Ipsilateral Clavicle Research Articles

Pseudo-hypotension in patients with ankylosing spondylitis during posterior osteotomy for correction of kyphosis

Study ObjectiveTo report the occurrence of pseudo-hypotension during posterior osteotomy for correction of kyphosis in patients with ankylosing spondylitis. DesignRetrospective case series. SettingUniversity-affiliated hospital. MeasurementsThe records of 36 patients with ankylosing spondylitis, who had severe thoracolumbar kyphosis and who underwent one-level transpedicular wedge osteotomy for correction from 2008 to 2010, were reviewed. Details of the patients’ condition, anesthetic induction and maintenance, hemodynamic responses during correction and the corresponding treatment, intraoperative course, and immediate postoperative neurological complications were analyzed. Main ResultsThe posterior osteotomy corrected all patients’ kyphosis. There were no deaths. In 8 cases, a significant decrease in radial arterial blood pressure (BP) occurred during the correction, but BP recovered to normal levels immediately after the ipsilateral clavicle was drawn downward. Three of the 8 patients suffered numbness and muscle weakness of the upper extremities postoperatively. ConclusionsThis decrease in BP may be associated with stenosis of the thoracic outlet with compression of neurovascular bundle due to correction, similar to the thoracic outlet syndrome.

The floating shoulder—Clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture

The aim of this study was to compare the clinical and radiologic results of titanium elastic nail (TEN) and plate osteosynthesis for treatment of clavicle fractures in patients with a floating shoulder injury. From 2000 to 2008, 16 patients with a floating shoulder injury (ipsilateral clavicle and minor displaced scapular neck fracture) were treated by isolated stabilization of the clavicle. The patients were treated with open reduction and plate osteosynthesis (group 1[G1]) or TEN osteosynthesis (group 2 [G2]). Both procedures were compared with regard to functional and radiologic outcome. Nine patients were treated with a plate osteosynthesis (G1) and seven with a TEN osteosynthesis (G2). The follow-up time was 35.7 months ± 16 months. There was no difference in functional outcome with regard to the intraindividual Constant score 83.9(G1) versus 86.7 (G2) or the American Shoulder and Elbow Surgeons score 79.1 (G1) versus 85.7 (G2). No significant postoperative dislocation of the glenopolar angle appeared. In the TEN-treated group, a clavicle shortening of 2.4 mm was observed. Subgroup analysis revealed significant greater shortening in type B and C compared with type A (OTA) clavicle fractures(4.7 mm vs. 0.8 mm). No clavicle shortening in the plate-treated group appeared. The treatment of floating shoulder injuries with TEN and plate osteosynthesis of the clavicle and nonoperative treatment of a minimally displaced glenoid neck fracture provide equal functional results. However, in type B and C (but not in type A) fractures of the clavicle, a shortening of 5 mm can be expected after titanium elastic nailing.

Doença de Gorham da escápula e clavícula: relato de caso e evolução de dois anos de uma afecção rara

A doença de Gorham é uma rara desordem osteolítica, de etiologia controversa, que pode afetar qualquer osso. O substrato histopatológico é a substituição óssea por uma formação expansiva de natureza vascular agressiva, não neoplásica. Descrevemos os achados radiográficos, tomográficos e de ressonância magnética de um caso desta afecção acometendo a escápula esquerda e, dois anos depois, a clavícula ipsilateral.

Lateral Clavicular Autograft for Repair of Reverse Hill-Sachs Defect

Posterior dislocations of the shoulder joint can result in an impression fracture over the anteromedial humeral head, termed the reverse Hill-Sachs lesion, the presence of which can contribute to recurrent dislocations. Methods described to repair this defect include using allografts, iliac crest and coracoid process autografts, and bone graft substitutes. We describe a novel technique using the lateral end of the ipsilateral clavicle as an autograft in a 78 year old man with a reverse Hill Sachs lesion. This graft can be harvested through the same incision and does not compromise the stability of the acromioclavicular joint or any future shoulder arthroplasty.

Modified placement of cervical drainage tube for anterior cervical spinal surgery

Little attention has been paid to the drainage wound scar caused by anterior cervical spine surgery; this causes patients to complain for cosmetic reasons. Therefore, we designed a modified placement of the cervical drainage tube to improve the esthetics. We made a subcutaneous drainage tube with an entry on the inferior-lateral site of the ipsilateral clavicle. No iatrogenic damage occurred due to the placement of the tube; the tube-entry wound healed well, and the scar could be hidden behind the collar or in the shadow of a necklace, thus, these patients were satisfied with the postoperative appearance of the neck.

