Can an extracorporeal glenoid aiming device be used to optimize the position of the glenoid component in total shoulder arthroplasty?

Purpose: Successful total shoulder arthroplasty (TSA) requires a correct position of the glenoid component. This study compares the accuracy of the positioning with a new developed glenoid aiming device and virtual three-dimensional computed tomography (3D-CT) scan positioning. Materials and Methods: On 39 scapulas from cadavers, a K-wire (KDev) was positioned using the glenoid aiming device. It consists of glenoid components connected to the aiming device, which cover 150 degrees of the inferior glenoid circle, has a fixed version and inclination and is available with several different radii. The aiming device is stabilized at the most medial scapular point. The K-wire is drilled from the center of the glenoid component to this most medial point. All scapulas were also scanned with CT and 3D reconstructed. A virtual K-wire (Kct) was positioned in the center of the glenoid and in the scapular plane. Several parameters were compared. Radius of the chosen glenoid component (rDev) and the virtual radius of the glenoid circle (rCT), spinal scapular length with the device (SSLdev) and virtual (SSLct), version and inclination between KDev and Kct, difference between entry point and exit point ("Matsen"-point). Results: Mean rDev: 14 mm +/- 1.7 mm and mean rCT: 13.5 mm +/- 1.6 mm. There was no significant difference between SSLdev (110.6 mm +/- 7.5 mm) and SSLct (108 mm +/- 7.5 mm). The version of KDev and Kct was -2.53 degrees and -2.17 degrees and the inclination 111.29 degrees and 111.66 degrees, respectively. The distance between the "Matsen-point" device and CT was 1.8 mm. Conclusion: This glenoid aiming device can position the K-wire on the glenoid with great accuracy and can, therefore, be helpful to position the glenoid component in TSA. The level of evidence: II

Diagnostic value of active protraction and retraction for sternoclavicular joint pain

Background: Sternoclavicular joint (SCJ) arthropathy is an uncommon cause of mechanical pain. The aim of this study is to evaluate the diagnostic value of two active clinical tests for localizing the sternoclavicular joint as the source of mechanical pain. Methods: All patients between June 2011 and October 2013 that visited the orthopedic departments of three hospitals with atraumatic pain in the area of the SC joint were evaluated. Local swelling, pain at palpation, pain during arm elevation and two newly described tests (pain during active scapular protraction and retraction) were evaluated. CT images were evaluated. The patients were then divided into two groups according to whether they had a >= 50% decrease in pain following the SCJ injection. Sensitivity and specificity for local swelling, the four clinical tests and CT-scan were measured. Results: Forty eight patients were included in this study and SC joint pain was confirmed in 44. The tests with highest sensitivity were pain on palpation, (93% sensitivity) and pain during active scapular protraction (86%). CT-scan showed a sensitivity of 84%. Local swelling showed a high specificity (100%). Conclusion: Pain at the SCJ during active scapular protraction is a good clinical diagnostic tool for SC arthropathy

Epidermoid cyst of the phalanx of the finger caused by nail biting

Intraosseous epidermoid inclusion cysts of the phalanx of the finger are rare, and are regarded as reactive or post-traumatic pseudotumours. We describe a case of an epidermoid cyst in the distal phalanx of the fifth finger caused by chronic nail biting, which was successfully excised

Angulated greenstick fractures of the distal forearm in children: closed reduction by pronation or supination

The purpose of this study was to evaluate a reduction method that is based on the theory of Evans to reduce angulated greenstick fractures of the distal forearm with a rotation manoeuvre, to evaluate an immobilisation technique and to evaluate a brief survey on surgeon practice for treatment of these fractures. A retrospective study was performed on 21 patients. Fractures were reduced with a pronation or supination manoeuvre depending on the angulation of the fracture and were immobilised in pronation or supination. A good reduction was achieved in all patients. Six weeks after manipulation a loss of reduction was seen in 6 out of 21 patients, but with a re-angulation of less than 15 degrees. There was no significant difference between fractures immobilized in pronation or in supination. There was no need for re-manipulation. At the 2008 Osteosynthesis and Trauma Care Foundation (OTC) meeting, a brief informal survey was performed concerning the reduction method and the use of K-wires after reduction. No surgeons indicated they would perform only a rotation manoeuvre

Extraarticular variants of the long head of the biceps brachii: a reminder of embryology

Developmental anomalies of the long head of the biceps tendon are rare and have been described in the literature mainly dealing with anatomy and embryology. Because most basic embryologic research on this topic was conducted before 1966, a literature search was performed from archived anatomy textbooks and manuscript references. These data were compared with the scarce case descriptions of developmental anomalies of the long head of the biceps tendon. An additional case illustration from our own experience was provided. From the literature, it appears that during the embryologic phase of development, a staged migration of the long head of the biceps tendon occurs from a position between the fibrous capsule and synovial layer to an intraarticular position. Recent anatomic and arthroscopic case reports have shown that interruption of this migration can occur in any of these stages. Given the recent increase in arthroscopic shoulder surgery, anomalies of the long head of the biceps tendon will be encountered more frequently. Knowledge of their existence and origin can help in evaluating unexpected anatomic variations or the absence of the biceps tendon in preoperative medical imaging or during an arthroscopic procedure