Anatomical and surgical considerations of the pectoralis muscle.

Introduction: The pectoralis major (PM) muscle is the largest and most superior muscle of the anterior chest wall. The PM plays an important role in flexion, adduction, and internal rotation of the arm. The pectoralis major's size, strength, and anatomical location make it an excellent candidate in transfer surgeries due to its ability to restore balancing forces that may be lost in scapular winging and subscapularis tears. Each of these injuries and pathologies involves the PM muscle in some way, and careful consideration of its anatomy and physiology is necessary. This review article aims to provide a comprehensive overview of the anatomy, physiology, and surgical considerations of the pectoralis muscle with a specific focus on the surgical techniques involving the muscle. Methods: A comprehensive literature search using a combination of the following terms: pectoralis major, rupture, transfer, chronic subscapularis tear, pectoralis surgery, anatomy, scapular winging, and long thoracic nerve anatomy. There were no limitations with regards to article type or publishing date, but article language was limited to only English. Conclusion: The pectoralis muscle is an important muscle when it comes to function of the upper extremity primarily or through transfer procedure. Injuries and impairments of the pectoralis major or other muscles of the upper extremity can significantly impact an individual's quality of life, limiting their ability to perform activities of daily living. A thorough understanding of anatomical, functional, and surgical purposes of the pectoralis muscle is crucial for achieving optimal outcomes and avoiding complications.

A systematic review of posterior pilon variant fractures.

Posterior pilon variant ankle fractures (PPVF) are a unique subtype of posterior malleolar fractures which have been a source of controversy and confusion in recent years. There has not been a thorough literature review previously written on the topic. Database searches of PubMed and Embase were conducted from inception until June 2023. The key words included "pilon variant," "posterior pilon variant," and "posterior pilon" fractures. Outcomes were evaluated by union time, rates of delayed union, nonunion, malunion, and complication. A total of 15 articles relevant to surgical repair of pilon variant fractures were included in the literature review. The unique mechanism of injury has been reported to involve both rotational and axial forces, leading to involvement of the posterior and medial aspects of the distal tibia. Pilon variant fractures can be suspected by several characteristics on radiographs and have a high confirmation rate via CT images. Multiple systems have been proposed to classify this fracture pattern, but there is no consensus on the ideal classification system. Surgically, direct fixation has shown better short-term clinical outcomes versus indirect fixation or no fixation. PPVF have a distinct fracture pattern involving the posterior and medial columns of the distal tibial plafond, and results from a mechanism intermediate to rotational and axial forces. These fractures are more severe than tri-malleolar fractures due to increased rates of articular impaction and incongruity. Future classification systems should focus on joint surface area and the tibial pilon column involved to avoid confusion with less severe posterior malleolar fractures.