Anterior Shoulder Instability with Concomitant Superior Labrum from Anterior to Posterior (SLAP) Lesion Compared to Anterior Instability without SLAP Lesion.

BACKGROUND: The aims of this study were to investigate the clinical characteristics of patients with combined anterior instability and superior labrum from anterior to posterior (SLAP) lesions, and to analyze the effect of concomitant SLAP repair on surgical outcomes. METHODS: We retrospectively reviewed patients who underwent arthroscopic stabilization for anterior shoulder instability between January 2004 and March 2013. A total of 120 patients were available for at least 1-year follow-up. Forty-four patients with reparable concomitant detached SLAP lesions (group I) underwent combined SLAP and anterior stabilization, and 76 patients without SLAP lesions (group II) underwent anterior stabilization alone. Patient characteristics, preoperative and postoperative pain scores, Rowe scores, and shoulder ranges of motion were compared between the 2 groups. RESULTS: Patients in group I had higher incidences of high-energy trauma (p = 0.03), worse preoperative pain visual analogue scale (VAS) (p = 0.02), and Rowe scores (p = 0.04). The postoperative pain VAS and Rowe scores improved equally in both groups without significant differences. Limitation in postoperative range of motion was similar between the groups (all p-value > 0.05). CONCLUSIONS: Anterior instability with SLAP lesion may not be related to frequent episodes of dislocation but rather to a high-energy trauma. SLAP fixation with anterior stabilization procedures did not lead to poor functional outcomes if appropriate surgical techniques were followed.

Above-the-knee replantation in a child: a case report with a 24-year follow-up.

Replantation of an amputated limb is generally contraindicated in crushing and traction injuries. Injury to muscle tissue and skin also creates difficulties in coverage, and bony fractures may shorten limb length which can impede lower extremity function. Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation. We report a case of successful thigh-level replantation in a 3-year-old child who sustained a crushing-traction type of injury with a follow-up of 24 years. After the replantation, early and late complications developed but these were successfully managed. On her last visit, the patient had pain-free ambulation without assistance, had intact protective sensation distal to the injury, and was very satisfied with the outcome. Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure. However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.

The prognostic value of pathologic fractures in patients with high-grade classic osteosarcoma

Pathologic fracture in osteosarcoma has traditionally been associated with a poor prognosis and is an immediate indication for amputation of the affected extremity. This concept has been questioned and remains an area of debate, especially because advances in osteosarcoma treatment have today resulted in better survival and limb salvage rates. It is the objectives of this paper to analyze the survival and limb salvage rate of osteosarcoma patients presenting with pathologic fractures and compare these with the population of osteosarcoma patients without pathologic fractures. Over a 15-year period (1993-2008), these were 84 patients presenting with non-metastatic high-grade classic osteosarcoma of the extremities (Enneking Stage IIB) who received complete treatment from the University of the Philippines-Musculoskeletal Tumor (UP-MuST) Unit and who had a follow up of at least 2 years. Ten of these 84 patients had pathologic fractures prior to surgery. Their overall survival was 50%, similar to the 50.38% overall survival of the entire group of 84 osteosarcoma patients. Limb salvage rate was 60%, similar to the 59% rate of patients without pathologic fractures. This study shows that contrary to traditional teaching, overall survival for this subset of osteosarcoma patients with pathologic fractures is acceptable at 50% and is equal to that of the entire group of osteosarcoma patients. At the same time, successful limb salvage surgery is possible despite the presence of a pathologic fracture, especially in patients with good response to chemotherapy.