Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player: A Case Report.

CASE: We present the case of a 21-year-old male, collegiate division I wide receiver, with a humeral avulsion of the posterior glenohumeral ligament (RHAGL) and near-full-thickness supraspinatus tear after falling on his outstretched arm. He returned to full collegiate participation with symptom resolution after arthroscopic repair of each tear. CONCLUSION: This case report emphasizes the importance of imaging studies in the diagnosis of RHAGL and details a treatment approach that provided an excellent result in a young, active patient. This information will bring attention to these rare injuries and provides reference for providers who encounter patients with similar symptoms or pathology.

Top 20 cited Spine Journal articles, 1990-2009.

AIM: To determine the most cited articles and most published authors in Spine Journal from 1990-2009. METHODS: Spine Journal, established in 1976, is affiliated with 12 spine societies and a leader in spine research articles. Citation analysis is a method to determine the impact of a journal and its articles on academia and clinical practice. Using the Institute for Scientific Information Web of Knowledge, we determined the most cited articles in Spine Journal between1990-2009. The characteristics and type of article were recorded. Next, we evaluated the most published authors during the same time period and calculated the number of citations for each author. The number of first authorships for each of these authors was also determined along with the number of citations for those articles. RESULTS: The top 20 cited articles range from 491 to 267 total citations. The top 20 published authors had between 41 and 135 articles. Seventeen of the top 20 articles were clinical studies. The range of citations per lead authorship ratio was 36 to 724 with one author having no lead authorships. Low back pain was the most common theme encountered in the top cited articles. The first-ranked article was not a spine-specific topic rather it was regarding general physical and mental health status survey update review. CONCLUSION: Spine Journal and its authors have a clear impact on the scientific community based on this review of the top articles and authors in the last 20 years.

Proposed alternative revision strategy for broken S1 pedicle screw: radiological study, review of the literature, and case reports.

BACKGROUND CONTEXT: There have been many reports outlining differing methods for managing a broken S1 screw. To the authors' best knowledge, the technique used in the present study has not been described previously. It involves insertion of a second pedicle screw without removing the broken screw shaft. STUDY DESIGN: Radiological study, literature review, and two case reports of the surgical technique. PURPOSE: To report a proposed new surgical technique for management of broken S1 pedicle screws. METHODS: Computed tomography (CT) scans of 50 patients with a total of 100 S1 pedicles were analyzed. There were 25 male and 25 female patients with an average age of 51 years ranging from 36 to 68 years. The cephalad-caudal length, medial-lateral width, and cross-sectional area of the S1 pedicle were measured and compared with the diameter of a pedicle screw to illustrate the possibility of inserting a second screw in S1 pedicle without removal of the broken screw shaft. Two case reports of the proposed technique are presented. RESULTS: The left and right S1 pedicle cross-sectional area in female measured 456.00 ± 4.00 and 457.00 ± 3.00 mm(2), respectively. The left and right S1 pedicle cross-section area in male measured 638.00 ± 2.00 and 639.00 ± 1.00 mm(2), respectively. There were statistically significant differences when comparing male and female S1 pedicle length, width, and cross-sectional area (p<.05). At 2-year follow-up, the two case reports of the proposed technique showed resolution of low back pain and radicular pain. Plain radiograph and CT scan showed posterolateral fusion mass and hardware in good position with no evidence of screw loosening. CONCLUSIONS: The S1 pedicle dimensions measured on CT scan reviewed in the present study showed that it may be anatomically feasible to place a second screw through the S1 pedicle without the removal of the broken screw shaft. This treatment method will reduce the complications associated with other described revision strategies for broken S1 screws.