Orthopedics
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Case Reports
Anatomical reconstruction of reverse hill-sachs lesions using the underpinning technique.
Posterior glenohumeral joint dislocation is an uncommon injury and is associated with bony and ligamentous disruption. It requires prompt diagnosis and early treatment to prevent acute or recurrent instability and subsequent dysfunction. Reverse Hill-Sachs lesions associated with this injury are challenging to treat, and optimal treatment is controversial. ⋯ No evidence of collapse, osteonecrosis, or osteoarthritis progression was seen at latest follow-up. Functional results were excellent, with a minimum follow-up of 2 years. This technique is an alternative method of restoring humeral head sphericity in patients with acute posterior glenohumeral joint dislocations with medium (20%-40%) reverse Hill-Sachs lesions.
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Diagnosis of occult hip fractures by initial radiographs remains challenging in the emergency department. Previously, the gold standard for accurate diagnosis of occult hip fractures was magnetic resonance imaging. This study used initial radiographs obtained in the emergency department to evaluate specific signs and measurements as diagnostic references for occult femoral neck fractures in elderly patients. ⋯ When elevation of the fat pad was ⩾1.5 mm, the sensitivity was 0.867 and the specificity was 0.857 for the diagnosis of occult femoral neck fracture. The lateral and posterior signs and elevation of the fat pad ⩾1.5 mm on initial radiographs are recommended as diagnostic references for occult femoral neck fracture. These references are clearly defined and may offer important information for all clinicians and radiologists in the emergency department.
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Glenoid and humeral head bone loss is the most common cause of failure after surgical shoulder instability stabilization. Large Hill-Sachs lesions involving >30% of the articular surface of the humeral head typically occur after neglected or locked shoulder dislocations. Such large lesions may require osteochondral allograft reconstruction or prosthetic replacement to regain shoulder stability and function. ⋯ The allograft was stabilized in the defect of the humeral head using cancellous screws placed from below the articular surface. Radiographs 20 months postoperatively showed complete incorporation of the osteochondral allograft. At 30 months postoperatively, his shoulder was stable and functional.
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Comparative Study
Comparison of dynamic and locked compression plates for treating midshaft clavicle fractures.
The purpose of this study was to compare the parameters of perioperative course and cost-effectiveness for patients with midshaft clavicle fractures treated by dynamic compression plates or locked compression plates. This retrospective, case-controlled study involved 54 patients with midshaft clavicle fractures who received dynamic compression plates (n=21) or locked compression plates (n=33) between January 2002 and December 2008. Indications for surgery included displacement or shortening >2 cm, comminuted fractures, and skin tenting. ⋯ The only statistically significant difference was a higher rate of plate removal requests in the dynamic compression plate group. Considering medical expenditure, locked compression plates cost 6 times more than dynamic compression plates in the authors' institution (US $600 vs $100, respectively). Other than more plate removal requests in the dynamic compression plate group and greater expense in the locked compression plate group, dynamic compression plates and locked compression plates achieved satisfactory operative outcomes in treating midshaft clavicle fractures, with no statistically significant difference between perioperative course and eventual fracture union observed between the 2 groups.
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Case Reports
Thoracic disk herniation with paraparesis treated with transthoracic microdiskectomy in a 14-year-old girl.
Herniated thoracic intervertebral disk causing spinal cord compression with paraparesis is uncommon in adults and rare in children. This article describes a case of pediatric thoracic disk herniation with paraparesis treated surgically. A 14-year-old girl presented with a 4-month history of diffuse back pain and sudden onset paraparesis. ⋯ If no compression of the spinal cord exists, the natural history of the disease justifies conservative management. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurologic deficit or severe radicular pain. Transthoracic microdiskectomy without fusion is considered a treatment in similar cases.