Rotator cuff repair: a biomechanical ex-vivo ovine study

The purpose of our work was to assess load to failure of sutures, suturing techniques, and suture anchors used in rotator cuff surgery. Ten types of sutures (absorbable and non-absorbable), four types of suturing techniques and eight types of sutures anchors (bioabsorbale and metallic) commonly used in open and arthroscopic rotator cuff surgery were tested. The biomechanical study was performed using Materials Testing Machine in ex-vivo ovine humeral heads and rotator cuff tissue and load to failure and stiffness were assessed. The mean load to failure and stiffness was higher in modern synthetic non-absorbable sutures. Massive cuff tear (MCT) and modified Mason-Allen (MMA) suturing techniques had higher failure strength and stiffness comparing to simple and mattress techniques but there was no substantial difference between them. Metallic suture anchors had higher failure strength comparing to bioabsorbable ones and often in either of them the eyelet fails first. Metallic anchors mounted with modern non-absorbable sutures will fail last. The tendon-suture level using simple and mattress technique will fail first, however, it can be improved with MCT or MMA techniques.Ο σκοπός της μελέτης ήταν να ερευνηθούν εμβιομηχανικά και να συγκριθούν ράμματα, τεχνικές συρραφής, και άγκυρες που χρησιμοποιούνται για την συρραφή του στροφικού πετάλου στον ώμο. Δέκα τύποι ραμμάτων (συνθετικά και απορροφήσιμα), τέσσερα πιο συνηθισμένα είδη τεχνικών συρραφής και οκτώ είδη αγκυρών που συχνά χρησιμοποιούνται στην χειρουργική ώμου δοκιμάστηκαν. Η εμβιομηχανική μελέτη έγινε με τη χρήση Οργάνου Μέτρησης Αντοχής Υλικών σε παρασκευάσματα στροφικού πετάλου και εγγύς βραχιονίου σφαγιασθέντων προβάτων. Φορτία και μετατόπιση καταγράφηκαν και η μέση των μεγίστων δύναμη εφελκυσμού όπως και η δυσκαμψία αυτών υπολογίστηκε. Το μέσο φορτίο αστοχίας και η δυσκαμψία ήταν υψηλότερη στα σύγχρονα συνθετικά ράμματα σε σύγκριση με τα αντίστοιχα απορροφήσιμα. Η ραφή τύπου Mαζικής Ρήξης Πετάλου (MCT) και η Τροποποιημένη ραφή τύπου Mason-Allen (MMA) είχαν υψηλότερο φορτίο αστοχίας όπως και δυσκαμψία σε σύγκριση με την απλή ραφή ή αυτήν τύπου mattress. Όμως δεν υπήρχε στατιστικά σημαντική διαφορά ανάμεσα στις δύο πρώτες. Οι μεταλλικές άγκυρες έχουν υψηλότερο φορτίο αστοχίας απ’ ότι οι βιοαπορροφήσιμες και συχνά όλες αποτυγχάνουν στο eyelet-«μάτι» τους. Οι μεταλλικές άγκυρες με περασμένα σύγχρονα συνθετικά ράμματα θα αποτύχουν τελευταίες. Το επίπεδο τένοντα-ράμματος θα αποτύχει πρώτο χρησιμοποιώντας απλή ή mattress ραφές, ενώ βελτιώνεται με MCT ή MMA ραφές

Posterior shoulder dislocation with reverse Hill-Sachs lesion. A technical note and report of two cases

Posterior shoulder dislocation (PSD) with a reverse Hill-Sachs lesion is a rare injury with challenging management. This article is a technical note, describing the combination of both, modified McLaughlin procedure with posterior Bankart repair, for the surgical treatment of traumatic PSD associated with a substantial reverse Hill-Sachs lesion. Two patients with mid-term follow-up are presented. Approaching and repairing both sides of the joint, balance and congruency are restored, the humeral head is centralized in the glenoid and the patient starts early mobilization and rehabilitation safely

Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: Is the Latest Version of Gamma Nail Superior to Its Predecessor?

Gamma nail is a cephalomedullary implant that was developed for the treatment of pertrochanteric hip fractures and has been successfully used for over 20 years. During this period, modifications of design and instrumentation have occurred to combat the intra- and postoperative complications that were associated with the use of early designs. The purpose of this study was to compare the complications observed with the use of the Gamma3 nail (G3N) with those seen following use of the previous trochanteric gamma nail (TGN). This study prospectively recorded the intra- and postoperative complications of 175 patients treated with the Gamma3 nail and compared them with those of a historical cohort of 192 patients treated with the trochanteric gamma nail. We encountered less intra- and postoperative complications with the use of Gamma3 nail. Femoral fractures and lag screw cutout were significantly lower. The reoperation rate was significantly higher in the TGN group. Gamma3 nail has proved to be a safe and efficient implant for the treatment of pertrochanteric fractures. The improvement of the biomechanical characteristics has led to a significant decrease in complication rates, demonstrating superiority over its predecessor

Epithelioid hemangioma of the scapula treated with chemoembolization and microwave ablation: Α case report

Bone epithelioid hemangiomas are classified within benign vascular tumours but are commonly misdiagnosed as low-grade angiosarcomas or epithelioid hemangioendotheliomas. Current therapeutic interventions include various treatment options but local recurrence or distal lymph node involvement has been reported. We report a rare case of scapular epithelioid hemangioma that was initially treated using a combination of chemoembolization and microwave ablation. This combination has not been previously reported in the literature regarding the management of this tumour. A year after the first course of treatment, the tumour size has been reduced more than 70% and the patient has remarkable clinical improvement. Results reported in this case study demonstrated that combination of chemoembolization and microwave ablation is a feasible, safe and effective technique in the treatment of bone epithelioid hemangiomas. Even if the tumour is still present afterwards, a substantially smaller surgical excision will be needed. Keywords: Epithelioid hemangioma, Chemoembolization, Microwave ablation, Scapul

Swimmers Are At Risk For Stress Fractures? A Systematic Review

Background: Stress fractures occur most commonly in the weight-bearing bones of the lower extremities. Swimming, a non-weight-bearing activity, is a potential activity form which associated with stress fractures? Objective: This systematic review aims to provide an answer in the above question and also to identify the reported cases of stress fractures among swimmers. Method: A systematic and comprehensive search was conducted using PubMed and Research Gate databases before January 2017. The search process was completed using the keywords: “stress fracture”, “stress injury”, “fatigue fracture”, “swimming” and “swimmers”. Results: There have been only 10 studies describing stress fractures in swimmers. This rare type of injury is commonly diagnosed in the ribs of young competitive swimmers, irrespective of their preferred swimming stroke. The etiology is multifactorial and includes a combination of intrinsic and/or extrinsic factors. Conclusion: Although any sport activity can potential cause a stress fracture, competitive swimming seems to be relatively safe in this respect. Rib stress fractures appear as the most common stress fracture in competitive swimmers that clinicians should consider. A prompt diagnosis can shorten the time required for healing and decrease the risk of complication

Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab

Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant–sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a “lasso-loop” technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device