Posterior Sternoclavicular Disruption With Ipsilateral Clavicle Fracture in a Nine-Year-Old Hockey Player

Posterior sternoclavicular joint disruptions are rare, and a concomitant fracture is even less common in the pediatric population. This case report concerns a posterior sternoclavicular joint disruption and ipsilateral medial clavicle fracture in a 9-year-old male hockey player. We describe the various imaging modalities that may be necessary for this injury, the complications to be considered in dealing with this injury as well as an internal fixation technique using FiberWire.

Which Lateral Radiographic Positioning Technique Provides the Most Reliable and Functional Representation of a Patient’s Sagittal Balance?

Prospective nonscoliotic cohort evaluation of the effects of various positions for obtaining standing lateral thoracolumbar radiographs. The purpose of this study was to compare the effects of various upper extremity positions on thoracolumbar sagittal spinal alignment. The standing position used to capture a lateral plane radiograph can have marked effects on measurements of sagittal spinal alignment and may compound the variability between measurements from successive radiographs. Twenty-two healthy female adolescents performed 3 repeated trials of 4 standing positions in a motion analysis laboratory. The positions included: (1) relaxed standing with arms at sides (CONTROL), (2) standing with fists overlying ipsilateral clavicles (CLAVICLE), (3) active shoulder flexion to 30 degrees with elbows extended (30 ACTIVE), and (4) passive shoulder flexion to 30 degrees with hand supports (30 PASSIVE). Sagittal alignment of the spine was described by kyphosis, lordosis, and the sagittal vertical axis (SVA), all of which were measured from the positions of reflective markers attached to the surface of the back and pelvis. Differences between alignment measures obtained for each of the 3 radiographic positions relative to the functional position (CONTROL) were calculated. Mean differences were then compared between positions using repeated measures ANOVAs (alpha = 0.05). Relative to the CONTROL position, all other positions resulted in negative shifts in SVA (range = -1.1 cm- -4.6 cm), decreased kyphosis (range = -1 degrees- -3 degrees), and increased lordosis (4 degrees for all positions). The shift in the SVA with the 30 PASSIVE position was significantly less than the other 2 positions (P < 0.05) and demonstrated the least variability. Standing with the hands supported while flexing the shoulders 30 degrees during positioning for lateral spinopelvic radiographic acquisition resulted in an SVA and measures of sagittal plane curvature that were comparable with a functional standing position with arms at the side. This seems to be the best way to move the arms anterior to the spine with the least effect on overall sagittal balance.

Use of the clavicle in anterior cervical discectomy/corpectomy fusion procedures: cadaveric feasibility study

Graft sources for cervical fusion procedures include synthetic materials, donor grafts, and autologous bones such as the iliac crest. Considering the data that autologous bone grafts seem to generate the best results for fusion, the next logical step is to seek alternative donor sites so as to attempt to reduce the morbidity associated with these procedures. To our knowledge, autologous clavicle has not been explored as a potential source for cervical fusion. Therefore, the following study was performed to verify the utility of this bone for these procedures. Seven adult cadavers were used for this study. In the supine position, a standard surgical approach and dissection to the anterior cervical spine were performed. Specimens underwent a standard discectomy or corpectomy with placement of harvested ipsilateral clavicle previously dissected. An anterior cervical plating system was next placed over these sites using standard techniques. Measurements of the harvested clavicle were made. The results of our morphometric analysis were as follows: An average of 5 cm of bone was easily removed from the middle one third of the clavicle. No gross injury was found to vicinal neurovascular structures. The middle one third of the clavicle offered sufficient bone for the one to two segments fused in our study with remaining bone for at least two additional segments. The mean diameter of this part of the clavicle was 1.2 cm. Based on our cadaveric study, such a bony substitute as autologous clavicle might be a reasonable alternative to the iliac crest for use in anterior cervical fusion procedures.

Treatment of ipsilateral clavicle and sternoclavicular physeal fractures with locked plating

Ipsilateral clavicle and sternoclavicular (SC) physeal fractures or dislocations are rare injuries. Only 10 cases of double clavicle fractures have been previously reported in the literature. We report two additional patients with this complex injury, each with the characteristic vertical displacement of the medial clavicle demonstrated by three-dimensional computed tomographic (CT) reconstructive imaging. A novel approach to treat these uncommon injuries and review of the literature is also presented.

Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.

