Injuries of the Pectoralis Major: Diagnosis and Management.

Pectoralis major ruptures are uncommon injuries that have become more prevalent over the past 20 years due to increased participation in weight lifting. Patients often present with localized swelling and ecchymosis, muscular deformity, thinning of the anterior axillary fold, and weakness in adduction and internal rotation of the affected arm. History and physical is often augmented with radiology, magnetic resonance imaging of the chest being the gold standard. Nonoperative management is reserved for old patients with low functional demands. Operative intervention is the treatment of choice with improved functional outcomes, cosmesis, and patient satisfaction.

Migration of a Lumbar Spinal Fusion Rod Into the Posterolateral Knee: A Case Report.

STUDY DESIGN: Case report (level V evidence). OBJECTIVE: We report a case of a 33-year-old man with Marfan syndrome that visited our clinic for left knee pain and stiffness. Radiographs of the left knee and lumbar spine demonstrated a spinal rod in the posterolateral left knee and its origin being a broken rod from his previous unilateral spinal fusion 17 years prior. SUMMARY OF BACKGROUND DATA: Spinal arthrodesis is a common treatment modality for a wide range of spinal pathologies including infection, trauma, congenital and developmental deformities, and degenerative conditions. A rare complication that may arise from said procedure is implant migration, most often a result of pseudoarthrosis. METHODS: Description of the case report. RESULTS: Patient was taken to the operating room 2 weeks later for an uneventful removal of the implant and immediate improvement with pain and range of motion. CONCLUSION: Spinal implant migration is a rare complication most often due to implant failure from pseudoarthrosis. In the case presented, this phenomenon was likely attributed to the use of unilateral instrumentation coupled with Marfan syndrome, shown to lead to insufficient implant stability and poorer fusion rates, respectively.Level of Evidence: 5.

Pectoralis major tendon reconstruction using semitendinosus allograft following rupture at the musculotendinous junction.

BACKGROUND: Pectoralis major (PM) rupture is an uncommon sports injury that has become more prevalent in the past 20 years as a result of an increase in recreational weight lifting and sports participation. Ruptures occur most commonly at the tendon insertion (65%) and musculotendinous junction (27%). This study describes an open technique and clinical outcomes after reconstruction of a PM rupture at the musculotendinous junction. METHODS: In this case series, 6 patients with PM ruptures at the musculotendinous junction were enrolled, with a 12-month follow-up period. The diagnosis was made with magnetic resonance imaging and correlated with clinical examination findings. All patients underwent PM reconstruction with a semitendinosus allograft, followed by a graduated rehabilitation protocol. Postoperative outcomes were assessed using the American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, cosmesis, return of strength, and overall satisfaction. RESULTS: The average age at the time of surgery was 39.5 years. At the 12-month follow-up visit, the average outcome scores were as follows: American Shoulder and Elbow Surgeons score, 98.3; Constant score, 98; and visual analog scale score, 0.67. All patients were pleased with their cosmetic outcomes, as well as return of strength, and showed overall satisfaction with their postoperative results. CONCLUSIONS: On review of the literature, this study is the first to describe the use of an isolated semitendinosus allograft to reconstruct a PM tendon following rupture at the musculotendinous junction. The excellent clinical outcomes suggest that the described technique can be a reliable tool in the orthopedic surgeon's armamentarium when approaching this uncommon PM tear.

Novel Spiked-Washer Repair Is Biomechanically Superior to Suture and Bone Tunnels for Arcuate Fracture Repair.

OBJECTIVES: Injuries to the posterolateral corner of the knee can lead to chronic degenerative changes, external rotation instability, and varus instability if not repaired adequately. A proximal fibula avulsion fracture, referred to as an arcuate fracture, has been described in the literature, but a definitive repair technique has yet to be described. The objective of this study was to present a novel arcuate fracture repair technique, using a spiked-washer with an intramedullary screw, and to compare its biomechanical integrity to a previously described suture and bone tunnel method. METHODS: Ten fresh-frozen cadaveric knees underwent a proximal fibula osteotomy to simulate a proximal fibula avulsion fracture. The lateral knee capsule and posterior cruciate ligament were also sectioned to create maximal varus instability. Five fibulas were repaired using a novel spiked-washer technique and the other 5 were repaired using the suture and bone tunnel method. The repaired knees were subjected to a monotonic varus load using a mechanical testing system instrument until failure of the repair or associated posterolateral corner structures. RESULTS: Compared with the suture repair group, the spiked-washer repair group demonstrated a 100% increase in stiffness, 100% increase in yield, 110% increase in failure force, and 108% increase in energy to failure. CONCLUSIONS: The spiked-washer technique offers superior quasi-static biomechanical performance compared with suture repair with bone tunnels for arcuate fractures of the proximal fibula. Further clinical investigation of this technique is warranted and the results of this testing may lead to improved outcomes and patient satisfaction for proximal fibula avulsion fractures.