Arthroscopy is an established modality of treatment for various conditions of the shoulder attributable to its minimally invasive nature. The possibility of surgical procedure-related complications is usually low. However, there have been sporadic reports of surgical emphysema following shoulder arthroscopy that can range from simple subcutaneous emphysema to life-threatening pneumothorax (PT) and pneumomediastinum (PM). The mechanism of this phenomenon is still elusive. We report the case of a 41-year-old female without pre-existing lung problems who developed extensive subcutaneous emphysema, PT, and PM after shoulder arthroscopy in the absence of an identifiable tracheal injury and masquerading as angioedema. We have extensively reviewed available literature and the mechanisms proposed have been analyzed. Acknowledging the existence of such a complication along with high degree of suspicion will help tackle the problem early and avert unforeseen complications.

Background: Successful placement of cervical pedicle screws requires accurate identification of entry point, trajectory and appropriate size of implant. Studies and guidelines regarding the direction of pedicle screw insertion and pedicle dimensions in Indian population are very limited and hence the objective of our study was to do Morphometric analysis of Typical Cervical Vertebral pedicle (C3 to C6) Materials and Methods: Osteological study of the pedicle was performed in 100 typical (C3-C6) dry bone specimens. The vertebral pedicles were evaluated by measuring its height, width, length, lateral mass + pedicle length, total pedicle axis length and transverse pedicle angle. Results: In our study, the mean pedicle length of C3, C4, C5, C6 was 6.04, 5.48, 5.30, and 5.92 respectively. The mean pedicle height in our study ranged from 5.05 mm (C3) to 5.86 mm (C6). The Range of Mean pedicle width was from 4.79 to 5.16 mm. The mean lateral mass + pedilce length ranged from 11.17 to 13.18 mm while the mean total pedicle axis length ranged from 27.05 to 30.04 mm. Conclusions: We found that there were high individual variations. The pedicle dimensions were relatively smaller in Indians compared to previous studies in other population. This mandates preoperative CT evaluation of pedicle and smaller size pedicle screws customized according to pedicle dimensions of Indians.

Highlights Extra articular osteochondromatosis is rare and scarcely reported around the ankle joint. Due to the subtle clinical and radiological presentation of SC they often lead to a diagnostic challenge. Higher degree of suspicion enables early diagnosis, thereby preventing both morbidity and inadequate treatment. Although MRI plays a key role in deciding the extent of the surgery, confirmation can be made only with histopathology. Long term follow up is mandatory considering both the risk of local recurrence and rare malignant transformation.