Periprosthetic Fracture of Greater Trochanter in Total Hip Replacement Stemming from Pin Site Placement in Navigation-Assisted Surgery

Surgeons are looking to use computer computer-assisted surgery (CAS) in total hip arthroplasty (THA) in order to quantify leg length measurement, angular cup placement, and enhance stability to provide enhanced accuracy in implant placement. As a result, CAS in THA is gaining popularity. This technology employs the use of pins and provides the surgeon with real-time feedback on positioning intraoperatively. Previous total knee arthroplasty (TKA) literature has reported pin-associated complications such as infections, neuropraxia, and suture abscess. To our knowledge, there have been reports of tibial stress fracture after CAS TKA, but this is the first report of a pin causing fracture of the greater trochanter leading to dislocation in THA. Further studies may be warranted to optimize pin placement for trackers to prevent fractures of the greater trochanter.

Reverse Mastopexy: A Novel Contouring Technique in Previously Reconstructed Breasts

Reverse mastopexy is a novel secondary surgical technique applied to patients who have previously undergone skin-sparing mastectomies with reconstruction. Benefits of this procedure include a natural contour to the reconstructed breast with greater breast mound projection, enhanced superior medial fullness, and reduced contour irregularities. Aesthetic improvement to the breast is appreciated with scar relocation to the inframammary fold. Nipple areolar reconstruction can then be performed in surgically undisturbed tissue. Eleven patients from January 2015 through January 2016 who underwent reverse mastopexy were included in our retrospective cohort review. A total of 22 reverse mastopexies were performed at a single institution by a single surgeon. Demographics included age (25-65 years), body mass index (25.5-41.4), and previous breast radiation (3 of 11). All the reverse mastopexies were performed secondarily to mastectomy with reconstruction to improve cosmesis. One patient had undergone unilateral autologous breast reconstruction with a latissimus dorsi flap; the remainder of the women had implant-based reconstruction. Initial short-term follow-up occurred at 1 week, 2 weeks, 1 month, and 2 months after the reverse mastopexy was performed. Follow-up phone survey revealed that all women were satisfied with their aesthetic outcomes (average preoperative vs postoperative satisfaction score: 3.9 vs 9.2; range: 0-10). Complications include localized suture abscess (n = 2), dermatologic reaction to the Dermabond skin closure tape (n = 1), and mild cellulitis 4 weeks after the procedure that resolved with oral antibiotics (n = 1). “Red-breast” syndrome was appreciated in 1 patient. No patient required reoperation. Reverse mastopexy improved cosmetic appearance and patient satisfaction in our population. Few options exist for secondary breast contouring after mastectomy with reconstruction. In comparison with fat grafting, reverse mastopexy is a single operation with predictable results without the potential to cause harvest site irregularities. In addition, reverse mastopexy offers improved scar location to the inframammary fold, which improves tissue bed quality for future nipple areolar reconstruction. Further study for long-term durability and satisfaction is indicated.

Corneal stromal pseudohypopyon in a pseudophakic patient

Background: Corneal stromal pseudohypopyon is a rare entity. Case: A 65-year-old female developed a suture abscess in her pseudophakic right eye, three years after conventional extra-capsular cataract extraction with posterior chamber intraocular lens implantation. Pus from the suture abscess tracked down the corneal stromal layers and formed a pus level leading to the appearance of a corneal intra-stromal pseudo-hypopyon. Conclusion:This case is unique due to its unusual clinical presentation and highlights the fact that corneal pseudohypopyon may occur without any associated anterior chamber hypopyon or Descemet’s detachment. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5871 NEPJOPH 2012; 4(1): 174-175