A novel plating technique for Ideberg type 1 A glenoid fractures: a report of five patients.

BACKGROUND: Glenoid rim fractures are uncommon and generally associated with high complication rates. The most common treatment techniques include screw or anchor fixation. Here, we introduce a new fixation method to treat Ideberg type 1 A fractures. METHODS: A retrospective analysis was performed on patients treated with open reduction and plate fixation for Ideberg type 1 A fractures. The active range of motion capacity of both shoulders was recorded postoperatively. Constant-Murley score and Oxford disability index scores were used as outcome tools. RESULTS: Five patients (three men and two women) were evaluated; their mean age was 56 years (standard deviation (SD), 10 years). The mean follow-up period was 25 months (range, 6-69 months); all fractures healed radiologically during the follow-up period. The mean Constant-Murley score was 80.36 (SD 11.01); the mean Oxford disability index was 37 (SD 9). The subsequent flexion and external rotation of the injured shoulders were similar to those of the uninjured side (injured vs. uninjured side: flexion, 176 ± 5.4 vs. 178 ± 4.4; external rotation, 48 ± 10.9 vs. 60 ± 0). No patient showed signs of osteoarthritis, stiffness, instability, or chronic pain at the last follow-up. DISCUSSION: Open reduction and internal fixation with a plate is suitable for Ideberg type 1A glenoid fractures.

The effectiveness of a Botulinum Toxin A infiltration in the management of bicipital cramps after arthroscopic biceps tenotomy.

A challenging complication of arthroscopic biceps surgery is the persistent painful cramping of the biceps. There is a paucity of data upon nonsurgical treatment of this debilitating complication. We pro- pose an intramuscular injection of botulinum toxin A (BTX-A) for painful bicipital cramping after tenotomy of the long head of the biceps brachii tendon (LHBT). Ten patients with a painful Popeye sign after tenotomy of LHBT, were treated with intramuscular injection of 100 IU of BTX-A. Mean patient age was 56 years and mean time from surgery to infiltration was 317 days. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was obtained. Pain was objectified by a visual analogue scale (VAS). Patient satisfaction was described as excellent, good, satisfactory, or poor, three and six months after injection. Mean VAS prior to infiltration was 6.8 and decreased significantly to 2.6 at follow-up. Mean QuickDash was 54.04 prior to infiltration and decreased to 19.84 at follow-up. Patient satisfaction was excellent in 9 and good in 1 patient. We report a significant pain reduction and functional improvement following BTX-A infiltration as treatment of painful bicipital cramping after tenotomy of LHBT.

Coracoid process transfer for anterior shoulder instability : a pectoralis minor sparing method.

The Latarjet procedure alters scapulothoracic motion by releasing the pectoralis minor insertion to the coracoid process and by changing the vector of the conjoint tendon. The purpose of this study is to evaluate the feasibility of retaining the pectoralis minor insertion and a part of the conjoint tendon on to the remainder of the coracoid, and to evaluate the efficiency of the procedure in avoiding scapular dyskinesis, without concessions to glenohumeral stability. Since June 2017, a modification to the Latarjet procedure has been used in the treatment of posttraumatic anterior shoulder instability. The pectoralis minor insertion and a part of the conjoint tendon is retained on its anatomical position, by harvesting only the lateral part of the coracoid. We retrospectively enrolled the first 9 consecutively treated shoulders with a minimum of 6 months follow up and recorded scapulothoracic position and scapulothoracic motion, patient satisfaction, Oxford score, and Short Form (SF)-36. All patients underwent a radiographic review at final follow up. No scapular dyskinesis was observed at final follow- up. Radiographies consistently showed a bony spur at the original osteotomy site, suggesting a functional attachment of the pectoralis minor tendon to the scapula. Harvesting only the lateral part of the coracoid is technically feasible, efficient in treating anterior shoulder instability and avoids scapular dyskinesis. Level of evidence : Level IV, Retrospective Cohort study, Treatment study.

Parameters influencing glenoid loosening.

