The pathology of oxidative stress-induced autophagy in a chronic rotator cuff enthesis tear

Partial-thickness rotator cuff tears (PTRCTs) are often found in daily orthopedic practice, with most of the tears occurring in middle-aged patients. An anaerobic process and imbalanced oxygenation have been observed in PTRCTs, resulting in oxidative stress. Studies have shown the roles of oxidative stress in autophagy and the potential of unregulated mechanisms causing disturbance in soft tissue healing. This article aims to review literature works and summarize the potential pathology of oxidative stress and unregulated autophagy in the rotator cuff enthesis correlated with chronicity. We collected and reviewed the literature using appropriate keywords, in addition to the manually retrieved literature. Autophagy is a normal mechanism of tissue repair or conversion to energy needed for the repair of rotator cuff tears. However, excessive mechanisms will degenerate the tendon, resulting in an abnormal state. Chronic overloading of the enthesis in PTRCTs and the hypovascular nature of the proximal tendon insertion will lead to hypoxia. The hypoxia state results in oxidative stress. An autophagy mechanism is induced in hypoxia via hypoxia-inducible factors (HIFs) 1/Bcl-2 adenovirus E1B 19-kDa interacting protein (BNIP) 3, releasing beclin-1, which results in autophagy induction. Reactive oxygen species (ROS) accumulation would induce autophagy as the regulator of cell oxidation. Oxidative stress will also remove the mammalian target of rapamycin (mTOR) from the induction complex, causing phosphorylation and initiating autophagy. Hypoxia and endoplasmic reticulum (ER) stress would initiate unfolded protein response (UPR) through protein kinase RNA-like ER kinase (PERK) and activate transcription factor 4, which induces autophagy. Oxidative stress occurring in the hypovascularized chronic rotator cuff tear due to hypoxia and ROS accumulation would result in unregulated autophagy directly or autophagy mediated by HIF-1, mTOR, and UPR. These mechanisms would disrupt enthesis healing.

Total elbow arthroplasty with tricep turn-down flap in an old unreduced elbow dislocation: A case report

INTRODUCTION AND IMPORTANCE

The treatment preference for neglected elbow dislocation is by open reduction and lengthening the tricep muscle. If the dislocation is not reduced for more than 6 months, degenerative resorption would have occurred. We did total elbow arthroplasty (TEA) with a tricep turn-down flap for the management in this case. The use of a tricep flap for tricep shortening after unreduced elbow dislocation has been reported in previous publications but none used a turn-down flap.

CASE PRESENTATION

An 82-year-old woman came to the orthopedic outpatient clinic with pain and discomfort on her right elbow. The arm affected by the injury was her dominant hand, restricting her from farming and leisure activities. Exploration findings confirmed the presence of a dislocated elbow with associated soft tissue complications. The cartilage was degeneratively destructed, and the tricep muscle was retracted.

CLINICAL DISCUSSION

In our case, tricep shortening was managed with elongation using a turn-down flap. The lack of soft tissue layers and thin fibrous fascias results in tension-vulnerable TEA surgical wounds. This is caused by the insufficient coverage of the joint, which leads to wound complications. Previous studies of turn-down flap procedures showed good flap survival and functional outcomes.

CONCLUSION

Tricep turn-down flap could be an option for tricep lengthening procedures in unreduced neglected elbow joint dislocation.

Short-term outcomes of one-stage debridement and fusion for ankle joint tuberculosis

PURPOSE

Tuberculosis remains a worldwide health problem, as well as its complications including arthritis in various joints. End-stage arthritis in weight-bearing joint would require surgery either arthroplasty or arthrodesis, in order to achieve painless and stable gait. In general, staged surgery consisted of debridement and subsequent definitive procedure is accepted. However, multiple surgery would be disadvantageous in terms of clinical and economic burdens. This study reported the short-term result of one-stage debridement and fusion for ankle joint tuberculosis.

METHODS

Retrospective evaluation of twenty-six patients with history of one-stage debridement and ankle fusion was conducted. Basic anthropometric measurement, local status, and surgical technique were recorded. Functional score using Foot and Ankle Ability Measures (FAAM) activities of daily living (ADL) was assessed pre-operatively and at two and half year post-surgery follow-up visit along with radiological fusion rate. Paired t test was used to analyse the improvement of the clinical scores.

RESULTS

There was improvement in FAAM score from 43.38 ± 9.51 to 62.19 ± 6.63% (p < 0.001). All sinuses had been subsided, albeit at various time spans. Modified radiographic union score for tibia (RUST) revealed various fusion rate results, ranged from 5 to 11.

CONCLUSION

One-stage debridement and fusion is proven efficacious for end-stage joint tuberculosis, with less surgery occasion compared with staged surgery. However, patient selection is important since any comorbidities or secondary infection may complicate the fusion.

Open Bankart Repair

Shoulder instability is one of the most common complaints seen by orthopaedic surgeons taking care of an athletic patient. The management of shoulder instability has varied over the years and significant controversy and debate about the proper management of this pathology.

The surgical treatment of anterior shoulder instability can present a dilemma. Historically, an open Bankart repair was the benchmark solution. Over the last decade as surgeons became more arthroscopically safe, the pendulum swung and a paradigm shift occurred. However, more recent studies have challenged this trend and, subsequently, revived interest in open repair. Thus, we feel it is critical to provide a more contemporary stepwise description of a procedure that has become essentially abandoned. The goal is to provide tips and pearls to achieve optimal exposure and, ultimately, a robust repair for a notoriously challenging operation. Patient selection, risk factors, and pathology are crucialin makig the correct treatment decision. The benefits of open Bankart repair including the indication of open Bankart repair will be discussed. Additionally, a reliable surgical technique will be presented

Multidirectional Instability of Shoulder Joint: A Review

Introduction:

The biomechanics of the shoulder joint are complex. To allow a functional range of motion, stability is sacrificed. Glenohumeral joint stability is maintained by static and dynamic stabilizers. Static stabilizers are non-contractile structures including capsulolabral structures and bony glenoid while dynamic stabilizers are contractile structures including rotator cuff, conjoint tendon, and long head of the bicep. The objective of this review is to elaborate on multidirectional instability (MDI) of the shoulder joint and the management of this disorder.

Review:

Laxity can be affected by hereditary and genetic factors. This can be seen for example in generalized joint laxity which often manifests in the shoulder as MDI. Mutations in collagen genes can cause altered collagen structure, mostly in collagen Type I, resulting in smaller and longer collagen cells. Abnormalities could be found in mRNA synthesis or amino acid transcription for collagen protein, resulting in amino acid content variation. Alterations in fine-tuning mechanism, cleavage process, ionic interaction, cross-linking and metabolism could also result in collagen quality variation. Genetic factors could also cause elastin overproduction rate or amount. Elastin amino acid content alterations could also be affected genetically. These alterations produced a looser static stabilizer. Even so, shoulder joint have multiple static stabilizers and the individual having hereditary laxity does not always have problems related to joint laxity. If the laxity caused problems, it is usually in the form of pain, discomfort, or disruption in shoulder joint function. To compensate for the loose static stabilizer, rehabilitation should be optimized on the contractile, musculature structure of the glenohumeral joint. Besides rehabilitation, capsular shift procedure could also be performed as management of the affected joint by open surgery, arthroscopic capsular plication, or arthroscopic thermal capsulorrhaphy.

Conclusion:

Based on the review conducted, reoperation rates for open surgery, arthroscopic technique, and thermal technique were approximately 10%, 5%, and 15% subsequently. This should be considered when choosing the appropriate surgery method for MDI management if rehabilitation on contractile structures does not improve patients’ condition.

