Late Deep Infections Complicating Percutaneous Pinning of Supracondylar Humerus Fractures.

OBJECTIVES: Complications following treatment of supracondylar humerus fractures are typically seen shortly postoperatively. Late complications occurring years after percutaneous pinning are rare but can be indolent and have permanent sequelae. We present cases of children presenting with late deep infections to discuss their diagnosis and treatment. METHODS: After institutional review board approval, we retrospectively reviewed records of three children who developed deep infections at least one year after percutaneous pinning of their supracondylar humerus fracture. Patient details and outcomes were analyzed. Radiographs and magnetic resonance imaging were reviewed along with each patient's clinical course and treatment. RESULTS: We report 3 cases of osteomyelitis and/or septic arthritis presenting at least one year after supracondylar humerus fractures treated with closed reduction and percutaneous pinning. The patients required several irrigation and debridement procedures with placement of antibiotic beads in addition to a prolonged course of antibiotics. CONCLUSION: Delayed deep infections can occur after closed reduction and percutaneous pinning of supracondylar humerus fractures in children. Vigilance is required to diagnose and treat such occurrences, and prolonged follow-up is needed to monitor for recurrent or intractable infections.

First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution.

First metatarsophalangeal (MTP) joint arthrodesis is a surgical procedure in which the first metatarsal head is fused to the proximal phalanx of the great toe in order to permanently stiffen the first MTP joint. It was originally proposed as a treatment for severe cases of hallux valgus deformity, but the procedure's indications and utilization have expanded since its initial development. Despite a wide variety of indications, first MTP arthrodesis has been shown to have reliable, satisfactory outcomes. As a result, the development of a wide array of surgical approaches, joint preparation techniques, and fixation devices used in the procedure has occurred. In this narrative review, we highlight the evolution of fixation constructs used in first MTP arthrodesis in order to provide a frame of reference for the various types of fixation constructs available.

Physical Therapy-Induced Fracture After Reverse Shoulder Arthroplasty: A Case Report.

CASE: We present a case of a physical therapy-induced fracture of the proximal humerus, presumably caused by forceful shoulder flexion and external rotation, after reverse total shoulder arthroplasty (RTSA) in a 70-year-old woman with underlying osteopenia, systemic lupus erythematosus, long-term glucocorticoid use, and common variable immunodeficiency. CONCLUSION: This case of a physical therapy-induced greater tuberosity fracture after RTSA presents an example of an early postoperative complication with no impact on eventual successful surgical outcomes. Special consideration should be given to tailor the postoperative rehabilitation after RTSA in patients with increased risk of fractures.