CT-based quantitative assessment of the surface size and en-face position of the coracoid block post-Latarjet procedure

Background

The success of shoulder stabilization with the Latarjet procedure might depend on the size of the bone graft and the positioning of the coracoid at the glenoid. The aim of this study was to quantitatively assess the surface of the coracoid bone graft and to assess its positioning in the en-face view.

Method

A series of 21 patients (17 men, 4 women, 26.1 ± 6.8 years—9 right, 12 left shoulders) were prospectively included and followed up with CT scans between December 2010 and April 2012 at an average of 2.4 ± 0.7 months postoperatively. The retrospective analysis of the CT scans was performed with Osirix? software. The coracoid surface was measured (cm²) in the sagittal plane. The positioning in relation to the center of the circumscribed circle of the glenoid was determined in the en-face clock face view of the glenoid.

Results

The grafts had a mean surface of 1.61 ± 0.51 cm² (mean ± standard deviation). The coracoid grafts were located between 01:05 hours (32.5°) and 05:33 hours (166.6°). Mean positioning was 02:00 hours (59.8° ± 16.1°) to 04:26 hours (133.0° ± 16.9°). The extent of the grafts was 73.2° ± 14.3°.

Discussion

The positioning of the coracoid graft on the clock face of the glenoid is situated in the decisive zone of 02:30–04:20 hours. The mean surface of the graft is smaller than expected from anatomical studies, but restores in defect situations bone stock in the potential defect areas at the anterior glenoid rim.

Level of evidence

Level IV, prospective case series, treatment study.     

α-Synucleinopathy associated with G51D SNCA mutation: a link between Parkinson’s disease and multiple system atrophy?

We report a British family with young-onset Parkinson’s disease (PD) and a G51D SNCA mutation that segregates with the disease. Family history was consistent with autosomal dominant inheritance as both the father and sister of the proband developed levodopa-responsive parkinsonism with onset in their late thirties. Clinical features show similarity to those seen in families with SNCA triplication and to cases of A53T SNCA mutation. Post-mortem brain examination of the proband revealed atrophy affecting frontal and temporal lobes in addition to the caudate, putamen, globus pallidus and amygdala. There was severe loss of pigmentation in the substantia nigra and pallor of the locus coeruleus. Neuronal loss was most marked in frontal and temporal cortices, hippocampal CA2/3 subregions, substantia nigra, locus coeruleus and dorsal motor nucleus of the vagus. The cellular pathology included widespread and frequent neuronal α-synuclein immunoreactive inclusions of variable morphology and oligodendroglial inclusions similar to the glial cytoplasmic inclusions of multiple system atrophy (MSA). Both inclusion types were ubiquitin and p62 positive and were labelled with phosphorylation-dependent anti-α-synuclein antibodies In addition, TDP-43 immunoreactive inclusions were observed in limbic regions and in the striatum. Together the data show clinical and neuropathological similarities to both the A53T SNCA mutation and multiplication cases. The cellular neuropathological features of this case share some characteristics of both PD and MSA with additional unique striatal and neocortical pathology. Greater understanding of the disease mechanism underlying the G51D mutation could aid in understanding of α-synuclein biology and its impact on disease phenotype.     

Alliance ruptures and rupture resolution in cognitive–behavior therapy: A preliminary task analysis

Abstract

An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive–behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures and what they actually do and suggested that the rational model should be expanded to emphasize client validation and empowerment. Therapists’ ability to attend to ruptures emerged as an important clinical skill.     

Community Led Co-Design of a Social Networking Platform with Adolescents with Autism Spectrum Disorder

Journal of Autism and Developmental Disorders - Adolescents with ASD face challenges in forming positive friendships due to their ASD condition. This study developed a social networking platform...     

Anterior shoulder stabilization by Bristow–Latarjet procedure in athletes: return-to-sport and functional outcomes at minimum 2-year follow-up

Purpose

The aim of this study was to assess return-to-sport outcomes following the Latarjet–Bristow procedure.

Methods

This retrospective study included all athletes <50 years old, who underwent a Latarjet–Bristow procedure for anterior shoulder instability in 2009–2012. Main criteria assessments were the number of athletes returning to any sport and the number returning to the same sport at their preinjury level. The main follow-up was 46.8 ± 9.7 months.

Results

Forty-seven patients were analyzed, 46 men/1 women, mean age 27.9 ± 7.9 years. Eighteen patients practiced competitive sports and 29 recreational sports. None of them were professional athletes. One hundred percent returned to sports after a mean 6.3 ± 4.3 months. Thirty/47 (63.8 %) patients returned to the same sport at the same level at least and 10/47 (21.3 %) patients changed sport because of their shoulder. Compared to patients who returned to the same sport at the same level, patients who changed sports or returned to a lower level had practiced overhead or forced overhead sports [OR = 4.7 (1.3–16.9), p = 0.02] before surgery, experienced avoidance behavior at the final follow-up (p = 0.002), apprehension (p = 0.00001) and had a worse Western Ontario Shoulder Instability Index score and sub-items (p = 0.003) except for daily activities (p = 0.21). At the final follow-up, 45/47 (95.7 %) patients were still practicing a sport.

Conclusion

All the patients returned to sports, most to their preinjury sport at the same level. Patients who practiced an overhead sport were more likely to play at a lower level or to change sport postoperatively.

Level of evidence

IV, retrospective study—Case series with no comparison group.