Combined Pyogenic and Tuberculous Osteomyelitis of the Clavicle: A Case Report.

INTRODUCTION: Tuberculous osteomyelitis of the clavicle accounts for 1-3% of cases of osteoarticular tuberculosis. It presents with non-specific symptoms and may have superadded infections with pyogenic organisms, requiring a high degree of suspicion to adequately diagnose and initiate appropriate treatment. CASE REPORT: We describe a case of a 35-year-old male with osteolytic clavicular lesion and abscess in the supraclavicular fossa. Tissue diagnosis revealed tuberculous osteomyelitis with superadded infection with Staphylococcus aureus. He was managed with debridement and anti-tubercular therapy. CONCLUSION: A high degree of suspicion is required to adequately test and diagnose the cause of osteomyelitis of the clavicle, in the absence of a predisposing event, as staphylococcal and tuberculous infection can present simultaneously.

Geometric analysis of the humeral head and glenoid in the Indian population and its clinical significance.

BACKGROUND: Total anatomic and reverse shoulder prostheses are designed to match the dimensions of the native bony anatomy. Chinese and Japanese bony dimensions of the shoulder have been found to be different from that of the Caucasian population. We hypothesized that the geometric dimensions of the humeral head and glenoid in the Indian population would also be different from that of the Caucasian population. METHOD: Fifty patients underwent computerized tomographic scans of their normal shoulders. We calculated the superoinferior (SI) diameter of the humeral head, anteroposterior diameter of the humeral head, radius of curvature of the humeral head, humeral head retroversion, humeral head thickness, inclination angle, critical shoulder angle, greater tuberosity angle, glenoid width, glenoid length, radius of curvature of the glenoid, glenoid inclination angle, and glenoid version. RESULTS: The radius of curvature of the humeral head averaged 22.9 ± 1.7 mm, the articular surface thickness 17.1 ± 1.6 mm, and the SI diameter 42.3 ± 3 mm. The SI diameter strongly correlated with the thickness (r = 0.617, P = .001). The anteroposterior/SI articular surface diameter ratio averaged 0.9 ± 0.9, the articular surface thickness/radius of curvature ratio 0.7 ± 0.9, the inclination angle 133.8 ± 6.4, and the retroversion angle 33.5° ± 8.5°. The radius of curvature of the glenoid averaged 23.3 ± 3.4 mm, the glenoid width 24.0 ± 2 mm, the SI length 31.3 ± 2.2 mm, the glenoid inclination angle 78.7° ± 4.8°, and the glenoid retroversion 1.8° ± 3.8°. DISCUSSION: Compared with the Western population, our cohort had a smaller humeral radius of curvature (P = .04), smaller articular surface diameter (P = .001), smaller inclination angle (P = .003), larger retroversion angle of the humeral head (P < .001), and smaller glenoid length and width (P < .0001). Most of the implant companies did not have smaller sized combinations of humeral heads with thickness to match our population. The glenoid width of females in our cohort was found to be smaller for the smallest size of the glenoid base plate. CONCLUSION: Smaller sized options in humeral head diameter and thickness of the anatomic prosthesis and glenoid baseplate of the reverse shoulder prosthesis need to be made available to suit our population and avoid a mismatch.

The Distance between the Pectoralis Major Tendon Insertion and the Top of the Humeral Head is a Reliable Landmark: An Anatomic Study.

Purpose This study aimed to analyze the distance between the superior edge of the pectoralis major and the top of the humeral head and evaluate whether this distance is a consistent measurement. Methods Twenty-two shoulders in eleven cadavers were dissected and the attachment of the pectoralis major tendon was preserved. Two distances were recorded with the help of digital vernier caliper: the distance between the upper edge of pectoralis major and tangent to the top of humeral head (PM-T) and the distance between the superomedial tip of greater tuberosity (GT) and the upper edge of the pectoralis major tendon (PM-G; ± standard error of the means). Results The mean PM-T distance was 53.8 mm (±0.8 mm) and the mean PM-G distance was 46.8 mm (±0.9 mm). The distance between the top of humeral head and tip of the GT was 7 mm. The PM-T distance was a significant outlier in three shoulders as it inserted high on the humerus. Conclusion We can conclude that the PM-T and PM-G distances were a consistent measurement. Clinical Relevance The distance between the pectoralis major tendon and top of the humeral head was measured in this study as a reliable method that can be used intraoperatively to decide the height of the humerus prosthesis in comminuted fractures of the proximal humerus.

Insertion anatomy of the pectoralis major tendon.

BACKGROUND: Pectoralis major tendon tears are encountered in young active patients. METHODS: In 10 fresh cadaveric shoulders we measured-1. Proximal to distal insertion width of the pectoralis major tendon.2. The distance of the superior border of the tendon from the supero-medial tip of the greater tuberosity (GT). RESULTS: The average insertion width was 46 mm. The average distance between the superior border of the tendon and the tip of the GT was 48.5 mm. CONCLUSION: The superior border of the tendon should be repaired with two anchors at a distance of 48.5 mm from the tip of the GT so as to cover a width of 46 mm.