Clavicle fracture after reverse total shoulder arthroplasty: a case report with literature review.

In reverse total shoulder arthroplasty, retensioning of the deltoid muscle is essential for regaining active elevation. However, the procedure remains problematic, in that it may potentially produce complications not only because it is a complex procedure but also because it causes anatomical changes. We experienced a rare case of a 64-year-old woman presenting with non-traumatic clavicle fracture after reverse total shoulder arthroplasty via a deltopectoral approach. In our case, the patient presented with pain in the clavicle area, which worsened during joint movement. Therefore, surgeons should consider the possibility of clavicle fracture in patients presenting with pain in the clavicle area which worsens.

Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty.

BACKGROUND: We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. METHODS: We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. RESULTS: The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups. CONCLUSIONS: Surgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed.

A tenosynovial giant cell tumor arising from femoral attachment of the anterior cruciate ligament.

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.

Positional change of hyoid bone after anesthesia in anterior surgery of upper cervical spine.

BACKGROUND CONTEXT: The hyoid bone is used as a landmark in anterior upper cervical spine operations and is supposed to represent the level of C3 body. However, this correspondence between hyoid bone position and cervical level is not static and changes during surgery (extension after anesthesia). PURPOSE: To find the cervical level corresponding to the position of hyoid bone before and after anesthesia and to evaluate the adequacy of its usage as a surgical landmark. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: One hundred twenty-eight patients with degenerative cervical diseases who had undergone anterior cervical discectomy and fusion. OUTCOME MEASURE: Radiologic measure. METHODS: For each patient, preanesthesia neutral, preanesthesia extension, and postanesthesia induction extension C-spine lateral image were obtained. The level of cervical vertebra that midline of hyoid bone indicated was measured by radiological method. A cervical vertebra was divided into three segments, consisting of upper half, lower half, and disc space, and each of these segments was considered as one level. The differences between pre- and postanesthesia induction hyoid positions were classified as minimal change (one level or less) and significant change (two levels or greater). Relationship between positional change of hyoid bone to gender, obesity, and age were respectively investigated. RESULTS: There were 20 cases of one-level distal displacement of the hyoid bone, 40 cases of two-level distal displacement, 34 cases of three-level distal displacement, 16 cases of 4-level distal displacement, and two cases of five-level distal displacement. In eight cases, there was no level change, and in the remaining 8 cases, the hyoid bone had been displaced proximally. There were 34 cases of minimal change. The remaining 94 cases (73.4%) had significant changes. No respective relationship was found between sex, obesity, age and pre-and postanesthesia induction positional change of hyoid bone. CONCLUSIONS: Among the 128 cases studied, 73.4% hyoid bone positions had changed by more than one cervical vertebra body between the pre- to postanesthesia induction X-ray images. Sex, age, and body mass index were not associated with statistically significant differences in these positions. The hyoid bone should not be trusted as a landmark for upper cervical operations, and the cervical level to be operated should be confirmed by a radiological method before a skin incision is made.

Unicondylar osteoarticular allograft reconstruction of the distal femur in a patient with a traumatic osteoaticular defect of the lateral femoral condyle.

PURPOSE: The objective of this study was to report the clinical results for a patient with a post-traumatic osteoarticular defect of the lateral femoral condyle treated with unicondylar osteoarticular allograft reconstruction. METHOD: We describe the case with a massive osteoarticular loss of the lateral femoral condyle combined with a grade IIIA open distal femoral diaphyesal fracture. The patient underwent unicondylar osteoarticular reconstruction with an allogenic fresh-frozen condyle. RESULTS: There were no complications after the reconstructive procedure. At the five year follow-up, the patient showed a favorable clinical outcome with a full range of motion of the knee joint. Degenerative changes were seen in the graft compartment, but they did not cause serious functional limitations. CONCLUSION: Unicondylar allograft reconstruction appears to be a surgical option for patients who suffer from a post-traumatic distal femoral osteoarticular defect in which only one condyle is absent or severely damaged.