Pectoralis-major-pedicled bone window for revision of a shoulder arthroplasty.

PURPOSE: The aim of this study is to review our experience with the pectoralis-major-pedicled bone window for the revision of shoulder arthroplasty. METHODS: This study used the retrospective case series of six patients who underwent a pectoralis-major-pedicled bone window for revision of shoulder arthroplasty, with a minimum follow-up of 2 years. Demographic, clinical, and radiological data were analyzed. RESULTS: The mean age of the included patients was 72.6 years old (standard deviation (SD) 4.7), and 83.3% were women (5/1). The mean follow-up was 36.6 months (range 25-48 months). Five patients had a shoulder hemiarthroplasty and one patient a reverse shoulder arthroplasty. The indications for revision were pain in five patients and recurrent dislocation in one patient. No intraoperative complications were found. One patient developed a wound infection that required debridement and a two-stage revision. Despite complications, 2 years after surgery, the range of motions and functional scores were improved from preoperative levels. The difference between preoperative and postoperative VAS pain scores was 7.1 points (p < 0.001). The difference between preoperative and postoperative CSS and ASES questionnaires were 32 and 31.6 points, respectively (p < 0.001). At the final follow-up, all radiographs showed bone union of the osteotomy, good fixation of all components, without evidence of prosthetic loosening or migration. CONCLUSIONS: Revision of a shoulder arthroplasty using a pectoralis-major-pedicled bone window can be an effective treatment that can yield pain relief; however, improvements in motion and function were difficult to achieve.

Patient outcomes after humeral fracture surgery during the COVID-19 outbreak in Spain.

BACKGROUND: The global spread of the 2019 novel coronavirus (COVID-19) has profoundly affected the way we conduct our health care practices. The goal of this paper is to report the outcomes of 11 patients who underwent humeral fracture surgery in the first few weeks of the COVID-19 outbreak in Spain. METHODS: This was a retrospective case series of 11 patients who underwent humeral fracture surgery during the first weeks of the COVID-19 outbreak in Spain, between March 10 and April 25, 2020. The clinical outcomes of these operative patients were monitored up to May 12, 2020, the final date of follow-up, a minimum of 15 days after all patients were discharged from the hospital. COVID-19 infection, mortality, demographic, clinical, and laboratory data were analyzed. RESULTS: Thirty-six humeral fractures were recorded between March 10 and April 25, 2020. During this period, humeral fracture fixation was the third most common surgery for fracture in our institution after hip fracture and ankle fracture surgery. Eleven patients underwent surgery (30.5%), of whom 7 were women (63.3%). The mean age was 64.8 years (standard deviation, 13.5). Nine operated cases had a proximal humerus fracture and 2 had a humeral shaft fracture. One of the 11 patients was positive for SARS-CoV-2 on the basis of the quantitative reverse transcription polymerase chain reaction of throat swab samples. The overall median surgical time was 101.2 minutes (standard deviation, 28.4). The overall median hospital length stay for the patient discharged was 2.2 days (range, 1-4 days). No COVID-19 nosocomial intrahospital infection occurred, and no patient reported COVID-19 infection during the 15 days after hospital discharge. No intrahospital mortality was recorded. Furthermore, no COVID-19 infection was reported in the shoulder surgeons who performed the surgeries. CONCLUSIONS: Although humeral fractures were not the most frequent fractures during this outbreak, some required surgery. With good preoperative management that included reverse transcription polymerase chain reaction for COVID-19 and chest radiographs, protective measurements for the surgical team, and rapid discharge of the patients, we were able to operate on 11 humeral fractures with no COVID-19 nosocomial intrahospital infection in the patients or in the shoulder surgeons who performed the surgeries.

Shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus in the elderly.

PURPOSE: The aim of this paper was to present our experience and the outcomes in 3 elderly patients who underwent combined shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus in our center. Also, we evaluate difficulties in their treatment and report their final follow-up. MATERIAL AND METHODS: Three cases of elderly patients who underwent shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus were reviewed. Demographic, clinical, and radiological data were analyzed. Also, Constant Shoulder Score, Mayo Elbow Performance Score, Short-Form Health Survey, and four-point Likert scale were evaluated. RESULTS: All patients were females (100%). Mean age was 75 years (range 73-78). Mean follow-up was 36.6 months (SD 11.5). Mean time between injury and surgery was 12 days (SD 7.6). The 3 patients had a displaced and comminuted fracture of the humeral head (4-part, by Neer classification) and a comminuted intraarticular fracture of the distal humerus (13-C3, by AO classification). One patient presented a wound infection that required debridement. Despite the complications, at final follow-up, all patients showed a sufficient capacity to perform comfortably in their daily activities. Radiographs showed good fixation of all components, without evidence of prosthetic loosening or migration. All evaluated scores had good or excellent results. CONCLUSIONS: Our study provides further evidence that the shoulder and elbow arthroplasty could be a reliable management for ipsilateral fractures of the proximal and distal humerus in the elderly. In our study, this technique showed in the final follow-up patient's good outcomes.

