Case Report of an Acute Complex Perilunate Fracture Dislocation Treated with a Three-Corner Fusion

Perilunate fracture dislocations are a rare but devastating injury, which is often missed on initial presentation leading to significant delays in treatment. With the delay in treatment and a high energy mechanism of injury, patients are at increased risk of developing complex regional pain syndrome following trauma. In this report, we review the case of a 57-year-old left-hand dominant female who presented to a clinic with a five-and-a-half-week-old transtriquetral, perilunate fracture dislocation with comminution of the scaphoid facet. Due to the increased likelihood of a secondary procedure and low probability of a satisfactory outcome with open reduction internal fixation secondary to the loss of the scaphoid articulation, a salvage procedure was deemed her best option. To our knowledge, this is the first case reported in the literature in which a scaphoidectomy, triquetromy, and midcarpal fusion (three-corner fusion) was performed in the acute setting for a perilunate fracture dislocation

Large Osteochondroma of the Scapula in a 2-Year-Old

Osteochondromas are a common tumour comprising up to 40% of benign bone tumours. Malignant transformation of osteochondromas is quite rare but increases based on genetics (EXT gene mutation) as well as location (pelvis and scapula). Osteochondromas of the scapula generally present once they reach a size that disrupts scapulothoracic motion or is noticed as an obvious palpable mass around the scapula. Here we present a case report of a 2-year-old boy with a large circumferential osteochondroma of the right scapula. Due to the size, location and rapid expansion of the mass, concerns for malignancy were quite high. On MRI examination, T2 imaging revealed an unimpressive cartilage cap but with substantial destruction of bone and mass effect causing alteration of the architecture of the surrounding ribs. On surgical excision of the lesion, the neurovascular bundle was found to be anterior to the mass and a small, thin, misshapen scapula was left following excision. Concerning features for malignant transformation include rapid expansion, growth after skeletal maturity as well as a cartilage cap >2 cm in size. Pathologic specimen was sent, ensuring the inclusion of a portion of the underlying scapula for assessment. Results of pathology revealed a benign lesion without signs of atypia in the lesion or scapular specimen sent.Osteochondromas of the scapula should be followed closely for many reasons. First there is an increased risk of malignancy in these lesions, particularly in a large, rapidly expanding lesion. Secondly, due to the location of the lesion, consequences of mass effect are more substantial due to disruption of scapulothoracic rhythm and the potential for joint injury distal to the scapula. Third, because of its hidden nature, ventral lesions may go unnoticed, and any abnormality of scapular positioning or movement should prompt further investigation of the architecture of the scapula

Posterior Glenohumeral Capsular Reconstruction With Modified McLaughlin for Chronic Locked Posterior Dislocation

Posterior instability is relatively rare when compared with anterior instability but can comprise up to 40% of operatively treated instability cases. Posterior dislocations are much rarer and are classically due to trauma, seizure, or electric shock. Due to a lack of an obvious deformity and an internally rotated and adducted arm position, posterior shoulder dislocations often are missed on initial presentation. In the management of posterior dislocations, considerations need to be made in regard to bony and soft-tissue pathology. In the setting of soft-tissue deficiency, previous options included nonoperative management primarily consisting of bracing and activity modification as well as arthroplasty options that do not rely on the capsulolabral complex for stability. In this paper, we present a technique for treating a chronic posterior shoulder dislocation with an associated large reverse Hill–Sachs deformity. In this setting, a revision labral repair and capsulodesis is generally not possible due to insufficient capsulolabral tissues. Here, we present the technique for an arthroscopic posterior capsule reconstruction using an acellular dermal allograft as well as a McLaughlin procedure for the treatment of a reverse Hill–Sachs lesion

Rotator Cuff Reconstruction Using Fascia Lata Patch Autograft for the Nonrepairable Rotator Cuff Tear

A large to massive rotator cuff tear is a common issue that lacks reliable options to return a patient's range of motion and function when conservative treatment has failed. With up to 96% of massive rotator cuff repairs failing within the first 6 months of repair, surgeons have been searching for a reliable treatment option for this difficult subset of patients. Surgical options for massive, retracted rotator cuff tears include re-establishing the counterforce coupling of the rotator cuff with techniques such as a partial repair or superior capsular reconstruction, preventing superior humeral migration as seen with balloon spacer implantation, and eliminating pain generators with techniques such as biceps tenotomy; however, these do not reconstitute dynamic cuff control. More recently, an acellular dermal allograft, as seen in superior capsular reconstruction, has been used to reconstruct the remaining rotator cuff. We describe a technique using a fascia lata autograft to reconstruct the rotator cuff in the setting of a massive cuff tear. This is of particular importance in centers that lack the funding or institutional approval to use acellular dermal allografts that have been popularized to date

Partial Thickness Rotator Cuff Tears: Current Concepts

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized

Partial Thickness Rotator Cuff Tears: Current Concepts

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized.Peer Reviewe