tibial artery detected 2 weeks after ankle arthroscopy in a 63-year-old woman. The diagnosis was confirmed with a Doppler ultrasonography scan of the right ankle, after which the patient was referred to an interventional radiologist, who performed an angiogram. Endovascular embolization of the pseudoaneurysm was performed thereafter, and the patient experienced an uneventful recovery after the intervention. The potentially catastrophic sequelae of delayed diagnosis or misdiagnosis of the complication, like hemarthrosis of the ankle and compartment syndrome, are dangerous and must not be underestimated. Therefore, a high degree of suspicion for a pseudoaneurysm should be maintained in the postarthroscopy period when a patient presents with abnormal swelling and pain. Potentially preventative measures include careful dissection while making the portals and preoperative mapping of the vascular structures with a duplex or handheld Doppler.

Wear-induced osteolysis and synovial swelling in a patient with a metal-polyethylene wrist prosthesis.

We present a patient with a metal and polyethylene wrist prosthesis who had recurrent synovial swelling on the volar side of the wrist. Surgical exploration showed synovitis, a severely worn and broken polyethylene insert, polyethylene wear particles, and titanium debris from fretting corrosion. Pathological analysis showed macrophage-phagocytosing polyethylene wear particles and titanium oxide debris. This shows that polyethylene and titanium wear in wrist prosthesis might be a bigger problem than originally believed.