Mid-term results of the use of structural humeral head autograft to correct glenoid bone loss in reverse total shoulder arthroplasty.

Background: Native glenoid bone loss presents technical challenges in shoulder arthroplasty. The purpose of this study is to report the mid-term clinical and radiographic outcomes of patients treated with structural humeral head autograft reconstruction of glenoid bone loss in the setting of reverse total shoulder arthroplasty (rTSA). Methods: Retrospective review of 30 shoulders in 28 patients undergoing rTSA with a structural humeral head autograft to correct glenoid bone loss. Demographics, comorbidities, anatomic details, and patient-reported outcome measures were collected for analysis. Results: Range of motion and patient-reported outcome measures were all significantly improved postoperatively (P < .001). Bone grafts were found to incorporate into 100% of shoulders, with no protheses displaying signs of loosening or other structural concerns. No revision procedures were performed, and all patients were satisfied with their shoulder postoperatively. Two patients developed scapular notching on follow-up. Discussion: The use of a humeral head autograft to reconstruct glenoid bone loss in patients undergoing rTSA is a safe and effective procedure. It allows for a local graft source to be utilized thus avoiding potential comorbidity and complications associated with the use of alternative site autografts or allografts and has the advantage of nearly congruent fit within the defect.

Musculoskeletal Injuries in Cross-Country Skiing.

Cross-country skiing, one of the oldest forms of skiing, is enjoyed widely as a recreational activity and as a competitive sport. It is practiced in regions with snow-covered landscapes, particularly in the Nordic countries and with increasing popularity in non-Nordic countries of Europe as well as in the United States, Canada, Australia, and New Zealand, among others. Cross-country skiing is a fairly safe activity, and historically the risk of injury has been relatively low. However, advances in equipment development, together with increasing speeds, more demanding trails, and growing numbers of participants, have all contributed to a larger report of injuries, although still comparatively low versus other skiing modalities. Injuries in cross-country skiing can occur either after a single traumatic event or in the setting of chronic repetitive microtrauma (i.e., overuse injuries).

Resolution of Osseous Sarcoidosis with Methotrexate.

Though a relatively uncommon manifestation of sarcoidosis, some clinicians are tasked with managing osseous involvement of disease, and the optimal treatment approach in this setting is not well established. Previous studies have shown variable efficacy for osseous sarcoidosis utilizing multiple agents alone or in combination, often using imaging follow-up in conjunction with clinical assessment to evaluate response to treatment. We present a case of widespread skeletal involvement of sarcoidosis without evidence of concurrent pulmonary disease demonstrating marked clinical improvement and near-complete resolution of imaging abnormalities on magnetic resonance imaging (MRI) following the use of methotrexate as the primary pharmacologic agent.

Klippel-Trénaunay Syndrome: Need for Careful Clinical Classification.

Klippel-Trénaunay syndrome (KTS) is a rare congenital malformation characterized by a triad of clinical presentations: (1) capillary malformations manifesting as a "port wine stain"; (2) limb hypertrophy; and (3) venous varicosities. It is distinguished from Parkes-Weber syndrome by the absence of substantial arteriovenous shunting. Due to the clinical implications of an arteriovenous fistula, differentiation between the two syndromes is important, as the prognosis and treatment greatly differ. We present a series of 5 cases of suspected KTS, while emphasizing the difficulties in distinguishing KTS from Parkes-Weber syndrome without diagnostic imaging and underscoring the importance of accurately classifying patients with the appropriate syndrome.

Detection of Intraneural Median Nerve Microvascularity Using Contrast-Enhanced Sonography: A Pilot Study.

OBJECTIVES: Demonstrating vascularity within the human median nerve may be difficult using power Doppler sonography. To this end, a pilot study documenting contrast-enhanced vascularity of the median nerve was conducted. METHODS: Patients undergoing contrast-enhanced transthoracic echocardiography were recruited for this study (n = 24). During echocardiography, a simultaneous contrast-enhanced sonographic examination of the median nerve was conducted. The study and study protocol were built from preclinical evidence. Image analysis was based on the power Doppler pixel intensity within a defined region of interest to obtain quantitative data representing the average pixel intensity, maximum pixel intensity, and power Doppler pixel dot count. Semiquantitative data representing the power Doppler dot count grading were also obtained. RESULTS: Spearman correlations between analytical methods showed strong positive, statistically significant (P< .05) correlations between the average pixel intensity and maximum pixel intensity and between the power Doppler dot count and dot count grading. Statistically significant increases in the average pixel intensity and power Doppler dot count were seen at all but 1 time point throughout the contrast-enhanced sonographic examination when compared to precontrast administration. Statistically significant increases in the maximum pixel intensity were seen at all but 4 time points. CONCLUSIONS: These pilot results represent early evidence that contrast-enhanced sonography can be used to image median nerve vascularity. In this convenience sample, median nerve contrast-enhanced sonographic data collection was feasible, safe, and consistent.