Glenoid bone loss is a significant risk factor for failure after arthroscopic shoulder stabilization. Multiple options are available to reconstruct this bone loss, including coracoid transfer, iliac crest bone graft, and osteoarticular allograft. Each technique has strengths and weaknesses. Coracoid grafts are limited to anterior augmentation and, along with iliac crest, do not provide an osteochondral reconstruction. Osteochondral allografts do provide a cartilage source but are challenged by the potential for graft rejection, infection, cost, and availability. We describe the use of a distal clavicular osteochondral autograft for bony augmentation in cases of glenohumeral instability with significant bone loss. This graft has the advantages of being readily available and cost-effective, it provides an autologous osteochondral transplant with minimal donor-site morbidity, and it can be used in both anterior and posterior bone loss cases. The rationale and technical aspects of arthroscopic performance will be discussed. Clinical studies are warranted to determine the outcomes of the use of the distal clavicle as a graft in shoulder instability.

Seventy-two Mitchell distal metatarsal osteotomies for hallux valgus performed over a period of 10 years have been reviewed. Sixty-six (92 per cent) were graded as excellent or good. Retrospective radiographic analysis of 29 of these cases showed that the operation had reduced the intermetatarsal angles to within normal anatomical limits. No patient experienced a worsening of symptoms as a result of the operation.

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SUMMARY:We report a case of a patient with an intradural hemangiopericytoma of the lumbar spine and the unusual MR angiography (MRA) and spinal angiography findings of arteriovenous shunting with spinal venous congestion. We highlight the concordance of the unusual MRA and angiographic findings and their relationship to combined endovascular and surgical therapy. H emangiopericytomas, initially described by Stout and Murray, 1 are vascular tumors derived from pericytes, the smooth muscle cells that control the diameter of the capillaries. The mass itself is composed of numerous capillaries with an intact basement membrane, with the neoplastic pericytes in the extravascular space.2 Hemangiopericytomas may be considered benign or malignant, have been identified in all age groups, and demonstrate no sexual predisposition.3 Primary spinal hemangiopericytomas are rare, with only 39 reported cases in the literature, those being primarily extradural.We describe the unique presentation of a lumbar intradural hemangiopericytoma that produced imaging findings consistent with an arteriovenous shunt, with congested spinal veins and concordant spinal MR angiography (MRA) and conventional angiographic findings. Endovascular embolization of the hemangiopericytoma was performed to treat the arteriovenous shunt and prevent excessive intraoperative blood loss. In addition, the enlarged radicular vein was ligated during surgery to definitively prevent any myelopathic complications. Case ReportA 54-year-old man presented to our emergency department with left paraspinal, buttock, and anterolateral thigh pain that radiated down the anterior shin and left foot. Initial noncontrast MR examination revealed a lesion in the left L4-L5 neural foramen, which was soft tissue signal intensity on all sequences. Serpiginous, intradural signal intensity voids were identified in the lumbar spinal canal without change in signal intensity in the cord (Fig 1). Contrast-enhanced spinal MRA and postcontrast images were recommended to elucidate the nature of the intradural flow voids and better define the neuroforaminal mass.The L4-L5 neuroforaminal mass enhanced with contrast (Fig 2). MRA (Fig 3, left) of the lumbar spine demonstrated prominent intradural vessels contiguous with the mass with congested pial veins, compatible with a spinal arteriovenous fistula or arteriovenous malformation. Spinal angiographic examination was recommended both to further elucidate the relationship between the soft tissue mass and the abnormal surface veins and for possible perioperative intervention.Spinal angiography (Fig 3, right) revealed a hypervascular mass in the left L4 recess with radicular venous drainage and filling of congested intradural veins ascending to the level of the conus, where congested anterior and posterior spinal veins were apparent. Devascularization of the tumor was performed without residual tumor blush and disappearance of the apparent arteriovenous shunting accounting for spinal venous congestion. At surgery, the L4-L5 nerve sheath was inc...