The latissimus dorsi is a flat muscle that covers most of the back. Its injury happens when there is avulsion of the tendon. There are currently few reported cases in the literature, but most sources agree that latissimus dorsi injuries are more common among professional athletes. The main injury sites should be highlighted: tendon, myotendinous junction, ventral muscle, and costal muscle. Patients with latissimus dorsi muscle injury describe a burning or popping sensation in the armpit followed by pain and weakness. Magnetic resonance imaging confirms the diagnosis of avulsion injury, defining its extent and excluding the hypothesis of the presence of other involvements and masses. We report a case of a 64-year-old woman who report pain in her right shoulder after a fall in the bathroom diagnosed with insertional rupture of the latissimus dorsi and teres major muscles. She was treated conservatively, presenting the range of motion recovered and being able to carry out daily activities after two months.
OBJECTIVE:we aimed to search for a correlation between neurophysiological changes in the anatomic distribution of the common peroneal nerve (CPN) and the degrees of valgus deformity correction after total knee arthroplasty (TKA). MATERIAL AND METHODS:a prospective cohort study of 23 patients was conducted. A preoperative and at one and six months postoperative neurophysiological studies of the CPN were performed. Subsequently, the association between the pathologic neurophysiological findings found (polyphasicity, motor unit loss, low amplitude of evoked potentials) with the degrees of deformity correction and the limb length difference after TKA was analyzed. RESULTS:sixteen of 23 patients completed the study. The mean valgus deformity correction was 9.3°, and the mean lower limb length difference was +10,1 mm. One-month postoperative electromyogram (EMG) was normal in seven patients while the other nine patients showed some findings that normalized at six months. In three patients, mild findings remained. As to electroneurogram (ENG), in all cases there were normal sensory and motor conduction velocities even though thirteen patients showed changes compatible with neurapraxia in different degrees of severity. At six months all patients showed normal values, except one. In any case, there was no clinical sign of major sensory or motor loss in the distribution of the CPN. No statistical correlation could be found between neurophysiological findings and the degrees of valgus deformity correction. CONCLUSION:we could not find a correlation between neurophysiological changes and the degrees of valgus deformity correction or leg length difference. A threshold of valgus deformity correction indicating prophylactic common peroneal nerve decompression could not be established.
INTRODUCTION:although anatomic anterior cruciate ligament reconstruction (ACLR) typically restores anteroposterior stability, residual rotational laxityoften manifesting as a positive pivot-shift testmay persist in some patients. To address this, anterolateral augmentation procedures, such as lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction, have regained interest for enhancing rotational control and graft protection. MATERIAL AND METHODS:we conducted a systematic review and meta-analysis (PRISMA guidelines) of 31 Level III comparative studies (randomized trials and cohort studies) involving a total of 3,172 patients with a minimum follow-up of 12 months. Studies compared isolated ACLR versus ACLR with anterolateral reinforcement. Pooled outcomes included objective stability measures (pivot shift, Lachman test, instrumented laxity), patient-reported functional scores (IKDC, Lysholm, Tegner), and graft re-rupture rates. RESULTS:the addition of anterolateral reinforcement significantly reduced the risk of residual pivot shift (RR = 0.45; 95%CI: 0.37-0.55; p < 0.001), indicating a 55% lower likelihood of postoperative rotational instability. Graft re-rupture rates were also lower in the augmented group (3.8 vs 11.3%; RR = 0.33; 95%CI: 0.24-0.48). Functional outcomes were slightly better with combined procedures: pooled IKDC scores were 2.96 points higher (95%CI: 0.47-5.45), Lysholm scores increased by 2.43 points (not statistically significant), and Tegner scores were 0.47 points higher (95%CI: 0.06-0.88). CONCLUSIONS:this meta-analysis indicates that supplementing ACL reconstruction with an anterolateral procedure provides superior rotational stability and lowers graft failure rates, without compromising short-term patient-reported outcomes. These findings support the consideration of combined approaches in patients at elevated risk of persistent rotational instabilityparticularly pivoting athletes.
INTRODUCTION:anatomical reduction and stable fixation are crucial in the treatment of articular fractures to prevent post-traumatic osteoarthritis and joint dysfunction. However, surgical exposure of the lateral tibial plateau remains a challenge, especially in the posterolateral column. New approaches are needed to provide adequate visualization of the articular surface. This study aims to anatomically describe a posterolateral double-window approach (anterior and posterior to the biceps femoris) in cadaveric specimens, optimizing surgical exposure without the need for osteotomies. MATERIAL AND METHODS:dissections were performed on two knee specimens, employing a posterolateral double-window approach (anterior and posterior to the biceps femoris). The exposed tibial surface was measured using a uniplanar ruler, and the percentages of lateral tibial plateau visualization were calculated. RESULTS:in the left knee, the exposure of the anterolateral quadrant was 82%, and in the posterolateral quadrant was 66%. In the right knee, 70 and 66% were obtained, respectively. The anterolateral window provided greater exposure compared to the posterolateral one. CONCLUSION:this technique represents a viable surgical option to optimize tibial exposure without osteotomies. Clinical studies are needed to validate its impact on functional recovery in patients.
Discoid lateral meniscus (DLM) is a structural anomaly characterized by an increased volume and altered collagen fibers, primarily affecting the lateral meniscus. Although its incidence varies, DLM is often present in the pediatric population and may present with acute or chronic knee symptoms, such as joint line pain, mechanical symptoms, and the inability to achieve terminal extension. Diagnosis is typically confirmed through magnetic resonance imaging and clinical evaluation. Histological studies have revealed disorganization and decreased collagen density in DLM, predisposing it to tears and instability. Various classification systems exist, with recent advancements focusing on meniscal width, height, stability, and tears, to guide treatment decisions. Conservative management is suitable for asymptomatic cases, whereas symptomatic patients may benefit from saucerization to restore meniscal function. Surgical intervention, including saucerization and repair, is indicated in cases of peripheral instability or tears. Additionally, addressing mechanical axis deviations in skeletally immature patients is crucial for optimizing the outcomes. This review provides insights into the pathogenesis, classification, and treatment strategies of DLM in children and adolescents.