INTRODUCTION: There is a lack of organization in existing studies on the outcome and complications of total shoulder arthroplasty. As a result, it is difficult to gain substantial evidence regarding the rate and risk factors for the occurrence of glenoid loosening which remains the most common cause of prosthetic failure. To improve the quality of future studies, an agreement should exist on definitions of glenoid loosening and on the potential risk factors. AREAS COVERED: Reviewing the literature, loosening can be defined as the appearance of radiolucent lines, radiological loosening, clinical loosening and revision as the end stage. Three different categories of influencing parameters can be distinguished: implant related, patient related and surgeon related. Expert commentary: The aim of this review is to organize the available knowledge on glenoid failure, as well as to describe the gaps so that it will constructively contribute to the debate on how to prevent glenoid failure in the anatomic total shoulder arthroplasty.

Is conservative treatment still defensible in grade III acromioclavicular dislocation? Are there predictive factors of poor outcome?

The optimal treatment of grade III acromioclavicular (AC) dislocation is still controversial. Recent studies recommend surgery at that stage whereas meta-analysis favours conservative management. The objective of the present investigation was to analyse a clinical series of non-operated grade III AC dislocations and to determine their functional status. Thirty-five patients treated conservatively with a grade III acromioclavicular dislocation were retrospectively reviewed. Simple shoulder test, Oxford shoulder and bilateral Constant shoulder score were used for assessment. Various predictive criteria of poor outcome, particularly scapular dyskinesis were taken into account for analysis. Overall mean and median Constant Score of the injured side were 92.9 and 94, whilst the contralateral shoulder values were respectively 94.9 and 95 (mean and median scores). Ten patients had scapular dyskinesis. Laterality, shoulder activity and scapular dyskinesis were not statistically related to worse outcome. Twenty-eight (80%) patients resumed normal activity within six months. All but two patients were subjectively very satisfied or satisfied. Conservative treatment provided satisfactory results whatever the shoulder activity. No risk factors were predictive of a poorer outcome. Conservative management should remain the first option to manage these injuries.

Diagnostic value of active protraction and retraction for sternoclavicular joint pain.

BACKGROUND: Sternoclavicular joint (SCJ) arthropathy is an uncommon cause of mechanical pain. The aim of this study is to evaluate the diagnostic value of two active clinical tests for localizing the sternoclavicular joint as the source of mechanical pain. METHODS: All patients between June 2011 and October 2013 that visited the orthopedic departments of three hospitals with atraumatic pain in the area of the SC joint were evaluated. Local swelling, pain at palpation, pain during arm elevation and two newly described tests (pain during active scapular protraction and retraction) were evaluated. CT images were evaluated. The patients were then divided into two groups according to whether they had a ≥50% decrease in pain following the SCJ injection. Sensitivity and specificity for local swelling, the four clinical tests and CT-scan were measured. RESULTS: Forty eight patients were included in this study and SC joint pain was confirmed in 44. The tests with highest sensitivity were pain on palpation, (93% sensitivity) and pain during active scapular protraction (86%). CT-scan showed a sensitivity of 84%. Local swelling showed a high specificity (100%). CONCLUSION: Pain at the SCJ during active scapular protraction is a good clinical diagnostic tool for SC arthropathy.

Fibroma of the tendon sheath of the long head of the biceps tendon.

Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings.

Use of the clavicular part of the pectoralis major in treatment of failed revision osteosynthesis of the clavicle.

BACKGROUND: Symptomatic atrophic nonunion after multiple clavicle osteosynthesis can be difficult to treat. The aim of this study was to evaluate the results of a transfer of the clavicular part of the pectoralis major muscle as augmentation of osteosynthesis of these nonunions. MATERIALS AND METHODS: A retrospective study included all patients who were treated between 2001 and 2010 (minimum 2-year follow-up). The indications for primary surgery, the number of operations, and the indication for a pectoralis major transfer were evaluated. Time of radiologic consolidation and postoperative complications were assessed. Clinical evaluation was performed with preoperative and postoperative satisfaction ratings and Constant-Murley scores. RESULTS: The study included 11 patients. The indications for a primary osteosynthesis were acute displaced fractures (7), delayed union (2), nonunion (1), and malunion (1). On average, 3.7 procedures were performed (range, 2-6) before the tendon transfer. At revision, there were 2 patients with infection and 9 without infection. Of the 11 clavicles, 10 showed radiologic consolidation after a mean time of 10 weeks (6-20 weeks). The mean follow-up was 62 months (24-132 months). The mean Constant-Murley score increased from 37 (24-55) preoperatively to 59 (43-98), and the satisfaction rating increased from 2 (1-3) to 7 (2-10). Complications included nonunion (1), hardware removal (2), hardware irritation (4), and donor site pain (1). CONCLUSION: The use of the clavicular part of the pectoralis major transfer as an augmentation in revision for symptomatic atrophic nonunion after multiple clavicle osteosynthesis showed good radiologic and acceptable clinical results.

A Concise and Comprehensive Description of Shoulder Pathology and Procedures: The 4D Code System.

Background. We introduce a novel description system of shoulder pathoanatomy. Its goal is to provide a comprehensive three-dimensional picture, with an additional component of time; thus, we call it the 4D code. Methods. Each line of the code starts with right versus left and a time designation. The pillar components are recorded regardless of pathology; they include subscapularis, long head of biceps tendon, supraspinatus, infraspinatus, and teres minor. Secondary elements can be added if there is observed pathology, including acromioclavicular joint, glenohumeral joint, labrum, tear configuration, location and extent of partial cuff tear, calcific tendonitis, fatty infiltration, and neuropathy. Results. We provide two illustrative examples of patients which show the ease and effectiveness of the 4D code. With a few simple lines, significant amount of information about patients' pathology, surgery, and recovery can be easily conveyed. Discussion. We utilize existing validated classification systems for parts of the shoulder and provide a frame work to build a comprehensive picture. The alphanumeric code provides a simple language that is universally understood. The 4D code is concise yet complete. It seeks to improve efficiency and accuracy of the communication, documentation, and visualization of shoulder pathology within individual practices and between providers.

Analysis of predisposing factors for contamination of bone and tendon allografts.

Bone and tissue allografts are widely used in transplantation. The increasing demand for safe allografts must be met, while minimizing disease transmission. We analysed the incidence and potential risk factors of allograft contamination and the effectiveness of disinfection, by reviewing 22 years of tissue bank activity and 474 donor procurements. We also compared different disinfection procedures used over the 22 years. The overall contamination rate was 10.1%. Risk factors were related to the donor or procurement method. Immediate culture at the tissue recovery site diminished the rate of false positives by reducing later sample manipulation. High-virulence allograft contamination was mainly related to donor factors, while low-virulence contamination was related to procurement methods. Analysis of donor-related risk factors showed no statistical differences for age, sex, or cause of death. An intensive care unit stay was associated with less contamination with high-virulence microbes. Procurement in a setting other than an operating theatre was associated with higher contamination rate. Team experience reduced contamination. Pelvic and tendon allografts were most frequently contaminated. Proper disinfection considerably reduced the contamination rate to 3.6%. We conclude that procurement must be performed under aseptic conditions, with short delays, and by trained personnel. Grafts should be disinfected and packed as soon as possible.

Sleeve fracture of the upper pole of the patella: a case report.

Sleeve fractures of the upper pole of the patella in children are rare; only 2 cases have been reported in the English literature and 1 case in the German literature. We present a case of this unusual lesion in order to stress the importance of being aware of the existence of upper pole sleeve fractures of the patella. We review the literature and we describe the symptoms, the clinical and radiological signs and the treatment. The diagnosis may be missed, the treatment is relatively simple and rewarding, and un- or mistreating this fracture leads to permanent disability.

The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis.

One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In four others, a lateral prosthesis was implanted subsequently to a medial one. One of these four was revised to a total knee prosthesis 6 years later. In another four cases, late complications of the meniscal bearing were treated with replacement of this bearing. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded. Since these results compare poorly to the survival of total knee arthroplasty, this prosthesis is not the first-choice implant. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in patients younger than 65. Further research is mandatory to confirm that this prosthesis very rarely needs revision in patients older than 75. It should not be used in osteotomized knees.