No abstract

No abstract

No abstract

Nonoperative treatment of scapular body fractures has shown good clinical results. Although scapula fractures of the inferior angle, particularly with oblique lines from the medial proximal to lateral distally, are very rare, we believe that such a fracture pattern would be regarded as an avulsion fracture of the serratus anterior muscle requiring surgery. We have experienced three cases demonstrating pseudowinging of the scapula due to displacement of the inferior angle fracture of the scapula. Surgical repair or plating showed satisfactory clinical results. Through these cases, we describe the cause of winging scapula and the problems resulting from an avulsion fracture of the serratus anterior muscle with a review of the relevant literature and explain the reason that an operation is needed for this fracture pattern.

This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic singlebundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant.H istorically, surgical treatment for ruptures of the anterior cruciate ligament (ACL) has evolved in different ways. Recently, attention has been brought to anatomic double-bundle (DB) ACL reconstruction and the importance of anatomic tunnel placement. Advocates of the DB technique suggest that it improves rotational control and overall function and possibly decreases radiographic evidence of postoperative degenerative joint disease, although there are reports that the clinical outcomes of DB reconstruction are not always significantly different from those of singlebundle (SB) reconstruction.1,2 The DB technique is considered complex, more time-consuming, and technically difficult. Several recent studies have shown that SB ACL grafts placed in the center of their anatomic insertions can provide nearly normal knee kinematics and the procedure was comparable with DB procedures.3 It is difficult to restore the anatomic femoral origin of the ACL using the traditional transtibial technique despite technical modifications of the coronal angle and starting position. However, a new technique drilling from the outside in with the FlipCutter (Arthrex, Naples, FL) facilitates placement of the femoral tunnel in the correct position. 4 Recently, there has been growing interest in the potential role of the remnant of the ACL after a tear (Fig 1A). Taking these recent new trends in ACL reconstruction into consideration, we focused our technique on anatomic SB remnant-preserving drilling from the outside in with the FlipCutter. Surgical TechniqueThe patient is positioned supine, and the operative proximal thigh is fixed in a leg holder. With 90 of knee flexion and by use of leg-drop position, standard anterolateral and anteromedial (AM) portals are made and routine arthroscopy is performed.After an arthroscopic evaluation and treatment of possible associated lesions, the semitendinosus and gracilis tendons are harvested through a small incision placed 2 cm medial to the tibial tubercle. The harvested grafts are prepared by folding them at their midsection and placing whip-stitched sutures (No. 2 Ethibond; Ethicon, Som...