INTRODUCTION:the multifidus muscle is a key stabilizer of the lumbar spine. While its deterioration has been associated with degenerative spinal conditions, the specific impact of its preoperative morphology on surgical outcomes remains unclear. The objective of this study is to evaluate the relationship between preoperative multifidus muscle morphology (cross-sectional area and fatty degeneration) and clinical-surgical outcomes following lumbar fusion surgery. MATERIAL AND METHODS:a retrospective cohort study of 99 patients aged 40-65 years with L4-L5 degenerative spondylolisthesis undergoing lumbar fixation and arthrodesis (2022-2024). Preoperative MRIs assessed cross-sectional area multifidus (CSAM) and fatty degeneration. Three spine surgeons performed measurements with substantial interobserver reliability (. RESULTS: = 0.80). Clinical outcomes (ODI, Roland Morris, SF-36, VAS), surgical variables, and complications were analyzed. the cohort (31.31% male, 68.69% female; mean age 59.15 ± 8.78 years) showed significant positive correlations between CSAM and intraoperative blood loss (r = 0.249, p = 0.013) and postoperative complications (r = 0.217, p = 0.031). Fatty degeneration demonstrated no significant association with complications (p = 0.214) or clinical improvement. All patient groups showed significant clinical improvement at 12 months postoperatively regardless of fatty infiltration severity. CONCLUSIONS:larger multifidus muscle volume correlates with increased surgical complexity, while fatty degeneration does not predict complications or clinical outcomes. These findings highlight the importance of comprehensive muscle morphology assessment in preoperative planning. A retrospective cohort study was conducted.
INTRODUCTION:lumbar spinal stenosis is a common condition in elderly patients, which can lead to neurogenic claudication or radiculopathy. One of the current surgical techniques used for decompression is the "over the top" approach, which consists of a unilateral microscopic decompression with partial resection of the lamina, ligamentum flavum, and part of the facet joint, without causing instability. The objective was to evaluate the clinical and radiological postoperative outcomes of patients with degenerative lumbar stenosis treated with the "over the top" technique. MATERIAL AND METHODS:a retrospective study was conducted between January 2022 and December 2023. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scales were used to assess clinical outcomes. The presence of the tomographic "vacuum sign" was evaluated, as well as imaging changes according to the Schizas classification. Postoperative complications and reoperations were also recorded. RESULTS:a total of 56 patients were included. The preoperative lumbar VAS was 7.21 ± 1.24 [range 4-9], and at 12 months it was 3.11 ± 1.54 [range 2-8] (p < 0.00001). The preoperative ODI was 32 ± 8.02 [range 25-39]; at 12 months, it significantly improved to 14.92 ± 5.03 [range 7-26] (p < 0.00001). A statistically significant association was found between patients with preoperative pneumodisc and those who underwent reoperation (p = 0.025). No patients showed signs of postoperative instability on radiographic assessment. CONCLUSION:the minimally invasive "over the top" decompression technique provides good clinical outcomes in the surgical treatment of lumbar spinal stenosis.
INTRODUCTION:fractures of the proximal phalanx of the hallux are among the most common forefoot injuries and are of significant clinical relevance due to their impact on gait biomechanics. These fractures may vary according to the mechanism of injury, the degree of articular involvement, and the associated soft tissue damage. Several therapeutic options are available, including conservative treatment and surgical management using different techniques and implants. Therefore, a review of the English and Spanish language literature published over the last 30 years regarding these fractures was conducted. OBJECTIVE:to gather the general information available about fractures affecting the proximal phalanx of the hallux, in relation to anatomy, biomechanics, trauma mechanism, clinical evaluation, fracture classification, management options and rehabilitation protocol. MATERIAL AND METHODS:the available literature from 1993 to 2024 was reviewed, including information obtained from textbooks and databases such as PubMed, Cochrane, Embase, Google Scholar, to unify the most important concepts published so far. CONCLUSION:traumatic injuries affecting the hallux should be adequately evaluated after figuring out the causal mechanism and do a right radiographic inspection, to rule out fractures or fracture-dislocation, which may require, according to stability or instability criteria, a possible surgical management. Many injuries are susceptible to conservative management, but in selected cases, closed or open reduction with the use of implants may become necessary to reduce the probability of symptomatic and/or functional sequelae.
Osteomyelitis, a bone infection, is rare in the pelvic bones of children, particularly in the ischium, with few documented cases in the literature. Staphylococcus aureus is the most common causative agent. Brodie's abscess, a subacute form of osteomyelitis, primarily affects boys and is challenging to diagnose, as it may be mistaken for bone tumors due to its insidious clinical presentation. Brodie's abscess causes bone destruction, bone marrow edema, and complications in soft tissues and joints. Diagnostic methods such as magnetic resonance imaging, which reveals the "penumbra sign", and needle biopsy are essential for diagnosis. Treatment involves prolonged antibiotic therapy and, in some cases, surgical drainage. Malignant tumors, avulsions, and inflammatory conditions, such as ischial osteitis, should be excluded in the differential diagnosis. The objective of this report is to describe a rare case of subacute osteomyelitis in the ischial bone of a pediatric patient, highlighting the imaging, laboratory findings, and clinical manifestations observed.
