Various strategies have been described to improve glenoid component cementation technique in shoulder arthroplasty, such as the ''weephole'' technique (WH), which is thought to allow for improved cement mantles by suction venting the glenoid vault through the coracoid. The purpose of this study was to compare the cement mantle created using standard syringe pressurization (SP) to WH or a new, modified weephole technique (MWH), not requiring specific instrumentation of the coracoid medullary canal. Fourteen cadaveric scapulae underwent preparation of the glenoid to allow for implantation of glenoid components. Component fixation was achieved using SP, WH, or MWH. The volumes of cement surrounding each individual peg on the component, of the cement mantle between the back of the glenoid, and of the reamed glenoid face were quantified using micro-CT. Total shoulder arthroplasty is an efficacious treatment for advanced arthritis of the glenohumeral joint with high patient satisfaction rates. 1-5 However, glenoid component radiolucent lines and potential associated loosening are continued areas of concern. 6-9 Radiolucencies, both early and late, are common with rates ranging from 26 to 94%. 1,7,[9][10][11][12][13][14][15][16] Initially their significance was unclear; however, several studies documented progression of radiolucent lines that correlated with clinical loosening of the glenoid component, resulting in decreased function. 7,17 Changes in component design, instrumentation, and cement techniques have all been employed to improve glenoid component fixation and decrease the incidence of radiolucent lines. 6,[18][19][20] The presence of radiolucent lines on immediate postoperative films has been commonly reported. 1,9,12,[20][21][22][23][24][25] These lines are considered an indicator of technical failure or a limitation of the cement technique. 1,12,20,22,26 Gross et al. 27 suggested that the unique anatomy of the glenoid, functioning as a ''cortical box,'' with a limited amount of cancellous bone, is a significant contributing factor to the presence of postoperative radiolucent lines with the radiolucencies representing trapped fluid in the glenoid vault. They described a ''weephole'' (WH) technique for venting the vault and applying suction to improve the fluid dynamics in the glenoid vault and cement penetration into cancellous bone. 27 The technique requires the creation of a burr hole through the superior cortex of the coracoid, followed by cannulation with a curette of the glenoid vault and either the superior peg hole or keel slot depending on component design.Based upon the anatomical relationship of confluence between the medullary canal of the coracoid and the glenoid vault, we hypothesized that the vault could be vented simply by making a burr hole in the cortex of the coracoid base through which to apply suction. This would simplify the WH technique, as no further instrumentation of either the coracoid medullary canal or the glenoid vault would be required, thereby limiting the risk of pr...
Case: A 17-year-old adolescent boy presented with anterolateral, right leg pain and numbness of his right foot 2 days after participating in football practice. He denied a traumatic event, and radiographs were negative for fracture. His imaging and physical examination raised suspicion for acute compartment syndrome (ACS). Single-incision fasciotomy with anterior and lateral compartment release was performed. The peroneus longus muscle was detached at the musculotendinous junction. The peroneus longus was then debrided and transferred to the peroneus brevis. Conclusion:Atraumatic ACS, although rare, is a diagnostic challenge. Prompt recognition of this atypical presentation is important for proper treatment.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B877).
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