The use of outcome scores in surgery of the shoulder

The pursuit of ‘best practice’, health economic planning, the increasing awareness and expectations of patients, pressure from politicians and the media, and the emergence of league tables for surgeons are some of the reasons why orthopaedic surgeons are encouraged to adopt evidence-based

Failure of internal fixation of the clavicle in the treatment of ipsilateral clavicle and glenoid neck fractures

Scapular neck and body fractures are typically treated nonoperatively, with operative treatment traditionally focused on intraarticular fractures or double disruptions of the shoulder suspensory complex. The objective of this study was to systematically examine and compile the existing literature in regard to operative and conservative treatment of extraarticular fractures of the scapula.A comprehensive search of multiple electronic databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to find outcome data on fractures of the scapular neck and body. All studies from 1988 to 2018 that met inclusion criteria were reviewed independently and graded based on the modified Coleman Methodology Score. Outcomes of interest were compiled and analyzed for adjusted means.42 manuscripts with a total of 669 patients were included for analysis from an initial search of 335 results. There was an average age of 41.2 years, 78.1% were male, 98.8% had a blunt force mechanism, and 66.7% had other injures outside the scapula at time of presentation. In total, there were 120 patients with scapular body fractures, 95 with scapular neck fractures, 130 with floating shoulder injuries including a scapular neck or body fracture, and 324 with an unspecified extraarticular scapular fracture. 464 patients were treated operatively, with a mean union rate of 99.4%, Constant score of 84.4, and end forward elevation of 158°. 205 total patients were treated non-operatively, with a mean union rate of 85.1%, Constant score of 79.0, and end forward elevation of 153°.Patients with extraarticular fractures of the scapula have excellent outcomes following either nonoperative or operative management. There is a need for high quality comparative studies to determine the optimal treatment strategy for these injuries.

Case report of a fracture of the base of the acromion in association with mal-union of the clavicle

Isolated acromial fractures are very rare in practical traumatology. Acromion fractures are usually due to violent trauma, associated with other serious lesions. Following observation of a clinical case of a fracture at the base of the acromion associated with a mal-union of the ipsi-lateral clavicle, the authors have reviewed the literature of isolated acromial fractures. The clinical observation reported here confirms the involvement of the claviculo-scapular system in the production of these fractures.

The floating shoulder: ipsilateral clavicle and scapular neck fractures.

In ipsilateral mid-clavicular and scapular-neck fractures, the mechanical stability of the suspensory structures is disrupted and muscle forces and the weight of the arm pull the glenoid fragment distally and anteromedially. To prevent late deformity we recommend internal fixation of the fractured clavicle by a plate and screws. We treated seven patients with this unusual injury; all achieved an excellent functional result without deformity.

Cutaneous Myiasis of the Eyelid due to Cuterebra Larva

HUMAN myiasis is the invasion of the body tissues of man by larvae of flies of the order Diptera. The disease occurs worldwide and many species of flies are involved.¹Occurrence in the United States is infrequent, and human myiasis caused by the highly host-specific botflies is rare.²We report a case of dermal botfly myiasis of the eyelid due to a<i>Cuterebra</i>larva, which developed after an apparent insect bite occurring remotely over the ipsilateral clavicle. We emphasize the importance of differentiating this condition from the bacterial furuncle that it closely resembles. <h3>Report of a Case</h3> A 28-year-old man was initially seen with a three-week history of a swollen, tender nodule on his right upper eyelid. The patient, who worked as a lumberjack, had no recent history of travel outside the state of Alabama. The patient stated that two weeks before the onset of symptoms, he was

The relationship between median nerve somatosensory evoked potential latencies and age and growth parameters in young children

Median nerve somatosensory evoked potentials (SEPs) were recorded in a group of 35 normal children aged 6–36 months and related to body length, body weight and head circumference. Recordings were made while the child was awake using the following derivations: ipsilateral clavicle - Fpz; seventh cervical vertebra (CV7) - Fpz; contralateral C′ - Fpz. the clavicular-Fpz response was bilobed in 77% of the recordings, the initial being designated CL1 and the following negativity, CL2. Early negativities, coincident in latency with CL1 and CL2, were often present inin CV7-Fpz recordings, however, a negativity longer in latency than CL2 was always present, was designated CVN, and preceded a prominent positivity. A scalp-recorded early negativity (N1) and a following positivity (P1) were well defined in all recordings. The latency of CL1, CL2 and CVN increased with an increase in age and stature. In contrast, significant negative correlations were found between the latency of N1, P1, age and statur. The CL1-CVN interpeak latency did not correlate significantly with age, while the central conduction time (CVN-N1) declined with an increase in age and stature. These findings confirmed the complexity of SEP absolute and interpeak latency changes with an increase in age and stature in young children.