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INTRODUCTION: This study delves into the management of acromion fractures and acromioclavicular (AC) joint dislocations-orthopedic injuries with significant implications for shoulder function. Despite their infrequency, these injuries present challenges due to potential persistent pain and functional limitations. Current treatment strategies span from conservative measures to surgical interventions, yet there exists a notable gap in comprehensive data on specific surgical approaches. PRESENTATION OF CASE: We present a compelling case involving a 38-year-old male athlete who sought medical attention following a motor vehicle accident due to severe right shoulder pain. Upon admission to the emergency ward, the patient reported an inability to move the affected shoulder. Radiographic evaluations, comprising X-ray and computerized tomography scans, revealed a displaced fracture at the base of the acromion coupled with an AC dislocation. A novel surgical technique was employed, featuring coracoid fixation with mersilene thread and a 2-hole reconstruction plate-a distinctive approach in the field. DISCUSSION: The systematic rehabilitation plan yielded successful healing and the restoration of normal shoulder function, offering promising insights into potential advancements in orthopedic practices. CONCLUSION: This case contributes valuable knowledge to the understanding of these complex injuries, paving the way for further exploration and refinement in their management. The innovative surgical approach showcased underscores the importance of continued research and exploration to enhance the overall treatment landscape for acromion fractures and AC joint dislocations.
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Background: Postoperative pain after spinal surgery is a major problem that can impact patients' quality of life. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) with analgesic effect in different pain disorders. In this study, we aim to evaluate the safety and analgesic effect of duloxetine on acute and chronic pain following spine surgery. Methods: A systematic search was completed on MEDLINE, PsycINFO, and Embase through OVID from inception to April 2023 to find relevant articles. We used Cochrane methodology to evaluate the bias of included studies. Investigated outcomes included postoperative pain, opioid consumption, and adverse events. Results: Seven articles involving 487 participants were included in our systematic review. Out of 7 papers, 5 were randomized clinical trials, 1 was a pilot trial and 1 was a retrospective observational study. The results of these studies indicated the analgesic effect of duloxetine on postoperative pain, which was measured using numeric rating scale, verbal numeric scale, brief pain inventory, and visual analogue scale. Duloxetine was generally safe without serious adverse events. The most common reported adverse events included headache, nausea, vomiting, itching, dizziness, and drowsiness. Conclusions: Duloxetine may be an effective treatment option for postoperative pain following spine surgery, but further rigorously designed and well-controlled randomized trials are required.
