Shoulder Arthroscopy (Cadaver) Patrick Vavken, MD1; Sabah Ali2 1Smith and Nephew Endoscopy Laboratory 2University of Central Florida College of Medicine
Shoulder arthroscopy is one of the most common procedures performed in orthopaedic surgery. It can be utilized to identify various pathologies including rotator cuff tears, degenerative arthritis, subacromial impingement, and proximal humeral fractures. With continued advancement in arthroscopy, patients benefit from smaller incisions, reduced risk of postoperative complications, and faster recovery compared to open surgery.
Shoulder arthroscopy is performed either in the lateral decubitus position or in the beach chair position (BCP) as seen in this video. The BCP provides greater benefits such as decreased neovascularization during portal placement, fewer cases of neuropathies, and reduced surgical time. In addition to position, there are various portals used in shoulder arthroscopy, with the posterior portal being the most common and used in this video. Complication rates from shoulder arthroscopy are low but include shoulder stiffness, iatrogenic tendon injury, and vascular injury. Therefore, proper patient selection, patient positioning, and appropriate portal selection are essential for successful shoulder arthroscopy. This article discusses shoulder arthroscopy and demonstrates the technique on a cadaver shoulder.
This article present the case of a female patient in her early 20’s who was seen for follow up after 5 months of rehabilitation following surgical procedures to address instability in both the medial and lateral sides of her right ankle. This patient reported achieving an excellent outcome, and her subjective sense of significant improvement after rehabilitation was aligned with her physical exam and radiographic evaluation. This case documents the improvements made by the patient during the rehabilitation process and outlines essential steps to be performed by the practitioner in the clinical examination and radiographic follow up after surgery for ankle instability.
This is the case of a 31-year-old female with a history of juvenile rheumatoid arthritis and uveitis who presented with a leg-length discrepancy and low back pain refractory to conservative management. She underwent a shortening osteotomy on her left femur around an intramedullary nail that went on to nonunion.
She underwent exchange nailing with a magnetic intramedullary nailing with autologous bone graft harvest from her affected femoral reamings. The magnetic intramedullary nail was extended 2 cm prior to insertion, and then implanted in the usual fashion with immediate compression in the operating room. Postoperatively the patient underwent a compressive program using the magnetic nail and went on to heal her osteotomy site.
Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.
Deltoid Ligament Repair William B. Hogan1; Eric M. Bluman, MD, PhD2 1Warren Alpert Medical School of Brown University 2Brigham and Women’s Hospital
Injury to the medial deltoid ligament complex is rare as it is the strongest of the ankle ligaments. However, damage to this structure can occur, often in association with an avulsion fracture of the medial malleolus due to the ligamentous strength of the complex. Deltoid ligament repair remains a primary option for patients with severe acute injuries, or patients with chronic instability who have failed conservative measures.
Repair of the medial ankle ligaments provides improved stability with reduced risk of recurrent sprains and potential damage to local cartilage. This article presents a case of a young woman with concomitant medial and lateral ankle instability who successfully underwent deltoid ligament repair for her medial ligament injury.
Diaphyseal tibial fractures are common injuries that are most often treated with intramedullary nailing. However, certain patient factors may necessitate alternative treatment strategies such as open reduction internal fixation (ORIF) with plates and screws. Presence of a total knee arthroplasty (TKA) in the injured extremity is one such factor. TKA is a common operation that is only increasing in popularity, and management of tibia fractures distal to TKA may be a frequently encountered clinical scenario.
This video presents a technique for ORIF of a distal diaphyseal tibia fracture distal to a TKA that precludes intramedullary nail fixation. The fracture is fixed with lag screws and secured with an anatomically-contoured distal tibia locking-compression plate (LCP) in neutralization mode.
This case presents a patient with a pathologic subtrochanteric femur fracture secondary to an undiagnosed primary lung adenocarcinoma. The fracture, occurring in the context of persistent atraumatic thigh and knee pain, prompted swift identification of its pathological nature in the Emergency Department. The treatment plan involved open reduction and internal fixation utilizing a carbon fiber nail, considering the immediate need for stabilization and underlying oncologic factors.
This article highlights the strategic use of carbon fiber implants in managing pathologic fractures, offering advantages in postoperative imaging, disease monitoring, and precision in radiation therapy planning. The multidisciplinary approach underscores the importance of considering implant selection nuances, especially in metastatic bone disease, to optimize outcomes.
Acute ankle sprains are most frequently treated conservatively, although some surgeons may advocate acute repairs in certain situations. Surgery is indicated for chronic sprains with persistent ankle instability despite well-designed conservative management. Several anatomic and nonanatomic operative procedures are available. The Broström-Gould procedure is a widely-used operative intervention for the treatment of chronic lateral ankle sprains. It consists of an anatomic repair or reconstruction of the injured lateral ankle ligament complex (Broström procedure), followed by suturing of the inferior extensor retinaculum to the periosteum of the distal fibula (Gould modification).
This article describes the standard Broström-Gould procedure starting with the identification of the anatomic landmarks. The skin incision follows the anterior border of the distal fibula, and careful subcutaneous dissection is carried out to expose the extensor retinaculum and the torn ligaments. This is followed by bone preparation and ligament repair utilizing a box stitch technique while holding the ankle in an appropriate position. Finally, the Gould portion of the procedure is demonstrated.
This is a case discussing a 21-year-old male who suffered from both non-comminuted mandibular parasymphyseal and body fractures as a result of a motor vehicle accident, requiring open reduction internal fixation (ORIF) without postoperative maxillomandibular fixation (MMF). The fracture was complicated by a broken tooth root, which required extraction.
After intraoperative MMF, ORIF was performed. The parasymphyseal fracture was plated using two locking four-hole 2-mm thick miniplates utilizing two locking screws on either side of the fracture with one plate along the alveolar surface (monocortical screw) and one along the basal surface (bicortical screw). For the right body fracture, a three-dimensional locking ladder plate was used via a transbuccal trocar approach for additional exposure needed for proper screw placement. Once the hardware was secured, the patient was taken out of MMF and restoration of premorbid occlusion was confirmed. Lastly, watertight mucosal closure was performed using absorbable sutures and Dermabond (cyanoacrylate adhesive).
Rotator Cuff Repair (Cadaver Shoulder) Patrick Vavken, MD1; Sabah Ali2 1Smith and Nephew Endoscopy Laboratory 2University of Central Florida College of Medicine
Rotator cuff tears represent the vast majority of shoulder disorders treated by orthopaedic surgeons. From partial-thickness tears in overhead throwing athletes to full-thickness tears in the elderly, the prevalence of rotator cuff tears continues to increase over time. While some cases are asymptomatic, most patients with rotator cuff tears report shoulder pain, limited range of motion, and nighttime pain with difficulty sleeping on the affected shoulder. When nonsurgical treatment is insufficient in relieving the symptoms, arthroscopic rotator cuff repair becomes a viable option for many patients.
This is the case of a rotator cuff repair of a full-thickness tear that extends into the infraspinatus on a cadaver shoulder in the beach chair position. The tear was repaired by placing an anchor, retrieving and passing three suture arms, and tying the suture. This article outlines the natural history, preoperative care, intraoperative technique, and postoperative considerations of rotator cuff repairs.
