Minimally Invasive Open Reduction and Maintenance Technique for Anterior Sacrococcygeal Dislocation: A Case Report.

Anterior dislocation of the coccyx is rare, but it can occur due to trauma. Conservative treatment is usually performed. However, dislocation reduction may be required to control severe pain in the acute phase or to prevent chronic complications. If manual reduction fails, open reduction is required. The extent of the incision and the method used to maintain the reduction should be considered during open reduction. A 56-year-old male patient experienced a dislocation of the sacrococcygeal joint after falling backwards. Despite conservative treatment, the patient complained of persistent pain during sitting and when using the bathroom. A manual reduction was attempted but failed. We performed joystick reduction via minimal incision and maintained the reduction using a one-strand trans-osseous suture passing through the skin. The patient was advised to use a soft cushion when sitting or lying down for four weeks after surgery. The supine position was not restricted. The patient's symptoms significantly improved after surgery. At the 6-month follow-up, the sacrococcygeal joint showed good alignment and no surgical complications occurred. During the treatment of sacrococcygeal dislocation, the rapid alleviation of acute pain and minimizing potential complications are key points. If open reduction is needed, the minimally invasive reduction technique with a one-strand trans-osseous suture may offer patient satisfaction and a good surgical outcome.

Analysis of three-dimensional computed tomography talar morphology in relation to pediatric pes planovalgus deformity.

Intraosseous alignment of the tarsal bone has not been investigated in relation to various foot deformities. This study aimed to investigate three-dimensional computed tomography (3D CT) talar morphology in children with idiopathic and neuromuscular pes planovalgus. Eleven children [nine boys, two girls; mean (SD) age: 10.5 (2.8) years] with idiopathic pes planovalgus and 15 children [three boys, 12 girls; mean (SD) age: 10.8 (3.4) years] with neuromuscular pes planovalgus were included. All patients underwent 3D CT and weight-bearing anteroposterior, lateral, and axial radiography. Demographic data and talar 3D CT and radiographic measurements were compared between both groups. The correlation between the measurements was also analyzed. The neuromuscular group showed significantly more severe deformity than the idiopathic group in the radiographic and 3D sagittal talus measurements. The 3D coronal talus measurement showed a significant negative correlation with the axial hindfoot alignment in the idiopathic group while the 3D transverse talus measurement was significantly correlated with the lateral talocalcaneal angle in the neuromuscular group. 3D intraosseous alignment of the talus is correlated with pes planus deformity. Longitudinal and biomechanical studies including a control group are necessary to elucidate the role of 3D talar morphology on a dynamic imbalance in pes planovalgus.

Metallic Press-fit Radial Head Replacement for Radial Head Fractures.

This study evaluated the clinical and radiographic results of patients who sustained nonreconstructible radial head fractures that subsequently were treated with a metallic press-fit radial head prosthesis (RHP). Nine patients with comminuted radial head fractures were treated with a metallic press-fit RHP; mean follow-up was 38.7 months. The radial head fracture was acute in 6 patients (group A) and chronic in 3 patients (group B). Functional evaluation was assessed using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Radiographs were assessed for loosening, radiocapitellar alignment, osteolysis of the radial neck, lucency, periarticular ossifications, and ulnohumeral degeneration. Average flexion and flexion contracture were 133° and 5°, respectively. Average supination and pronation angles were 70° and 73°, respectively. Mean MEPS was 90 (range, 70-100), and elbow performance was excellent in 4 patients, good in 4 patients, and fair in 1 patient. Mean DASH score was 21.9 (range, 0-61). Flexion contracture, forearm rotation arc, and MEPS score were better and the complication rate was lower in group A compared with group B. Centering of the stem was observed on both anteroposterior and lateral radiographs in 6 patients. Lucent lines around the prostheses, stress shielding under the neck of the radius, and ectopic ossification occurred in 5 patients. Three patients had osteoarthritis. Elbow stiffness and ulnar impaction syndrome occurred in 2 patients but only after placement of a secondary RHP. Satisfactory outcomes were obtained using a metallic press-fit RHP for nonreconstructible radial head fractures. [Orthopedics. 2019; 42(6):e545-e551.].

Acute rib fracture caused by preoperative positioning for direct lateral interbody fusion: A case report.

RATIONALE: Degenerative spondylolisthesis is defined as forward slippage of a vertebra with respect to the underlying vertebra and is associated with the induction of lumbar canal stenosis. The use of anterior column support for degenerative lumbar conditions has been well documented. Direct lateral interbody fusion (DLIF) gains access via a lateral approach through the retroperitoneal fat and psoas muscle. It avoids many of the access-related complications yet comes with its own risks and limitations. The location of the iliac wing precludes exposure of the L5-S1 disc space and may make L4-5 surgery difficult. Therefore, accurate preoperative patient positioning is essential. PATIENT CONCERNS: A 71-year-old female with a body mass index (BMI) of 39.2 kg/m (height 155.9 cm, weight 79.5 kg) presented with lumbar pain radiating to the left lower limb. She complained of neurologic claudication with more than 100 m ambulation. DIAGNOSIS: Plain standing view on spine radiography revealed L4-5 spondylolisthesis and disc-space narrowing. Magnetic resonance imaging (MRI) revealed severe L4-5 bilateral foraminal stenosis. After the first surgery, simple rib cage radiography was performed to examine the source of her right-sided flank pain and it revealed acute fracture of the right ninth and tenth ribs. INTERVENTIONS: The patient was laterally positioned on the table in an extreme bending position. The intervertebral cage was inserted in the L4-5 disc space and disc height was restored. With respect to the rib fracture, treatment was conservative. OUTCOMES: The patient's radiating pain was immediately relieved and her lower back pain disappeared at 3 months after surgery. The patient reported right-sided flank pain after the first surgery. Simple rib cage radiography was performed and revealed fracture of the right ninth and tenth ribs. Follow-up assessments conducted 2 months later revealed complete bony union. LESSONS: DLIF avoids many access-related complications. However, it is associated with other intraoperative complications, including injury to the lumbar nerve root and plexus. In addition, there are preoperative complications associated with improper patient placement on the table. In this case, the patient's obesity and strict positional requirements resulted in rib fracture. We suggest that surgeons consider this complication and exercise care in preoperative positioning.

Pectoralis major tendon transfer for recurrent anterior shoulder dislocation after primary surgery in an elderly patient: A case report.

RATIONALE: Adequate stability of traumatic anterior shoulder dislocation without any obvious damage to the anterior capsulolabral structure in elderly patients can be achieved by treating the associated rotator cuff injuries. However, in case of recurrent shoulder dislocation despite rotator cuff repair, the repaired rotator cuff may be weakened or reruptured and is often impossible to repair again. Therefore, the role of the rotator cuff as a shoulder stabilizer cannot be expected. Even if the anterior joint capsule is left, it is too weak to imbrication either. An additional anterior structural reconstruction that can replace the rotator cuff and capsule is needed to prevent recurrence. PATIENT CONCERNS: A 59-year-old man visited our clinic because of traumatic anterior dislocation of the right shoulder combined with anterior-superior rotator cuff tear. Because there was no obvious anterior capsulolabral injury, he underwent arthroscopic rotator cuff repair only. Postoperative rehabilitation was maintained; however, anterior shoulder dislocation recurred 10 months postoperatively. DIAGNOSIS: Physical examination revealed anterior instability in abduction and external rotation of the shoulder joint. Magnetic resonance imaging suggested retear of the repaired anterior-superior rotator cuff and Hill-Sachs lesion of the humeral head. INTERVENTIONS: Diagnostic arthroscopy was performed. The reruptured rotator cuff seemed impossible to repair; thus, arthroscopic remplissage procedure was performed for engaging the Hill-Sachs lesion. In addition, open pectoralis major tendon transfer for anterior stabilization was performed via the deltopectoral approach. OUTCOMES: At the 12-month follow-up, the patient showed good clinical outcomes, including internal rotation of the shoulder joint without recurrent instability. LESSON: Recurrent anterior shoulder dislocation after primary surgery in the elderly may be a challenging situation for surgeons. In patients with irreparable anterior rotator cuff tear and for whom reconstruction of the anterior glenoid is not indicated, pectoralis major tendon transfer is a good treatment option for satisfactory clinical outcomes without recurrence.