Phalangeal Fractures and Fingertip Injuries.

A comprehensive analysis of the assessment, diagnosis, and management of phalangeal fractures and fingertip injuries should emphasize the importance of achieving the right balance between undertreatment and overtreatment. Phalangeal injuries are complex, requiring an in-depth understanding of hand anatomy, fracture patterns, and treatment options to optimize patient outcomes. A thorough examination of proximal and middle phalangeal fractures and fingertip injuries, including those to the nail bed and distal phalanx, is important. A systematic approach to addressing the most prevalent injuries in this category should be implemented while highlighting the need for patient-specific approaches to treatment and a multidisciplinary perspective to ensure the best possible outcomes for patients.

Scapular Stress Fracture of the Inferior Angle in an Adolescent Swimmer.

We present the case of a competitive swimmer who was 14 years, 9 months old and had a 4-month history of posterior shoulder pain. She was initially evaluated by her school's trainer and completed a 2-week rehabilitation program, but pain returned with return to swimming. After feeling a "pop" while swimming with an increase in associated shoulder pain, the patient presented for medical evaluation. Plain radiographs were read as unremarkable. A formal physical therapy program resulted in increased pain, and the patient returned to clinic within 2 weeks with pain out of proportion to examination. Magnetic resonance imaging at this time identified a stress fracture along the inferior angle of the scapula, prompting a complete shutdown of activity for 4 weeks with vitamin D and calcium supplementation. A physical therapy regimen was restarted at 6 weeks with complete resolution of symptoms and return to swimming at 3 months. This case report is important because it highlights a sports-related stress fracture of the inferior angle of the scapula, a finding not currently present in the literature, in a swimmer, a sport not yet associated with scapular stress fractures. [Orthopedics. 2023;46(4):e249-e252.].

Magnetic Resonance Imaging Findings After Superior Capsule Reconstruction.

PURPOSE: To evaluate graft properties on magnetic resonance imaging (MRI) after superior capsular reconstruction (SCR) to help improve our understanding of postoperative imaging. METHODS: We identified consecutive patients who underwent SCR by a single surgeon and who had postoperative MRIs available. MRIs were analyzed to look for common postoperative findings on imaging. RESULTS: Ten consecutive patients with an average age of 58 years who underwent SCR by a single surgeon had postoperative MRIs on average 404 days from surgery. Eight patients had completely intact grafts on follow-up MRI. All intact grafts were similar with homogenous appearance on all coronal images. All patients displayed some trace fluid with mild heterogenous signal at the level of the glenoid, which could represent failure of the graft to completely incorporate at the level of the glenoid or could be normal in the postoperative setting since all eight intact grafts displayed this finding. None of the patients with intact grafts had bony edema noted on either the glenoid or humeral side. Four of 8 patients were noted to have trace bony edema at the level of the lateral acromion. One patient had complete disruption on the glenoid side. One patient had partially intact graft that revealed heterogenous appearance of graft. CONCLUSIONS: An intact graft displays a more homogenous signal on consecutive postoperative MRI coronal images than disrupted grafts or partially intact grafts. This suggests that intact grafts have better clinical outcomes than a partially disrupted or completely disrupted graft. However, the finding of heterogenous signal/fluid at the glenoid graft interface in all intact grafts could not be explained in this study. LEVEL OF EVIDENCE: Level IV, therapeutic case series.