Congenital intrathoracic accessory spleen is a very rare trick of nature: a case report.

BACKGROUND: Congenital intrathoracic accessory spleen (CIAS) refers to a developmental anomaly resulting in the presence of splenic tissue within the chest. The differential diagnoses for the resulting mass are pulmonary malformations, or lesions with malignant potential. To our knowledge, only four cases of presumed CIAS have been described in literature to date, and no cases were reported in the United States. CASE PRESENTATION: We report on a 14-year-old Caucasian female with a left chest mass discovered incidentally on a CT scan performed following an all-terrain vehicle accident. Following resection, the mass was diagnosed as a CIAS. CONCLUSIONS: From our review of literature, we found that CIAS can pose a diagnostic dilemma as it is rare, difficult to distinguish from pulmonary sequestration, or malignancy, and biopsy is often inconclusive. Resection is required to rule out malignancy and determine the diagnosis. Pediatric thoracic surgeons should consider CIAS in their differential for an intrathoracic mass with an inconclusive biopsy.

Timing of Surgical Reduction and Stabilization of Talus Fracture-Dislocations.

Talus fractures with associated dislocations are rare but have high rates of complications, including avascular necrosis (AVN). Management of these injuries involves urgent surgical reduction and fixation, although there are no definitive data defining an operative time frame for preserving the blood supply and preventing complications. To determine the effect of time to surgical reduction of talus fractures and talus fracture-dislocations on rates of AVN and posttraumatic osteoarthritis (PTOA), we retrospectively reviewed talus fractures surgically managed at a level I trauma center during the 10-year period 2003 to 2013. Operative reports were obtained and reviewed, and 3 independent reviewers, using the Hawkins and AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) systems, classified the injuries on plain radiographs. Analysis of AO/OTA 81 fractures with associated tibiotalar, subtalar, or talonavicular dislocations was performed. Primary outcomes were presence of AVN/PTOA and subsequent arthrodesis of tibiotalar or subtalar joints. We identified 106 surgically managed talus fractures. Rates of AVN/PTOA were 41% for all talus fractures and 50% for talus fracture-dislocations. Mean time to surgical reduction was not significant for development of AVN/PTOA for all talus fractures (P = .45) or talus fracture-dislocations (P = .29). There was no difference in age (P = .20), body mass index (P = .45), or polytrauma (P = .79) between patients who developed AVN and those who did not. Open fractures were significantly correlated with the development of AVN/PTOA (P = .009). Talar fracture-dislocations are devastating injuries with high rates of complications. Our data suggest there is no effect of time from injury to surgical reduction of talus fractures or talus fracture-dislocations on rates of AVN and PTOA.

Outcomes Following Suture-Anchor Repair of Pectoralis Major Tears: A Case Series and Review of the Literature.

BACKGROUND: Rupture of the pectoralis major muscle (PMM) is an uncommon injury that occurs during physical exercise and high-impact contact sports; it may result in pain, weakness, and disability. Surgical repair is currently the preferred treatment of PMM rupture. Our study assesses subjective and functional outcomes of patients following repair of acute and chronic PMM ruptures. METHODS: Retrospective review identified twenty patients who underwent PMM repair by the senior author (BRW) between 2003 and 2011. Injury and surgical data was reviewed for all 20 patients. Six patients were assessed minimum 1-year post operatively for clinical outcomes, (SF-36, DASH, and ASES), physical exam (ROM & cosmesis), and Cybex isokinetic strength testing. RESULTS: All patients were men with an average age of 30 years (range 20-55) at time of injury. The average time from injury to surgical repair was 3.8 months (range <1-28 months), and average follow up was 16.5 months (range 0-99). The majority of patients suffered injury while bench pressing (12/20; 60%) or wrestling (3/20; 15%). The most common intra-operative findings were partial sternal tears (9/20; 45%) followed by complete sternal tears (4/20; 20%). Six (30%) of twenty patients consented for on-site follow-up and clinical assessment. Average preoperative physical component scores from SF-36 improved from 43 (range 37.8-52.7) to 53.1 (range 48.1-55.8) at follow up. Average preoperative DASH scores decreased from 74 points (range 68.7-83.3) to 5.3 points (range 1.7-8.3) at follow-up. Average pre-operative ASES scores improved from 82.8 points (range 71.7-96.7) to 96.7 points (range 91.7-98.3) at follow up. Average isokinetic strength deficiency in horizontal adduction at 60°/s was 15% (range 16%-29%) and average at 120°/s was 9% (range 2%-21%). According to the Bak criteria, overall results were excellent in two patients (33%), good in two (33%), while two (33%) had a fair result. CONCLUSION: Surgical repair of PMM rupture by suture anchor fixation provides high patient satisfaction and predictable return of strength, cosmesis, and overall function. Suture anchor fixation produced similar clinical outcomes and return of strength when compared to other surgical repair methods. Our results demonstrate isokinetic strength deficiency similar to historical results. LEVEL OF EVIDENCE: Level 4: Retrospective Case Series.