Symptomatic contralateral osteophyte fracture with migration causing lumbar plexopathy during oblique lumbar interbody fusion: illustrative case

BACKGROUND While performing lateral lumbar interbody fusion surgery, one of the surgical goals is to release the contralateral side with a Cobb elevator, allowing distraction of the interbody space. Many times, there are large osteophytes on the contralateral side, and the osteophytes can be split open with the Cobb or blunt instrument. It is extremely rare for the actual osteophyte to break off from the vertebral body into the contralateral psoas muscle and lumbar plexus. OBSERVATIONS The authors report a case of symptomatic lumbar plexopathy caused by an osteophyte fracture after an oblique lumbar interbody fusion requiring a right-sided anterior approach to excise the bony fragment. They illustrate the case with imaging that the radiologist did not comment on, and they also show a video of the surgical excision of the osteophyte through a right-sided anterior lumbar retroperitoneal approach. The authors also show how the patient had spontaneous right-sided electromyography (EMG) firing before excision of the osteophyte and how the EMG firing resolved after excision. LESSONS Although the literature is plentiful with regard to ipsilateral approach–related complications, the authors discuss the literature with regard to contralateral complications after minimally invasive lateral lumbar interbody fusion.

Pharyngeal perforation: A rare complication of occipitocervical injury

Background: Atlantoaxial dislocation is a rare injury following high-energy trauma. We report an undescribed complication of atlantoaxial dislocation. Case Description: A 75-year-old man presented with atlantoaxial dislocation and Jefferson C1 fracture after a high-energy trauma. Occipitoaxial stabilizations were performed the day after. A nasopharyngeal fistula was identified at day 5 causing a persistent epistaxis. Conclusion: Nasopharyngeal fistulization of C1 bony fragment is a rare complication of complex occipitocervical injury. Combined treatment with ENT surgeon should be considered.

Delayed proximal hamstring tendon repair after ischial tuberosity apophyseal fracture in a professional volleyball athlete: a case report

Background Ischial tuberosity apophyseal fractures are avulsion fractures of the anatomic footprint of the proximal hamstring tendons. Generally, these injuries are rare and frequently occur in skeletally immature, active patients due to incomplete ossification. Depending on the fragment displacement, non-operative or operative treatment approaches are used. Case presentation We report a case of a 29-year-old professional volleyball athlete who has suffered from a nonunion avulsion fracture for 14 years. Isolated suture anchor fixation was performed after open excision of a large bony fragment followed by excellent clinical and functional outcome at 1 year postoperatively. Conclusion In conclusion, avulsion fractures of the ischial tuberosity with large fragments and restrictions to activities of daily living due to pain can, in individualized cases, be treated with an open excision of the fragment followed by repair of the proximal hamstring tendons using suture anchors.

A review of bone grafting techniques for glenoid reconstruction

Background Traumatic anterior shoulder dislocations can cause bony defects of the anterior glenoid rim and are often associated with recurrent shoulder instability. For large glenoid defects of 20–30% without a mobile bony fragment, glenoid reconstruction with bone grafts is often recommended. This review describes two broad categories of glenoid reconstruction procedures found in literature: coracoid transfers involving the Bristow and Latarjet procedures, and free bone grafting techniques. Methods An electronic search of MEDLINE and PubMed was conducted to find original articles that described glenoid reconstruction techniques or modifications to existing techniques. Results Coracoid transfers involve the Bristow and Latarjet procedures. Modifications to these procedures such as arthroscopic execution, method of graft attachment and orientation have been described. Free bone grafts have been obtained from the iliac crest, distal tibia, acromion, distal clavicle and femoral condyle. Conclusion Both coracoid transfers and free bone grafting procedures are options for reconstructing large bony defects of the anterior glenoid rim and have had similar clinical outcomes. Free bone grafts may offer greater flexibility in graft shaping and choice of graft size depending on the bone stock chosen. Novel developments tend towards minimising invasiveness using arthroscopic approaches and examining alternative non-rigid graft fixation techniques.

Spontaneous Erosion of Retained Bone Chip into Anal Canal Following Progressive Perineal Urethroplasty with Inferior Pubectomy: Lessons Learnt!

We present a never before reported delayed complication of progressive perineal urethroplasty with inferior pubectomy in a young male, where retained bone chip spontaneously erodes through anal canal. Our case cautions urologists doing inferior pubectomy for pelvic fracture urethral distraction defect to make sure that no loose bony fragment is left in the operative field. We also emphasize to make sure to nibble the sharp bony margins of the cut pubic bone after inferior pubectomy so that it will not impinge onto the anterior wall of rectum eliminating the risk of delayed perforation of rectum or anal canal.

Fracture Dislocation of the Anatomical Neck of the Proximal Humerus: Case Report and Literature Review

Fractures of the anatomical neck of the humerus are an extremely rare pathological entity in the field of orthopedic surgery. One of the most feared complications associated with anatomical neck fracture of the humerus is avascular necrosis (AVN). The literature does not contain clear, evidence-based guidelines for the surgical management. This case report highlights the case of a 33-year-old male patient who presented with anatomical neck humerus fracture dislocation after a snowboarding accident. Computed tomography showed a comminuted displaced fracture involving the right humeral neck associated with anterior dislocation of the right shoulder. A small bony fragment adjacent to the glenoid posteriorly was also revealed. The patient was treated with open reduction and internal fixation (ORIF). After 3 years of follow-up, the patient is fully recovered with a normal range of motion of his right shoulder joint. The patient did not show any signs of AVN of the humeral head throughout the course of the 3-year follow-up. Anatomical neck fractures of the humerus are uncommon injuries in the literature. Due to the poor vascularization and the absence of attachment to soft tissue, there is a significantly high risk of AVN associated with fractures of the anatomical neck of the humerus. The patient presented in our report was treated with ORIF since it allows preservation of the humeral head.

Medical management of a penile fracture with presumed pyelonephritis in a juvenile dog

A three-month-old male entire Bouvier des Flandres was presented for acute onset dysuria, haematuria, lethargy and severe pain on palpation of the penis. Further investigation revealed a parcellar fracture of the cranial separate ossification centre of the os penis and associated urinary tract infection with presumed pyelonephritis. Fluoroscopic retrograde urethrography was performed revealing intermittent urethral obstruction caused by displacement of the cranial bone fragment of the separate ossification centre of the os penis. The urethra was catheterised to realign the fragments and to permit urination and antibiotic treatment was started. The urinary catheter was kept in place for five days. After its removal, normal urination was observed with complete resolution of the clinical signs. Follow-up radiographs and ultrasound examination confirmed resolution of mechanical obstruction with fusion of part of the separate ossification centre and realignment of the displaced bony fragment.

Presumed bilateral patella cubiti in a six-month-old German shepherd dog

A six-month-old entire male German shepherd dog was presented for lameness of left thoracic limb and bilateral elbow deformity without trauma reported. Elbow radiographs and CT showed a large bony fragment comprising both the anconeal process and the olecranon separated from the proximal ulna bilaterally. The proximal physis of the ulna was still present but smaller than usual. A part of the triceps tendon had its insertion on the fragment. Based on radiological findings, a bilateral patella cubiti was suspected. Patella cubiti is a rare elbow anomaly described in people and in dogs. Surgical treatment may be warranted if pain or stiffness is present. No recent report is available in veterinary literature.