Combined surgical treatment for missed rupture of triceps tendon associated with avulsion of the ulnar collateral ligament and flexor-pronator muscle mass

Triceps tendon ruptures are rare injuries. Coexistence of ipsilateral ulnar collateral ligament injury is even rarer. Here, we describe an unusual combination injury to elbow of a 39-year-old male construction worker consisting of triceps tendon rupture, avulsion of elbow ulnar collateral ligament and flexor pronator muscle origin ipsilaterally. A simultaneous repair and reconstruction of all damaged structures was proposed with individualized postoperative rehabilitation. Return to pre-injury level of activities obtained with this treatment protocol. High degree of suspicion and careful examination were needed to prevent missed diagnosis and prolonged instability which may be inevitable after inappropriate treatment of such injury

Rafting technique without bone grafting in reverse Hill-Sachs lesions

WOS: 000415126000011PubMed: 29125820In this article, we report a case of bilateral posterior shoulder instability, having reverse Hill-Sachs lesions of 25 to 50% of the articular surface on the right side, and of 50% on the left side. The defects were anatomically reconstructed after tuberculum minus osteotomy by elevation of the articular surface and buttressing with raft screws without graft usage. Early rehabilitation with pendulum shoulder exercises was started at third postoperative day. At postoperative sixth week, patient had full range of motion without instability and pain. At postoperative 18th month, the patient had normal physical examination and the constant shoulder score was 86, which was 92.4% of the age-and gender-matched population. Rafting technique without bone grafting may be a treatment alternative with satisfactory clinical results for medium to large sized reverse Hill-Sachs lesions of posterior shoulder instability

Re: Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach Rresponse

WOS: 000467807900008PubMed: 30844957

Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach

Annual Meeting of the European-Federation-of-National-Associations-of-Orthopaedics-and-Traumatology (EFORT) -- MAY 30-JUN 01, 2018 -- Barcelona, SPAINWOS: 000467798900020PubMed: 30277985Objectives: To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee. Design: Prospective clinical investigation. Setting: Academic level I trauma center. Patients/Participants: Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up. Intervention: Locked intramedullary nailing using a SP approach. Main Outcome Measurements: Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion. Results: The mean age of the patients was 35.4 +/- 12.4 years (range, 18-63 years), and the mean follow-up period was 15.+/- 2 6 3.2 months (range, 12-21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 +/- 1.3 (range, 0-4). The SF-36 physical score was mean 45.1 +/- 9, and the SF-36 mental score was a mean of 51.7 +/- 9.9. The knee joint range of movement was measured as 133.1 +/- 87 degrees on the affected extremity side and 134.05 +/- 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.7 +/- 6 4. No intra-articular pathology was seen on arthroscopy after nail insertion. Conclusions: The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series.European Federat Natl Assoc Orthopaed & Traumato

Surgical Treatment of a Giant Primary Cardiac Angiosarcoma

Primary cardiac angiosarcoma is a rare tumor, and surgical resection is often required to relieve its symptoms. A 54-year-old male with a large primary cardiac angiosarcoma is described in this case report. The tumor was located in the right atrium and right ventricle. The bulk was resected with the right coronary artery (RCA), and partial right atrium and partial right ventricle resections were performed during cardiopulmonary bypass. The resected tumor measured 15 x 10 x 8 cm, and the histopathological diagnosis was well differentiated primary cardiac angiosarcoma. In the postoperative period, the patient was followed up for 22 months, and radiotherapy and chemotherapy were performed for metastases. The optimal therapy for cardiac angiosarcoma is still controversial, but combined treatment including surgical resection should be considered