Os Acromiale in Reverse Total Shoulder Arthroplasty: A Cohort Study

Background Increased passive deltoid tension after reverse total shoulder arthroplasty (RTSA) potentially leads to displacement or tilting of a preexisting os acromiale. Purpose To analyze patients with an os acromiale who underwent RTSA and compare their outcomes and complications with a matched control group without an os acromiale. Study Design Cohort study; Level of evidence, 3. Methods In this study, 45 shoulders in 42 patients with an os acromiale (cases) were matched to 133 patients without os acromiale (controls) who underwent RTSA between 2005 and 2016. The mean follow-up was 52 ± 32 months. Matching criteria included sex, type of surgery, duration of follow-up, and age. The Constant score (CS), Subjective Shoulder Value (SSV), and radiological outcomes were assessed postoperatively at 1-year, 2-year, and final follow-up visits. Results The mean CS, SSV, and range of motion improved from preoperative levels to the final follow-up in both groups (P < .01). Patients with an os acromiale had a relative CS of 70 ± 23 versus 76 ± 21 points (P = .15) and an SSV of 70 ± 30 versus 73 ± 24 (P = .52) compared with controls at the final follow-up visit. Patients with an os acromiale had significantly decreased active flexion of 104° ± 33° versus 114° ± 33° (P = .03) at 1 year and active abduction of 103° ± 37° versus 121° ± 38° at 2 years postoperatively (P = .02). A postoperatively painful os acromiale was found in 12 cases (27%) and spontaneously resolved in 8 cases after a mean of 33 months (range, 12-47 months; P = .04). Conclusion RTSA reliably restores patient satisfaction despite the presence of an os acromiale, with a slightly impaired range of motion. Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients, but this resolves spontaneously over time in the majority of patients

Serious delayed hair toe tourniquet syndrome with bone erosion and flexor tendon lesion.

Hair toe tourniquet syndrome (HTTS) is an uncommon pediatric condition occurring when the toe is circumferentially strangulated by human hair or fibers. An 8-week-old little girl was admitted to the Emergency Department because of the worsening swelling in the right second and third toes, which had been been previously treated with a local antibiotic thinking of an infection. An unrecognized HTTS was leading the third toe to necrosis. An urgent release of the constricting band on the two toes was performed and bone erosion and partial flexor tendon lesion on the third toe were detected. We would like to raise awareness in the community and in colleagues about HTTS in children, because early recognition and urgent treatment are mandatory to provide an adequate management and prevent severe complications

Small anteroposterior inclination of the acromion is a predictor for posterior glenohumeral erosion (B2 or C)

BACKGROUND Anatomic factors associated with static posterior translation of the humeral head with or without glenohumeral osteoarthritis are unknown. We tested the hypothesis that there is an association between glenoid wear, glenoid version, and/or anteroposterior acromial tilt. METHODS Ninety-nine patients with glenohumeral joint degeneration involving advanced glenoid cartilage wear and/or rotator cuff disease scheduled for anatomic or reverse total shoulder replacement underwent standardized conventional radiographic and computed tomographic shoulder imaging. Measurements included glenoid version, humeral torsion, posterior acromial slope, and critical shoulder angle. The glenoid shape was classified according to Walch et al, and the integrity of the rotator cuff was assessed. RESULTS Patients with glenoid type B2 or C had a median of 4° more glenoid retroversion (P = .022), a 5° less steep acromion (posterior acromial slope, 61° vs 56°; P = .004), and a higher combined score (glenoid version minus slope; odds ratio, 0.93 [95% confidence interval, 0.89-0.97]; P < .001; cutoff, -27°) than those with type A or B1. When the rotator cuff was torn, osteoarthritic changes were milder than when the cuff was intact (eg, P < .001 for supraspinatus). CONCLUSION The study's hypothesis that the bony anatomy of the scapula and in particular the acromion is correlated with the type of glenoid wear was confirmed. Both a more horizontal acromial orientation in the sagittal plane and increased posterior glenoid version are found in osteoarthritis of the shoulder associated with eccentric, posterior glenoid wear. Tears of the rotator cuff are significantly associated with concentric osteoarthritis of the glenoid

3D Printed replica of articular fractures for surgical planning and patient consent: a two years multi-centric experience

Abstract Background CT scanning with 3D reconstructed images are currently used to study articular fractures in orthopedic and trauma surgery. A 3D-Printer creates solid objects, starting from a 3D Computer representation. Case Description We report from two year of multicenter experience in 3D printing of articular fractures. Discussion and Evaluation During the study period, 102 patients (distal radius fractures, radial head, tibial plateau, astragalus, calcaneus, ankle, humeral head and glenoid) underwent 3D printing. The medical models were used by surgeons to appreciate the dislocation of fragments and the yielding of the articular surface. In addition, models were showed to patient as part of the acquisition of the informed consent before surgery. Conclusions 3D printing of articular fractures are innovative procedures that achieve a preoperative tangible, highly useful evaluation of the fractures to plan intervention and educate patients

Desmitificando os tubarões e raias de Santa Catarina

E-book do Projeto “Desmitificando tubarões e raias para educar e conservar”.O presente E-book é um produto oriundo do Projeto “Desmitificando tubarões e raias para educar e conservar”. Esse projeto trabalha, principalmente, em virtude do que as pessoas pensam desses animais. Uma concepção errônea e que compromete a sobrevivência deles e funcionamento do oceano. O objetivo principal é que parem de ser mal vistos e comecem a ser conservados. Nesse contexto explicamos como é a história de vida deles,a fim de desmascarar a fama de tubarões assassinos e raias perigosas, apontando as importâncias ecológicas deles, além de escancarar a sobrepesca que ameaça grande parte das espécies. Nesse E-book explicamos o projeto, quem são os tubarões e as raias e detalhamos cada espécie que ocorre em SC.SESu/ME