Cuff tear arthropathy represents a broad spectrum of pathology in which, at least to some degree, three critical features are present: rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. Other characteristics that may be seen are humeral head collapse, erosive changes to the superior glenoid or acromion, and subdeltoid effusion. The reverse total shoulder arthroplasty has recently received attention for the treatment of rotator cuff tear arthropathy. However, many complications of reverse total shoulder arthroplasty have also been reported, and infection is one of the major complications.
CASE REPORTA 77-year-old woman visited our hospital because of heat, pain and pus discharge at the surgical site. She had underwent reverse total shoulder arthroplasty for a rotator cuff tear arthropathy two years and three months ago. And she had underwent irrigation and debridement two times due to infectious signs. But no symptoms had been improved, so she had been refered to our hospital.The medical history of the patient indicates that she was diagnosed with diabetes mellitus three years ago, and she was on medication for angina pectoris. There was no past history of immunocompromising disease. Her chief complaint was pus discharge, pain and swelling at the surgical site, 8 months after a reverse total shoulder arthroplasty. Physical examination revealed a drainage opening at the front of the right shoulder, which was in the middle area of the previous skin incision site and measured about 1 cm in diameter.The drained fluid was a dark yellowish color with relatively light viscosity. At that time we performed a Gram stain and culture, and Reverse total shoulder arthroplasty has recently received attention for treatment of rotator cuff tear arthropathy. However, many complications of reverse total shoulder arthroplasty have also been reported, and infection is a major complication. We are reporting on a case of an approximately 77-year-old female patient who underwent reverse total shoulder arthroplasty with surgical site infection caused by Mycobacterium tuberculosis. The patient had undergone irrigation and debridement two times due to infectious signs at 8 months after a reverse total shoulder arthroplasty. At the last debridement operation, we performed AFB staining, culture for Mycobacterium tuberculosis and biopsy. Mycobacterium tuberculosis was cultured and we did not hesitate to administer 4 regimen therapy for tuberculosis. The outpatient follow-up result was satisfactory without recurrence. At the time of the latest follow-up, the degree of pain and function were good.
Trapezoid fracture is a rare condition and especially, isolated trapezoid fracture is most rare condition of carpal bone fracture. And principle of treatment has not yet been established. Most of trapezoid fractures can be treated using cast but displaced fracture or fracture combined with other carpal bone fractures may require operative treatment. There have been reports about case of conservative treatment in trapezoid stress fracture but no report about case of operative management. We treated a trapezoid stress fracture in a weight lifting athlete by operative treatment and report the results with literature review.Key words: stress fractures, trapezoid bone
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