The role of suprascapular nerve block in hydrodilatation for frozen shoulder

Introduction: Frozen shoulder is a debilitating problem that requires comprehensive diagnosis and management. Patients usually recover, but the possibility of not reobtaining a full range of motion exists. Thus, early shoulder exercises are necessary to achieve their full range of motion. This study aims to understand the effects of suprascapular nerve block (SSNB) augmentation at the spinoglenoid notch in hydrodilatation to treat frozen shoulder to facilitate early shoulder exercises. Methods: The current study retrospectively observed 31 patients, including 40–60-year-old patients diagnosed and treated with primary frozen shoulder. The participants were divided into groups A (hydrodilatation) and B (hydrodilatation and the augmentation of an SSNB). Shoulder function and pain scores were assessed before, during, and after the intervention (at months 1 and 6). Results: The result of this study shows that suprascapular nerve block plays a role in decreasing pain in intraintervention (0.69 vs. 5.73; p < 0.05), month 1 of follow-up (3.44 vs. 6.40; p < 0.05), but not significant on month 6 of group A and B after intervention (5.88 vs. 7.20; p > 0.05). Better delta functional scores were noted in the therapy group during month 1 of the follow-up (delta American shoulder and elbow surgeons [ASES]: 19.29 vs. 34.40, p < 0.05; delta disabilities of the arm, shoulder, and hand [DASH]: 17.88 vs. 38.15, p < 0.05). The difference in functional score on month 6 between both groups was not significantly different (delta ASES: 31.97 vs. 30.31, p > 0.05; delta DASH: 36.63 vs. 38.92, p > 0.05). Discussion: One rationale for using an SSNB augmentation at spinoglenoid notch in hydrodilatation for treating frozen shoulder was to obtain pain relief immediately to facilitate early manual exercise. SSNB has positive effects on short-term evaluation of shoulder pain and function after glenohumeral hydrodilatation, but not in the long term.

Ultrasound-Guided Suprascapular Nerve Block at Spinoglenoid Notch and Glenohumeral Joint Hydrodilation

Hydrodilation of the glenohumeral joint is commonly employed as a nonsurgical intervention for the frozen shoulder. Accuracy and pain during the procedure can be regarded as difficulties in performing this procedure. Ultrasonography (USG) guided injection and suprascapular nerve block can improve the accuracy and can decrease pain during the hydrodilation procedure. We present the step-by-step method for performing USG-guided injections for suprascapular nerve block and hydrodilation.

Soft tissue reconstruction on the very late presenting neglected acromioclavicular dislocation Rockwood type IV. A case report

Introduction and importance

Acromioclavicular (AC) joint dislocation Rockwood type IV is a rare condition characterized by the posterior displacement of the distal clavicle and soft tissue damage. The rate of soft tissue healing markedly decreases as time from injury increases. In this case report, we had a very late presenting neglected AC joint dislocation Rockwood type IV successfully treated by AC and coracoclavicular (CC) reconstruction.

Case presentation

A 24-year-old female presented with pain around her right shoulder since a motorcycle accident four years prior to current presentation. She was diagnosed with a posterior AC joint dislocation and suggested undergoing surgery, but she refused and chose to seek an alternative treatment. The patient felt pain chronically and could not elevate her shoulder, and she decided to come to our hospital. We performed a physical and radiograph examination that showed an AC joint dislocation Rockwood type IV. The management, suggested to the patient, was AC and CC soft tissue reconstruction.

Clinical discussion

The advantages of using this procedure were to restore effective anatomy and avoid bone-to-bone contact between the clavicle and acromion. The disadvantages were increased cost and needed to be evaluated for long-term results. We considered the idea of maintaining AC joint reduction by biologic soft tissue healing of the graft and augmentation fixation to replace the CC ligaments. We could not rely on biological soft tissues healing themselves due to the chronicity.

Conclusion

AC and CC reconstruction can be an option of treatment in neglected AC joint dislocation Rockwood type IV with excellent clinical and radiographic results.

•

Acromioclavicular (AC) joint dislocation Rockwood type IV is a rare condition.

•

Soft tissue reconstruction on the neglected acromioclavicular dislocation Rockwood type IV gives excellent clinical and radiographic results.

•

The advantages of using these procedures were restoring effective alignment between the clavicle and acromion and reconstructing the acromioclavicular (AC) ligament and coracoclavicular (CC) ligament.

High-Grade Bursal Side Rotator-Cuff Repair: A Surgical Outcome Review

Purpose

We aimed to evaluate surgical outcomes of high-grade bursal rotator cuff–tear repairs.

Methods

This systematic review was performed in May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed. Inclusion criteria were English-language studies reporting the results of pain improvement, functional outcome scores, and radiographic examinations after repair of bursal side partial rotator-cuff tears at any time point in patients of any age and with all levels of evidence. Exclusion criteria were articles not in English, in vitro or animal studies, epidemiological studies, and such article types as technical notes or narrative reviews.

Results

Of 58 articles, five were included in this study, of which three and two had level III and IV evidence, respectively, four were comparative studies, and one was a case series. Visual analogue scales were used in four of the five studies, all showing improvement in pain assessment from 5.87 preoperatively to 1.02 postoperatively. All five studies showed significant improvement on each functional outcome score at the final follow-up. The retear rate for all studies was 10.97% (27 of 246).

Conclusion

High-grade bursal side partial-thickness rotator cuff–tear repair gave satisfactory results in terms of pain scores, range of motion, and functional outcomes. The retear rate was still considerably high (10.9%), necessitating better understanding of the basic science, such as molecular mechanisms during adaptation, to improve the surgical technique.

Open Reduction on very late-presenting unreduced posterior elbow dislocation: Still promising treatment option

Background

Neglected dislocation of the elbow is associated with instability, pain, and limitation of elbow function. In developing countries, neglected dislocations of the elbow are quite common, and most patients initially go to local bonesetters, which only aggravates the problem.

Presentation of case

Two patients with a history of unreduced posterior elbow dislocation for more than 1 year and were treated by a traditional bonesetter were included in this case study. The first case was a 65-year-old female with a history of injury around her right elbow around 12 months before admission. The patient underwent open reduction with triceps lengthening and immobilization with plaster of paris for 3 weeks. The second case was a 53-year-old male with a history of injury caused by a fall on an outstretched hand around 18 months before admission. The patient underwent arthrolysis followed by triceps lengthening, internal fixation with transarticular k-wire, and immobilization with elbow slab for 3 weeks.

Discussion

To optimize treatment goals and patient function, various surgical approaches have been described for treating chronic elbow dislocations. The benefit of the V—Y triceps lengthening is to simplify the reduction procedure, especially in the elbow dislocations with greater chronicity. The downside of the V—Y lengthening is possible triceps weakness, delayed physiotherapy, and increased postsurgical pain. On the basis of this study, open reduction should remain a treatment option for patients regardless of age and chronicity of injury.

Conclusion

Operative treatment of late-presenting, unreduced elbow dislocation is effective in restoring the joint to a painless, stable, and functional limb.

•

Old unreduced posterior dislocation of the elbow is not uncommon in developing countries.

•

The posterior elbow approach with V—Y triceps lengthening, arthrofibrolysis, open reduction, and fixation with k-wire is showing a promising outcome.

•

Open reduction should remain a treatment option for patients with neglected posterior elbow dislocation, regardless of age and chronicity of injury.

Modified Eden-Lange procedure for iatrogenic lateral scapular winging

•

Lateral winging scapula is rare and generated by the trapezius paralysis. It is most likely iatrogenic from procedures involving the posterior cervical triangle.

•

The modified Eden-Lange procedures one of the options by restoring the major actions of a flaccid trapezius.

•

The modified and standard Eden-Lange procedure has been proven to successfully remove the scapular wing by restoring the main action of the trapezius muscle.

•

This procedure allowed patient to achieve excellent results in terms of pain relief, strength, and stability after a routine physical therapy program.

Introduction

Lateral winging scapula is rare and generated by the trapezius paralysis. It is most likely iatrogenic from procedures involving the posterior cervical triangle. The modified Eden-Lange procedures one of the options by restoring the major actions of a flaccid trapezius. This case report aims to evaluate the outcomes.

Case report

A 34-year-old female came with right lateral scapular winging after radical neck tumor dissection and miss diagnosed by another hospital and underwent shoulder surgery. We performed a physical examination and showed lateral winging scapula. The best management therapy for this patient used modified Eden-Lange procedure.

Discussion

Conservative treatments for Lateral scapular winging caused by spinal accessory nerve injury might be successful in early 20 months. However, our patient was injured 26 months before surgery which made Eden-Lange Procedures was the best choice for the patient. Modifications to this procedure allowed her to achieve excellent results.

Conclusion

Correction of the lateral scapular winging by modified Eden-Lange procedure combined with physical therapy for patient’s trapezius palsy to gain adequate stability for daily activities.

Clinical features and repair integrity after knotless - In situ suture bridge technique in high-grade bursal side rotator cuff tears

Introduction

The purpose of study is to describe outcome of the knotless-in-situ suture-bridge repair technique, combining concept of articular-preservation, medial-row knotless, and full-layer repair on the high-grade bursal-side rotator cuff tear (PBS-RCT).

Methods

The repair-technique, on 27 shoulders with PBS-RCT, were retrospectively evaluated. Range of Motion (RoM), visual analog scale (VAS), American Shoulder and Elbow Surgeon (ASES) score were evaluated. Minimal 6-months Post-operative MRI were evaluated for repair-integrity.

Result

RoM evaluation, VAS, and ASES Score were improved significantly (P < 0.01). Post-operative MRI showed intact repaired tendon in 25-patients (96.2%).

Conclusion

Arthroscopic knotless-in-situ suture-bridge repair technique in PBS- RCT showed good functional-outcome and repair-integrity at minimum 2-years after surgery.

Preoperative planning of medial opening wedge high tibial osteotomy using 3D computer-aided design weight-bearing simulated guidance: Technique and preliminary result

BACKGROUND

High tibial osteotomy (HTO) is an established treatment for uni-compartmental osteoarthritis with varus deformity in relatively active young patients with good knee mobility. The most important factor for success and low complications of HTO is the precise correction of osteotomy. The objective of this study was to evaluate the accuracy of pre-operative planning of open-wedge HTO using t3D computer-aided design (CAD) weight-bearing simulated guidance technique for the succession of surgery.

MATERIALS AND METHODS

Nineteen patients who met the inclusion criteria were recruited between July 2013 and June 2014. 3D CAD weight-bearing simulated guidance technique was obtained from standard anterior-posterior, lateral of hip-to-ankle full leg standing radiographs, and computed tomography (CT) scan provided the weight-bearing corrective axis of preoperative planning and predictive corrective mechanical axis value. Post-operative mechanical axis value was obtained after surgery.

RESULTS

This comparative study between the predictive corrective, using 3D CAD weight-bearing simulated guidance technique, and post-operative mechanical axis value, analysed with t-test statistical analysis, showed the insignificant difference ( p > 0.05).

CONCLUSION

We conclude that the 3D CAD weight-bearing simulated guidance technique has good accuracy as preoperative planning of open-wedge HTO for succession surgery.

The role of teriparatide in tuberosity healing after reverse shoulder arthroplasty in complex proximal humeral fragility fracture

INTRODUCTION

Tuberosity healing is known to be one of the factors that increase functional outcome in Reverse Total Shoulder Arthroplasty (rTSA). In fragility fractures, tuberosity healing is difficult to be achieved. The fragment stability and bone-forming agent application become strategies to overcome this problem. The purpose of this study was to evaluate the benefit of teriparatide application to promote tuberosity union in rTSA on four-part proximal humeral fractures to achieve better functional outcome.

METHODS

A retrospective study of a prospectively collected shoulder arthroplasty medical record was performed. Eleven patients were included in this analysis and consisted of two groups, teriparatide and no-teriparatide groups. Patients were evaluated on the range of motions and clinical outcome using the American Shoulder Elbow Surgeon (ASES) Shoulder Score and X-ray to determine tuberosity union. The group differences were analyzed by t-test or Mann-Whitney U test with SPSS version 20.0 for Windows.

