Anatomic Reduction and Fixation for Glenoid Fractures: The Kissing Anchor Technique.

Up to one fifth of glenoid fractures are intra-articular and associated with recurrent anterior dislocation. Surgery is often the indicated treatment, and as with many other articular fractures, it aims for a perfectly congruent and flush reconstruction of the articular surface to avoid the onset of secondary degenerative joint diseases. The purpose of this paper is to describe a reproducible, simple arthroscopic technique that uses suture anchors to fix the glenoid fragment with a strong and stable construct called "kissing anchors." This method provides the advantages of both direct and indirect stabilizing effects. It applies 2 anchors, one inside the fragment and the other inside the fracture bed, to stabilize and fix the fragment, and is adequately associated with labrum refixation, which provides the construct with increased stability. However, a surgeon willing to apply it should already be confident with basic shoulder arthroscopy and should have performed an appropriate amount of arthroscopic shoulder stabilizations.

Multidirectional Shoulder Instability: Arthroscopic Labral Augmentation.

Capsulolabral augmentation is one of the most used arthroscopic techniques to address multidirectional instability of the shoulder. Given the thin and weak capsule seen in the affected patients, reconstruction in this subset of patients can be particularly challenging. This arthroscopic technique aims to reduce the capsular volume and deepen the glenoid socket through the creation of a particularly voluminous "bumper" along the glenoid bone. Increasing the depth of the glenoid facilitates a concavity-compression stabilizing effect and, therefore, shoulder stability, especially midrange stability. This technique aims to augment the bump of the standard capsulolabral reconstruction by using a resorbable surgical mesh derived from porcine skin.

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation.

BACKGROUND: The purpose of this work is to evaluate the results of arthroscopic capsulolabroplasty in patients affected by atraumatic shoulder instability (ASI). METHODS: A retrospective review was performed of 10 patients (7 women and 3 men) who underwent arthroscopic treatment of symptomatic ASI. Mean age at evaluation was 27.9 (19-35) years and the mean follow-up was 23.3 (12-37) months. We evaluated recurrence rate, range of movement, apprehension and relocation tests, hyperlaxity, and sport activity. The ASES score, the Rowe score, the Simple Shoulder Test (SST) and Visual Analogue Scale (VAS) were also used as outcomes measure. RESULTS: None of the patients experienced episodes of dislocation or subluxation after surgery. The apprehension and relocation tests produced positive results in 2 patients. Six out of 10 patients reported apprehension with the arm in specific positions. The ASES mean score was 93.4 (55-100); the Rowe mean score was 85.5 (70-100); the SST mean score was 9.1 (5.8-10). On average, external rotation is reduced by 10° in adduction, and by 8° in abduction in 6 out of 10 patients; internal rotation is reduced on average by 6.6° in abduction with the arm abducted, and was overall limited in 6 out of 10 patients. CONCLUSIONS: Arthroscopic capsulolabroplasty ensures excellent results in patients showing atraumatic shoulder instability in terms of recurrence. Still, an underlying insecurity persists and the risk of residual stiffness is tangible. LEVEL OF EVIDENCE: V.

New and emerging infectious diseases.

New emerging infectious diseases include "severe acute respiratory distress syndrome" (SARS) and avian influenza A H5N1. First cases of SARS, induced by a new strain of coronavirus, were described in China in 2002 and by May 2003 8360 cases and 764 deaths were reported by the World Health Organization. The disease can be transmitted from person to person and at the onset is characterized by nonspecific symptoms such as a fever of > 38 degrees C, dry cough, myalgia, and dyspnea. Adults can develop severe hypoxemia requiring intubation, whereas the course of the disease is generally benign in children. Avian influenza A H5N1 is another emerging infectious disease transmitted from avian species to humans, without clear evidence of transmission from human to human. The widespread outbreaks of H5N1 avian influenza in 2003-2004 have caused major problems for the poultry industry in many Asian countries. On January 2004 the disease crossed over to humans, for the first time in Vietnam, causing 74 deaths to date (mortality rate of 50%) in southeastern countries. Unlike SARS, the avian flu occurs in rural areas, where people live in intimate contact with birds, and many of the victims are children < 5 years of age. As for SARS, the World Health Organization has adopted a global action plan to control avian influenza among chickens and ducks and at the same time to limit the threat of a human flu pandemic.