Acute brachial plexopathy secondary to surgical management of an atrophic nonunion of a clavicle fracture.

We report the case of a 28-year-old patient who developed acute transient brachial plexopathy secondary to surgical management of an atrophic clavicle nonunion. The treatment was conservative, with symptom resolution at 4 months after surgery. This is the first reported case with electromyographic and neuroconduction follow-up, demonstrating complete and spontaneous resolution of axonal damage. The limited number of cases reported in the scientific literature allows for exploring some underlying causes of the acute plexopathy depending on the nature of the non-union (hypertrophic or atrophic).

Ramp-like lateral meniscus tear. Description of an infrequent lesion.

Numerous studies on meniscal tears have been published, a pathology that continues to evolve in terms of treatment and patient outcomes. As our understanding of anatomy and biomechanics improves, new entities have emerged. The lateral meniscus, especially its posterior attachment, tends to be overlooked due to its greater mobility compared to the medial meniscus. Evaluating the instability of the posterior horn poses a challenge, even during arthroscopy, therefore, it is crucial to understand the posterior menisco-synovial detachment lesions, which are indeed real and, to date, haven't received enough attention in the existing literature. The aim is to describe a new entity affecting the posterior synovial attachment of the lateral meniscus, without injury to the posterior horn of the lateral meniscus (PHLM). We also aim to present a case report detailing the intraoperative diagnosis and management of a 20-year-old patient with a sports trauma that led to a combined anterior cruciate ligament (ACL) and lateral meniscus tear managed with arthroscopic ACL reconstruction and all-inside meniscal suture. Through conventional arthroscopic evaluation of the posterior capsule anatomy and dissections, we have identified a distinct lesion of the PHLM at the menisco-synovial junction. Further research is necessary in this field to understand the biomechanical repercussions and determine the ideal surgical management.

Latin American formal consensus on the indications for the surgical treatment of massive and irreparable rotator cuff tears.

OBJECTIVES: To implement the Formal Consensus Method among a group of experts in shoulder surgery in Latin America, in order to establish appropriate indications for the surgical treatment of massive and irreparable rotator cuff injuries. METHODS: The Formal Consensus Method was used to develop surgical treatment recommendations for massive and irreparable rotator cuff tears (MIRCT). Three independent groups of experts in shoulder surgery were confirmed. The steering group conducted a systematic literature review and constructed a voting matrix consisting of 348 clinical scenarios. The rating group, composed of 15 members, rated each scenario on two occasions: first anonymously and then during an in-person discussion meeting. The median and voting ranges were used to classify each scenario as inappropriate, uncertain, or appropriate for each surgical technique. Finally, the reading group, consisting of 10 surgeons, reviewed, evaluated and rated the recommendations derived from the detailed analysis of the voting grids. RESULTS: The main finding of the study reveals a high percentage (70%) of clinical scenarios in which consensus was achieved regarding the appropriateness or inappropriateness of different surgical alternatives for the treatment of massive and irreparable rotator cuff injuries. Through a detailed analysis of the voting grids, a total of 20 recommendations were elaborated concerning the appropriateness of various surgical techniques in addressing irreparable rotator cuff tears. CONCLUSIONS: The indications for the operative treatment of MIRCT were determined based on expert consensus and the best available evidence, they seek to provide guidance on the appropriateness of various surgical techniques for different clinical scenarios. LEVEL OF EVIDENCE: V.

Dolor protésico de rodilla en pacientes con baja probabilidad de infección y gammagrafía ósea positiva / Knee replacement pain in patients with low probability of infection and positive bone scintigraphy findings

Introducción Los estudios de medicina nuclear han sido omitidos en el abordaje diagnóstico de prótesis dolorosa con sospecha de infección por heterogeneidad de la evidencia y costo efectividad. Existen pacientes con baja probabilidad de infección y gammagrafía ósea de tres fases positiva, el objetivo del estudio fue evaluar el desenlace diagnóstico y terapéutico de estos pacientes. Materiales y métodos Estudio observacional serie de casos. Se seleccionaron pacientes con antecedente de RTR, dolor protésico posoperatorio y/o rigidez, baja probabilidad de infección, PCR y VSG negativa y gammagrafía ósea de 3 fases positiva. Se evaluó dolor pre y posoperatorio, la escala de Oxford para rodilla y la necesidad de cirugía de revisión. Resultados Se estudiaron 20 pacientes, promedio de seguimiento 42,1 meses. No se identificó infección o aflojamiento al final del seguimiento en ninguno de los casos. Al 25% se realizó revisión protésica secundario a (artrofibrosis, síndrome patelofemoral y dolor), este subgrupo tuvo una puntuación promedio de Oxford de 23.8 y EVA 7 al final del seguimiento, en los pacientes no reintervenidos la puntuación promedio de Oxford y EVA fue de 29 y 5 respectivamente. En el 70% de los pacientes no se estableció la causa del dolor protésico. Discusión El diagnóstico etiológico de una prótesis fallida es un reto. En pacientes con baja probabilidad de infección y gammagrafía ósea de tres fases positiva la infección como factor casual es poco probable. Pocos estudios describen el resultado de la gammagrafía ósea en pacientes con baja probabilidad de infección.

Background Nuclear medicine studies have been omitted in the diagnostic approach of painful bone replacements with suspicion of infection due to heterogeneity of evidence and cost effectiveness. There are patients with low probability of infection and positive three-stage bone scintigraphy, and the objective of the study was to evaluate the diagnostic and therapeutic outcome of these patients. Methods A retrospective case series study was carried out on Patients with a history of total Knee Replacement (TLR), postoperative prosthetic pain and / or stiffness, low probability of infection, and negative CRP-ESR results, and positive 3-phase bone scintigraphy were selected. Pre- and post-operative pain was included. The Oxford knee scale and the need for revision surgery were evaluated. Results A total of 20 patients were studied, with a mean follow-up of 42.1 months. There were no cases of infection or loosening identified at the end of follow-up. Twenty-five percent of the patients underwent prosthetic revision secondary to, arthrofibrosis, patellofemoral syndrome, and pain). An Oxford Knee Score of 23.8 and an average VAS of 7 was found, whereas the non-intervention group were 29 and 5, respectively. In 70% of patients, no aetiological diagnosis was established. Discussion The aetiological diagnosis of a failed prosthesis is a challenge. In patients with low probability of infection and positive three-stage bone scintigraphy infection as an aetiological factor is unlikely. Few studies describe the outcome of bone scintigraphy in patients with low probability of infection.