Background: Anterior shoulder instability is common and may cause a considerable effect on quality of life. For cases with glenoid bone loss, there is still a controversial discussion regarding the optimal treatment. Most of the recent methods are using metal implants to attach the needed graft to the glenoid with reported disadvantages such as metal impingement, damage to the humeral head, cartilage destruction, and premature arthritis. Indications: (1) Erosion-type defects with significant bone loss (>15%-20%); (2) chronic fragment-type defects if the size of the fragment is not large enough for an anatomical reconstruction; and (3) non-reconstructible, multifragmented acute fragment type of lesions. Technique Description: After placing the patient in a lateral decubitus position and fixing the arm in a traction devise, 3 arthroscopic entries are established: a posterior portal, an anterosuperior portal, and an anteroinferior portal. A harvested tricortical iliac crest bone graft is provided with 2 drilling holes which match the drilling holes through the glenoid. The tapes are then placed from the posterior to the anterior side of the glenoid, and then the graft is passed from the anterior to the posterior side, thus compressing the cancellous side of the bone block onto the glenoid defect. A following interconnection of the sutures creates a continuous loop. The end of the tapes was loaded into a pretied racking hitch knot system, which creates sliding knots between the 2 pair of tapes, whereon the knots can be reduced to the glenoid in a symmetrical fashion. Finally, the reconstruction of the anterosuperior labrum can be done, to cover the bone block with enough soft tissue. Results: First short-term results show radiographic consolidation after 3 months and an increased median glenoid estimated surface area at 12 months. The functional scores showed good outcomes, and there were no serious complications reported. Discussion/Conclusion: The presented arthroscopic reconstruction of the glenoid using a tricortical bone graft and high-strength fiber tapes provides a metal-free technique which results in a high primary stability of the construct and should therefore be considered when treating anterior shoulder instability with significant bone loss.
Chondral defects of the glenohumeral joint are common but still remain a diagnostic and management challenge. Whereas arthroplasty is a reasonable treatment option in the elderly and low-demand population, joint preservation should be aimed for the remaining patients. For larger defects the current gold standard of treatment is autologous chondrocyte implantation. However, disadvantages such as high cost, the restriction in availability of specialized laboratories, and the 2-stage surgical design need to be accounted for if choosing this option. Showing first good clinical results for the knee joint, minced cartilage implantation is moreover a cost-effective procedure bringing autologous cartilage chips harvested from the defect walls and bringing them into the area of damage in a single-step open or arthroscopic approach. We describe an arthroscopic strategy of this technique to treat chondral defects at the glenohumeral joint.
In der Regel wird die Zwerchfellhernie bereits pränatal in der Routinesonographie festgestellt. Mutter und Fetus werden vom Zeitpunkt der Diagnose an im spezialisierten Perinatalzentrum betreut. Bei einer pränatal nicht bekannten Zwerchfellhernie führen die typischen Symptome der rasch nach Geburt auftretenden kardiorespiratorischen Insuffizienz, das abgeschwächte Atemgeräusch auf der betroffenen Seite, sowie die thorakal zu auskultierenden Darmgeräusche zur ersten Röntgenaufnahme und damit zur Diagnose. Eine verzögerte Diagnosestellung Monate oder gar Jahre nach der Geburt ist selten und dann eher zufällig. Die Perforation des Magens ist eine mögliche akute Komplikation der angeborenen Zwerchfellhernie.
FallbeschreibungEin bislang gesunder und regelrecht gediehener 6 Monate alter männlicher Säugling wurde in einer pädiatrischen Klinik wegen galligen Erbrechens vorgestellt. Die Röntgenübersicht im Hängen zeigte freie Luft unterhalb des Zwerchfells und einen Hochstand des linken Diaphragmas (Abb. 1). Nach der Notverlegung im Schock auf die Intensivstation unserer Klinik war das Abdomen des Patienten distendiert und die Bauchdecke gespannt. Die initialen Laborbefunde zeigten eine Hypoglykämie (35 mg%), eine Hyponatriämie (120 mmol/l) und eine metabolische Azidose mit einem pH von 7,1.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.