Humeral metastases: an unusual presentation of pancreatic cancer.

In patients presenting with symptomatic bone metastases, the usual primary malignancies are breast, prostate, thyroid, lung and kidney. Pancreatic cancers are an uncommon cause of bone metastasis and, when they are, it is typically to the axial skeleton. We present the case of a 77-year-old woman who presented to our emergency department with right arm pain. Investigation demonstrated a metastatic lesion with impending pathological fracture. Further investigation found a necrotic pancreatic mass in the tail of the pancreas. Histopathology from the humeral metastasis was consistent with metastatic adenosquamous carcinoma of pancreatic origin. The humerus metastasis was successfully managed with an intramedullary nail. This case highlights an unusual presentation of pancreatic adenocarcinoma with humeral bone metastasis.

Patient-specific instrumentation for total shoulder arthroplasty: not as accurate as it would seem.

BACKGROUND: There is an increasing body of literature suggesting that the use of patient-specific instrumentation (PSI) in total shoulder arthroplasty (TSA) results in improved positioning of the glenoid component. The aim of this in vivo study was to assess the accuracy of PSI of the glenoid component in TSA in a consecutive series at a single center. METHODS: Eleven consecutive TSAs (7 TSAs and 4 reverse TSAs) were performed using custom-made patient-specific positioning guides for the glenoid component. Each patient had preoperative computed tomography scans and guides produced to allow 0° of glenoid inclination and version in anatomic TSAs and 10° of inferior inclination for reverse TSAs. Postoperative computed tomography imaging was performed to determine accuracy of component implantation. Patients were observed to the 1-year mark. RESULTS: For the conventional TSA group, the mean version was measured at 8° ± 10° retroversion and 1° ± 4° inclination. For reverse TSAs, mean version was 10° ± 10° retroversion and -1° ± 5° inclination. There were 5 cases classified as outliers in terms of version (>10° anteversion or retroversion). We had a mean correction of version of 22° ± 9° and 17° ± 9° in inclination compared with preoperative measurements. CONCLUSION: Our results suggest that the in vivo accuracy of PSI-guided glenoid positioning is not as successful as suggested in the literature.

Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature.

BACKGROUND: Flexor tendon rupture is a rare but major complication associated with volar plate fixation of distal radius fractures. MATERIALS AND METHODS: We performed a systematic review to evaluate the demographics, clinical profile, treatment and outcome of flexor tendon rupture following volar plate fixation of distal radius fracture. Electronic searches of the MEDLINE, EMBASE, and Cochrane databases for systematic reviews and conference proceedings were performed. Studies were included if they reported flexor tendon rupture (partial or complete) as a complication of distal radius fracture plating (all levels of evidence). RESULT: Our search yielded 21 studies. There were 12 case reports and 9 clinical studies. A total of 47 cases were reported. There were 11 males and 23 females (n = 16 studies). The mean age was 61 years old (range 30-85). The median interval between the surgery and flexor tendon rupture was 9 months (interquartile range, 6-26 months). Twenty-nine plates were locking and 15 were nonlocking (n = 20 studies). FPL was the most commonly ruptured tendon (n = 27 cases, 57 %), with FDP to index finger being the second most common (n = 7 cases, 15 %). Palmaris longus tendon graft and primary end-to-end repair were the most common surgical methods used in cases of FPL tendon rupture. CONCLUSION: Flexor tendon rupture is a recognised complication of volar plating of distal radius fracture. Positioning of the plate proximal to the "watershed" line and early removal of the plate in cases with plate prominence or warning symptoms can reduce the risk of this complication.

Chronic suppurative cryptococcal extensor tenosynovitis in a patient with Castleman's disease: a case report.

Cryptococcus neoformans is an ubiquitously occurring encapsulated fungus that is commonly found in the environment. It is also an opportunistic pathogen that has potential to cause systemic fungal infection, predominantly in the immunocompromised host with cell-mediated immunological defects. Cryptococcal tenosynovitis is an extremely rare condition, with only a few cases previously documented in the literature. We report a case of chronic suppurative cryptococcal extensor tenosynovitis in a patient with Castleman's disease who was successfully managed with surgical debridement and antifungal therapy.

Long-term outcome of nonsurgically managed Kienböck's disease.

PURPOSE: To analyze the natural history of patients with Kienböck's disease who did not have any surgical treatment-in effect, to map the pattern of the disease process. METHODS: Thirty-three patients (33 wrists) with conservatively treated Kienböck's disease had a full clinical and radiologic review. The review involved an assessment of pain, range of motion, function, grip strength, and patient satisfaction, as well as a detailed radiologic evaluation. RESULTS: Analysis of the results shows reduction in the range of motion of the wrist, particularly flexion, with progression of the disease process. In addition grip strength deteriorated by 40% between stages 2 and 4. The Disabilities of the Arm, Shoulder, and Hand evaluation system also showed deterioration between stages 2 and 4. Radiologic progression was best measured by the radioscaphoid angle. CONCLUSIONS: Kienböck's disease is progressive and does pass through the various stages described by Lichtman. Progression can be monitored clinically by the Disabilities of the Arm, Shoulder, and Hand score and the loss of flexion of the wrist. Radiologic progression is best measured by the radioscaphoid angle.