RESULTS

The statistical analysis revealed no significant differences in mean age in both the groups. There were significant differences between teriparatide and no-teriparatide groups in external rotation (29.5° vs. 7.5°; p = 0.004), external rotation in 90° abduction (55° vs. 12.5°; p < 0.020), forward flexion (120° vs. 105°; p = 0.002) range of motions, and ASES (84.5 vs. 74.6; p = 0.019). We found clinical difference between teriparatide and no-teriparatide groups in time to achieve the initial callus (33 ± 18.3 days vs. 150 ± 42.4 days) and tuberosity consolidation (165.8 ± 70.3 days vs. 315 ± 106.1 days).

CONCLUSIONS

Teriparatide administration supports tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after rTSA in acute complex proximal humeral fractures.

Accuracy comparisons of intra-articular knee injection between the new modified anterolateral Approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion

Background

Intra-articular knee injection with steroid or various other agents have been used to control the local inflammation and relieve pain in the osteoarthritis knee. To achieve the maximal potential therapeutic worth and decrease the complications from the inaccurate knee injection, these medications should be delivered directly into the intra-articular space. Injection technique is one of the most important factors for accuracy of knee injection. Therefore, this study was aimed to propose the new modified anterolateral injection technique for higher accuracy of knee injection in symptomatic osteoarthritis knee without effusion.

Material and methods

Patients with symptomatic osteoarthritis without effusion were included prospectively from May 2014 to May 2015 and randomized into 2 groups for knee injection: Modified anterolateral (MAL), Standard superolateral (SL). Knee injection was performed by one experienced orthopaedic. Accuracy of injection was test by mini air-arthrography technique. The pain from injection were evaluated by visual analog scale (VAS).

Result

132 knees were included, 66 knees were modified anterolateral group same as superolateral group. The modified anterolateral injection was significantly yield the higher accuracy rate than the standard superolateral injection (89% vs 58%, P < 0.05). The pain visual analog scale was not significantly different between the modified anterolateral and standard superolateral injection technique (2.61 vs 2.65, P = 0.917) No adverse events were occurred.

Conclusion

The new modified anterolateral injection yields the higher pooled accuracy rate. From the accuracy and the advantage of the new modified anterolateral injection, this is the preferred injection technique for the symptomatic osteoarthritis without knee effusion.

Fixation of femoral attachment: anterior cruciate ligament avulsion fracture with arthroscopy suture loop technique

Anterior cruciate ligament (ACL) avulsion fracture is rare and mostly occur in tibial attachment. Avulsion fracture of femoral attachment of ACL was uncommon and mostly reported in skeletally immature patient. This article aims to report an interesting case of femoral attachment-ACL avulsion fracture in skeletally mature patient with arthroscopic suture loop fixation.A 32-year-old man, with no significant medical-surgical history, sustained a right non-contact pivoting knee injury during soccer competition. Plain radiographs of knee joint demonstrated intra-articular bone fragment in the intercondylar notch space. The MRI confirmed femoral attachment-ACL avulsion fracture. Then, we planned to perform fixation of femoral attachment-ACL avulsion fracture with arthroscopy suture loop technique. At 5 months after surgery, patient had no pain and swelling knee. The physical examination demonstrated negative Lachman test, anterior drawer test, pivot shift test and patient can return to preinjury daily activity and sport activities.

Posterior root medial meniscus reconstruction: an option in chronic posterior root meniscal injury management

Posterior root medial meniscus (PRMM) tears have shown to be biomechanically equivalent to complete meniscectomy. Drawbacks from PRMM tears repair are unsatisfactory healing rates. In this case report, we outlined a PRMM reconstruction with gracilis graft healing outcome in chronic PRMM tear case, based on clinical and MRI evaluation. A 60-year-old man reported a chief complaint of increasing pain on the right knee joint in the last 1 year after a deep-flexion injury. On MRI investigation, we confirmed the chronic PRMM tear as Osteoarthritis Kellgren-Lawrence grade II. Then, we planned to perform a PRMM reconstruction with gracilis graft per arthroscopy. At the 6-month MRI evaluation, we found healing of the attached PRMM on its footprints, with intact graft transition from the meniscus to the tibial bone tunnel.

Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair

Meniscal extrusion (ME) is defined as extension of the meniscal margin by at least 3 mm beyond the tibial margin. The main purpose of meniscal root repair is to restore the anatomy and function of the meniscus. Therefore, the reduction in the ME is one of the important objective outcomes. Nevertheless, the reduced meniscal extrusion was obtained in limited patients after meniscal root repair. This technical note described the arthroscopic direct meniscal extrusion reduction as surgical tips to reduce persistent meniscal extrusion in posterior meniscal root repair.

Bipolar fracture dislocation of clavicle: A report of osteosynthesis and early soft tissue reconstruction

•

Bipolar fracture-dislocation of the clavicle in concomitant with coracoid fracture are uncommon traumatic injuries.

•

The scarce number of published cases have made the treatment of these injuries still controversial.

•

Osteosynthesis and early soft tissue reconstruction are an option treatment to be considered.

•

Anatomic reconstruction is the key to achieve success and good functional outcome in bipolar fracture- dislocation

•

Re-dislocation of acromioclavicle and sternoclavicle joint, as bipolar clavicle fracture dislocation, can be prevented after achieving the graft's biological healing.

Introduction

Bipolar dislocation of the clavicle, also called bifocal or pan-articular dislocation or floating clavicle, is an uncommon traumatic injury. The injury of this case is also concomitant with distal third clavicle and coracoid fracture. This article aimed to report the experience of performing osteosynthesis and early soft tissue reconstruction on these injuries.

Case report

We reported a case of bipolar clavicle fracture-dislocation in concomitant with coracoid fracture in a man, aged 32 years old, successfully treated 24 days after accident by fixation of both fractures and early simultaneous reconstruction of sternoclavicular- acromioclavicular-coracoclavicular joints.

Discussion

These injuries are rare and capable of causing many complications if they are treated improperly. It is compulsory to carefully assess any fractured clavicle along its whole length, both clinically and radiologically. Various options, from non-operative to operative, have been reported to manage such of these cases. Early bony fixation and soft tissue reconstruction can correct the alignment of clavicle and recover the function of sterno-clavicular and acromio-clavicular- joints promptly.

Conclusion

Fracture osteosynthesis and early soft tissue reconstruction can be regarded as an option treatment for bipolar fracture-dislocation of the clavicle to facilitate prompt treatment and early rehabilitation.

Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique

The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner.

The efficacy of flavonoid antioxidant from chocolate: bean extract: prevention of myocyte damage caused by reperfusion injury in predominantly anaerobic sports

ABSTRACT

Background : Use of predominantly anaerobic energy systems such as that seen in 800-meter athlete runners disrupts mitochondrial function as an energy source. Furthermore, it produces free radical substances and causes myocyte damage. Malondialdehyde (MDA) plasma concentrations correlate with free radical levels and are therefore predictive of cell damage.

OBJECTIVE

To analyse the effect of flavonoid antioxidant from chocolate bean extract for prevention of lipid peroxidation of myocyte membranes caused by free radical substances in athletes partaking in predominantly anaerobic sports.

MATERIALS AND METHODS

The study of population consisted of 16 junior athletes who compete in 800-meter races. This was a randomized experimental study. Subjects were divided into two groups, chocolate bean extracts and placebo groups, and then practiced regularly for 14 days. All subjects were assessed on day 15. RESULTS were analysed statistically using paired t test, ANOVA and Duncan tests.

RESULTS

Concentrations of MDA were reduced in flavonoid group.

CONCLUSION

Flavonoid antioxidant from chocolate bean extract may prevent myocyte damage was caused by reperfusion injury.