We report the case of a 74-year-old woman who sustained a scapular spine (SS) fracture after a fall 4 weeks after reverse shoulder arthroplasty (RSA). Open reduction and internal fixation (ORIF) with locked 90°-double plating resulted in union of the SS fracture with a good outcome (subjective shoulder value: 80%; Constant score 67; 1 year) despite of an adjacent lateral acromion fracture 3 weeks after ORIF. This is the second description in the literature of a successful double plate ORIF with union of an SS fracture after RSA. SS fractures are known to lead to poor RSA outcomes with a high mal-union rate and non-union rate. We describe the positioning of the plates and technical steps for successful ORIF to avoid complications, discuss the aftercare and report the outcome.

Bilateral agenesis of the long head of the biceps brachial tendon (LHB) is a very rare variation of the anatomy. We report a case of an 18-year-old man with bilateral agenesis of the long head of the biceps brachii tendon. We present initial findings, radiographical examinations and the follow-up of an unusual entity. Diagnosis of agenesis of the LHB can be challenging especially in cases of traumatic shoulder pain. It is not a very known entity because of its rareness. However, it could be associated with other congenital anomalies. The absence of the LHB is easily ignored in the diagnostic process. Clinical examination should be a pitfall, radiological examination is helpful to confirm the suspicion of LHB absence. MRI is often the first choice, although ultrasonography is cheaper and much easier to access and it is an excellent tool to visualise this anatomic variation with empty or shallow intertubercular groove.

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After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical ‘Awareness Criteria’ (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.

BackgroundChordoma is a rare malignant tumor of the axial skeleton. Percutaneous cryoablation (PCA) is a minimally invasive technique that allows freezing of tumors under imaging control. The purpose of our retrospective study was to investigate the outcome of PCA in a selected cohort of patients with sacrococcygeal chordoma, with a minimum of 5 years follow‐up.Materials and MethodsFour patients were treated in 10 sessions. The mean follow‐up was 57.3 months. We evaluated the feasibility, the procedure‐related complications, the impact on pain control and oncological outcomes.ResultsFreezing of 100% of the tumor volume was possible in 60%. Pain control was not reliably evaluable. Local recurrence occurred in 90% of the treated lesions; the mean time to progression was 8.1 months (range 1.5–16). At last follow‐up, one patient had died of the disease, one of another cause and one was receiving the best supportive care. The only patient alive without the disease had received additional carbon‐ion radiotherapy. The 5‐year survival rate after index PCA was 50%.ConclusionComplete freezing of the tumor was technically challenging, mainly due to the complex local anatomy. Recurrence occurred in 90% of the lesions treated. PCA should be considered with caution in the curative management of sacrococcygeal chordoma.

Diagnosis of hand tumours by conventional imaging remains difficult. Shear wave elastography (SWE) is a noninvasive method used to quantitatively assess the mechanical properties of tissues. We provide the first report of “histoelastographic” data concerning a finger tumour. Our data support the notion of ultrasound assessment using multiple parameters including morphology, elasticity, viscosity, and microflow vascularization likely contributing towards a more precise diagnosis in the future.

Background: Chronic rotator cuff tears (RCTs) are common and are often only partially repairable. Surgical treatment is challenging in younger patients. Surgical options include partial repair, tendon transfer, subacromial spacer, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty. The use of SCR has been expanded and commercialized. The proposed techniques are complex using free avascular grafts and up to 7 anchors with associated increase in theater time and nonrefunded cost. Biceps SCR has shown promising biomechanical resistance and seems to offer a simple and cost-effective alternative. Indications: Patients with RCTs (Goutallier stage ≥3, Patte 3) without arthritis that are at least partially repairable (infraspinatus and subscapularis) are candidates. Patients with mechanically intact long head of biceps (LHB) and superior labrum anterior to posterior (SLAP) anchor (minimal fraying of <10% and fraying of SLAP without full-thickness tears acceptable) are also candidates. Technique: Key steps include arthroscopic release/lateral opening of the bicipital grove (15-20 mm) and placement of a first footprint anchor 8 to 10 mm posterior to the anatomical sulcus. Use of a 5-mm burr to create a new rerouting groove obliquely from the first anchor to the original groove, 15 to 20 mm caudal to the summit of the tubercle. Lasso-loop translation and tenodesis of the LHB to the first anchor. Use of a second caudal biceps tenodesis anchor with lasso-loops at the caudal end of the new groove. These 2 anchors create a rerouting bipedicle tenodesis performing the function of both an SCR and biceps tenodesis. Single-row, tension-free over-the-top repair of infraspinatus and the bursal layer of supraspinatus is completed with a third anchor on the rerouted biceps which remains in continuity. Results: The pilot series (n = 10) with a mean follow-up of 12 months (9-18 months) shows satisfactory outcomes. One patient developed a postoperative frozen shoulder and one a secondary Popeye deformity. Functional scores and patient satisfaction improved in all cases. The subjective shoulder value improved from a mean of 30% (10%-40%) preoperatively to 75% (60%-80%) postoperatively and the constant score from 30 points (20-40) to 68 points (60-71). Conclusion: As long as LHB and its SLAP anchor are adequate, biceps rerouting in combination with partial rotator cuff repair is a safe alternative to time-consuming and expensive commercialized SCR techniques.

Background Intramedullary long nailing is a popular method to treat femoral shaft or sub-trochanteric fractures. Various complications have been described such as intraoperative anterior cortical perforation of the distal femoral shaft or post-surgical lateral thigh pain. In order to prevent those possible complications, a new intramedullary nailing system (Chimaera, Orthofix®) was designed. This study aims to evaluate the clinical and radiological results after antegrade intramedullary nailing of traumatic femoral shaft and inter-/subtrochantreric fractures.Methods A prospective cohort study was conducted on 20 consecutive patients with AO/OTA type 31A2.3-A3.3 and type 32A-C fractures treated with the Chimaera long nailing system from December 2017 to January 2021 at our level 1 trauma center. Parker & Palmer and Jenson scores were assessed at 3 months and compared to before the surgery. Radiologic assessment consisted in checking the position of the cephalic screw, using the tip-apex distance (TAD) and Cleveland zone. The mean follow-up was 12.5 (1–33) months.Results Parker and Palmer scores were equivalent to before the fracture for 4 patients (31%); minor changes were seen in 6 patients (46%). Jensen score was equivalent or with maximum gain of 1 point for 11 patients (87%) at 3 months. No intra-operative major complication was recorded. The median TAD was 16.4 mm (IQR 14.0-20.2) and lag screw position was in 85% of patients in the Cleveland central zone. Two patients needed revision surgery. Fracture union occurred in all patient.Conclusion The long Chimaera nailing device showed good functional and radiological outcomes.