Notes

The impact involving ultrasound-guided transmuscular quadratus lumborum stop along with neighborhood infiltration analgesia regarding arthroplasty in postoperative pain relief.
Medical and associated speciality journals aim to disseminate area-specific knowledge, discoveries, experiences, cases and substantiate or negate the previously published pieces of information. These Journals are considered essential for doctors, researchers, and scientists to disseminate work, research, and experiences with the rest of the world. However, it is often quite challenging to choose an appropriate journal to submit work for possible publication. Researchers attempt to choose the most appropriate platform to highlight their research work so that their work gets published in good order, read, and referred. Hence, selecting an appropriate journal is the most vital task for them. Although no ranking and scoring system can be 100% perfect and foolproof, yet the scoring systems are required to be fair and objective in scoring the journals on various metrics and parameters.Paralabral cysts of the shoulder are a rare cause of shoulder pain. Their association with neurological symptoms is uncommon. This case report presents an antero-inferior paralabral cyst in a painful atraumatic shoulder causing axillary and musculocutaneous nerve palsy. The patient in the present study showed a rapidly worsening active shoulder function with dull pain in the posterior shoulder and hypoesthesia over the deltoid. selleckchem Magnetic resonance imaging revealed an antero-inferior paralabral cyst. Electromyography showed a profuse denervation of the deltoid, teres minor and biceps brachii muscles. The patient was diagnosed with a axillary and musculocutaneous nerve compression neuropathy caused by the cyst. Shoulder arthroscopy was performed with the goal of decompressing the cyst and explore the terminal branches of the brachial plexus. During surgery a partial labral tear was detected and anatomically repaired after cyst resection. Exploration of the terminal roots of the plexus brachialis showed the presence of dense fibrotic tissue that was released. Shoulder function recovered completely after surgery. Paralabral cysts are rare and surgical management consists of cyst removal and labral repair. In presence of neurological symptoms exploring the retrocoracoid plexus may be a useful option to check for fibrosis around the nerves that could limit or slow down nerve recovery.
Pediatric tibial eminence fractures constitute a complex injury with multiple treatment options. We have described a technique that combines direct visualization through an open approach and stable fixation using a bioabsorbable screw. The purpose of this study is to describe our surgical technique for tibial eminence fractures and to compare the radiographic and functional outcomes to previous open or arthroscopic methods.

We retrospectively reviewed a series of five pediatric patients who underwent open reduction and internal fixation of a tibial eminence fracture with a headless, bioabsorbable poly-L lactic acid (PLLA) screw (Bio-Compression screw, Arthrex Inc, Naples, FL) from 2016 to 2017. The surgical technique involves an open approach, direct fracture reduction, and fixation with a PLLA screw without violating the epiphyseal plate. Postoperative assessment was quantified using the Lysholm knee score (LKS), knee arc of motion (AOM), presence of a pivot shift or Lachman, and knee radiographs with an average of 18.4 months of follow-up.

Five patients (average age of 11.3 years) were treated with a biobsorbable screw and followed for an average of 18.4 months. Average LKS was 99.6, AOM was 98.4%, all patients had negative pivot shift and Lachman exams, and all patients went on to radiographic union. No patients required re-operation or implant removal.

The goals of tibial eminence fracture management are fracture union, restoring knee stability, and regaining normal knee motion and kinematics. Our study demonstrates that open treatment with a bioabsorbable screw is an excellent alternative surgical method as it reliably results in rigid fixation, fracture union, excellent knee function scores, and it mitigates the possible need for hardware removal.

Therapeutic Level IV - Case series.
Therapeutic Level IV - Case series.Varied symptomatology exists in hyperparathyroidism. The current approaches and evaluation of altered calcium homeostasis have led to the practice of early identification and subsequent management of the adenomas. Hence, bony manifestations (deformities, lesions, and fractures) termed to be end stage of bone metabolism failure, have rarely been encountered in the last two decades. We report this infrequent presentation in a 47-year-old female, who visited the emergency department following a trivial fall. Her background history recorded left superior parathyroidectomy three months prior to fall. The clinical and radiological evaluations were suggestive of insufficiency fractures of right proximal humerus and right shaft of femur, multiple lytic lesions and other bony manifestations pathognomonic of hyperparathyroidism. Metabolic profile revealed a primary cause despite prior adenectomy, and targeted scintigraphy demonstrated a hyper-functioning right inferior parathyroid gland. The high resolution ultrasound used before the prior surgery failed to localise additional hyper-functioning glands. Post-parathyroidectomy, the hungry bone disease was adequately managed. The femur fracture required surgical stabilization. In conclusion, bony manifestations of hyperparathyroidism can be disabling and difficult to treat. Although a rare clinical presentation, the severity of bony manifestations arise from a preventable cause and that the initial evaluation of hyperparathyroidism should also include parathyroid scintigraphy, and not limited to screening of the neck with ultrasonography, for its combined additive information and improved diagnostic value.Reverse oblique peritrochanteric fractures are unstable injuries. They have an inherent tendency of lateral wall opening and varus displacement. Cephalomedullary nails are the preferred implants for fixation of these fractures. Standard techniques and a medial entry point may not always be helpful in correcting alignment, resulting in persisting varus malreduction. A simple technique using a Lowman clamp and a conventional 3.5 mm plate has been described to prevent lateral wall opening and indirectly, the varus malreduction.
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