Lateral subtalar dislocation associated with bimalleolar fracture: case report and literature review.

Subtalar dislocation is an uncommon injury that affects the talocalcaneal and talonavicular joints, with the tibiotalar and calcaneocuboid joints remaining intact. The 4 types of subtalar dislocation are medial, lateral, anterior, and posterior, although the latter 2 are rare. These injuries-especially lateral dislocation-occur as a result of high-energy trauma. Medial dislocation is the most common type, and lateral dislocation is associated with osteochondral fractures of the talus and calcaneus, as well as with open injuries; hence, its worse prognosis. We report the case of a 62-year-old woman diagnosed with lateral subtalar dislocation accompanied by an ipsilateral bimalleolar fracture after a fall downstairs. She underwent emergency reduction of the dislocation under sedation. Surgical treatment of the bimalleolar fracture was delayed 9 days to avoid cutaneous complications. This is the first report of a subtalar dislocation accompanied by a bimalleolar fracture.

Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience.

INTRODUCTION: The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim is to share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and strategies we have implemented. METHODS: Our experience comes from our work at a referral hospital within the Spanish National Health System. Changes to clinical practice have largely been guided by the current evidence and four main principles: (1) patient and health-care worker protection, (2) uninterrupted necessary care, (3) conservation of health-care resources, (4) uninterrupted formation for residents. Based on these principles, changes in the service organization, elective clinical visits, emergency visits, surgical procedures, and inpatient and outpatient care were made. RESULTS: Using the guidance of experts, we were able to help the hospital address the demands of the Covid-19 outbreak. We reduced to a third of our orthopaedics and trauma hospital beds, provided coverage for general emergency services, and five ICUs, all continuing to provide care for our patients, in the form of 102 trauma surgeries, 6413 phone interviews and 520 emergency clinic visits. Also in the third week, we were able to restart morning meetings via telematics, and teaching sessions for our residents. On the other hand, eight of the healthcare personnel on our service (10.8%) became infected with Covid-19. CONCLUSIONS: As priorities and resources increasingly shift towards the COVID-19 pandemic, it is possible to maintain the high standard and quality of care necessary for trauma and orthopaedics patients while the pandemic persists. We must be prepared to organize our healthcare workers in such a way that the needs of both inpatients and outpatients are met. It is still possible to operate on those patients who need it. Unfortunately, some healthcare workers will become infected. It is essential that we protect those most susceptible to severer consequences of Covid-19. Also crucial are optimized protective measures.

Pseudoaneurysm of the superior gluteal artery during iliosacral screw fixation.

We present a case of a pseudoaneurysm of the superior gluteal artery following placement of an iliosacral screw in a patient with an unstable pelvic ring fracture. Percutaneous fixation of posterior pelvic ring injuries is becoming a popular method for pelvic stabilization. Several techniques are available t achieve stability and allow early mobilization in patients with displaced pelvic fractures. Percutaneous screw fixation of sacral fractures or sacroiliac joint disruptions should reduce operative and anaesthesia times as well as blood loss, while lowering the risk of surgical wound problems are decreased. The risks with this technique are generally iatrogenic, related with surgeon's lack of experience or imaging difficulties at the time of screw placement. The present case report describes an injury to the superior gluteal arterial system during percutaneous iliosacral screw insertion.

Subtrochanteric fractures: treatment with cerclage wire and long intramedullary nail.

Fracture malalignment and nonunion are not infrequent after treating subtrochanteric fractures with intramedullary nails. The use of a cerclage wire with a minimally invasive approach to aid and maintain reduction in certain subtrochanteric fracture patterns can be an effective surgical strategy to improve outcome. It allows the surgeon to obtain and maintain an anatomic reduction with more bone contact, which will aid in fracture consolidation. This has the added advantage of optimizing the greater trochanteric starting point. It minimizes malreductions of the proximal femoral fragment, and, we believe, that its rational use with a minimally invasive technique is a key factor in achieving good results.

Traumatic floating clavicle: a case report.

Most published reports of a floating clavicle consist of a dislocation of both ends of the clavicle and are associated with a high-energy injury. We report a 71 year old patient with a fracture of the medial end of the clavicle with anterior sternoclavicular dislocation and a nondisplaced fracture of the lateral end of the same clavicle distal to the insertion of coracoclavicular ligaments due to a low velocity fall.