Dysphagia 27 years after cervical disc arthroplasty

IntroductionDysphagia is a frequent postoperative symptom after anterior cervical disc arthroplasty. However, onset of dysphagia and neck pain a long time after surgery should suggest a diagnosis of prosthesis dislocation.Care reportA 65-year-old man with a history of cervical disc arthroplasty 27 years previously consulted for rapidly progressive dysphagia with no other associated symptoms. Physical examination and CT scan confirmed the diagnosis of anterior dislocation of the prosthesis with no signs of perforation. Surgical extraction via a neck incision allowed resolution of the symptoms.DiscussionProsthesis dislocation should be considered in a patient with a history of cervical disc arthroplasty presenting with dysphagia and neck pain. The clinical and radiological assessment confirmed the diagnosis and early surgical management allowed resolution of the symptoms and avoided complications such as pharyngo-oesophageal perforation.     

Metastasis size in pathologic femoral fractures

Radiographic assessment was made of metastases in 69 consecutive patients with pathologic femoral fractures. The following variables were considered: width of metastasis, ratio between width of metastasis and bone, axial length of cortical destruction, and proportion of cortical bone destroyed of the circumference. Differences in size of the metastases were not related to location in the femur or histologic type. In 62 of 69 fractures the ratio between width of the metastasis and bone was ≥ 0.60, axial cortical destruction in the neck was ≥ 13 mm and in other parts of the femur ≥ 30 mm, and cortical destruction of the circumference ≥ 50 percent. Prophylactic internal fixation need not be considered for femur metastatic lesions that do not reach these limits.     

阔筋膜重建环状韧带治疗陈旧性桡骨小头脱位的疗效

目的观察阔筋膜重建环状韧带治疗陈旧性桡骨小头脱位的疗效，为临床治疗提供参考。方法选择2010年6月-2012年5月收治的34例陈旧性桡骨小头脱位患者作为研究对象，均接受阔筋膜重建环状韧带治疗。术后随访6个月，以Mackay肘关节功能评分、Barthel指数等评价疗效，对比治疗前后患者肘关节功能、生活质量的差异性。结果与治疗前比较发现，治疗后患者肘关节功能明显改善，生活质量明显提高，差异具有统计学AX（P〈0．05）。结论阔筋膜重建环状韧带治疗陈旧性桡骨小头脱位，可明显改善患者的肘关节功能和生活质量，疗效具有一定的优越性，值得在今后的临床工作中予以推广应用。     

The role of postoperative positioning after DSAEK in preventing graft dislocation

Purpose: The aim of the study was to evaluate the importance of immediate postoperative supine patient positioning after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Forty eyes from 40 patients who underwent DSAEK were randomized into two groups: 20 patients sat in a chair for 2 hr postoperatively (group 1), and 20 patients were placed in a supine position (group 2) for the same time interval. At the end of surgery, the anterior chamber was fully filled with air, aiming at an intraocular pressure (IOP) of approximately 20 mmHg. The dislocation rate in the two groups was registered. IOP was measured 2 hr postoperatively and compared with endothelial cell loss at 6 months. Results: There was no statistically significant difference in the dislocation rate between the two groups (p = 0.548): two patients (10%) in group 1 and one patient (5%) in group 2. Endothelial cell loss at 6 months was 29.6% and 29.7% in group 1 and 2, respectively. There was no correlation between the IOP 2 hr after surgery and endothelial cell loss at 6 months (p = 0.741). Conclusion: Supine positioning does not seem to be of crucial importance in avoiding graft dislocation in DSAEK when the anterior chamber is fully filled with air for 2 hr postoperatively.     

Acute high-grade acromioclavicular dislocations treated with triple button device (MINAR): Preliminary results

ObjectiveDescribe the clinical and radiological results of triple button device in the treatment of high-grade AC dislocations (Rockwood, type V) and assess whether improves vertical and horizontal stability compared to the techniques previously described.Material and methodsThis retrospective study included 39 patients with type V acromioclavicular dislocations treated with Twin Tail TightRope™ system (triple button device). Of the 39 patients, 33 (26 men and 7 women) were able to participate in clinical and radiographic follow up. At the time of surgery, the mean age was 25 years ± 7 (range, 17–49). All patients underwent bilateral-weighted Zanca (CC distance) and Alexander view (AC distance) as well as the Constant Score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI). Radiological and clinical outcome was assessed during routine follow-up examinations preoperatively, postoperatively, 1, 3, 6 months and every year after the surgery. The presence of calcification, degenerative changes, mobilization of implants and bone resorption were also assessed.ResultsAfter a mean follow up of 25 ± 4 months (range 14–38), the results of the Constant (CS) were 94.1 ± 5,5 (range 76–100) and test ACJI 87.3 ± 9,8 (range 65–100), showing no significant differences with the uninjured shoulder (CS 95.8 ± 2.5, range 83–100; ACJI 94.1 ± 3.7, range 80–100). At final review, we observed that preoperative coracoclavicular distance (Zanca View) improved from 21,75 ± 1.97 mm to 8,73 mm ± 0.75 and the acromioclavicular distance (Alexander View) from 12,65 mm ± 1.99 to 0,35 ± 0.3 mm. Compared with healthy shoulder, these differences were not significant. There was no loss of reduction with this system in the vertical plane. 4 patients (12.12%) revealed signs of posterior instability with worse clinical test results. The presence of degenerative joint changes (6,06%), calcifications (27,2%) or mobilization of the implant (18,18%) was not associated with worse clinical outcomes.ConclusionTwin Tail device using minimally invasive technique improves stability in the vertical and, specially in the horizontal plane relative to the previously described techniques without increasing number of complications.     

Lunate dislocation causing median nerve entrapment

Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy.