Scaphoid lunate advanced collapse (SLAC) is the most frequently encountered cause of wrist osteoarthritis. Proximal row carpectomy (PRC) and four-orner arthrodesis (4CA) are the two main surgical options to address it. Three three-corner arthrodesis (3CA) was introduced in 1997 as an alternative to PRC and 4CA. It is a motion preserving midcarpal arthrodesis easier to perform than 4CA, for which the literature has documented satisfactory outcomes and low complication rates. We report a case of a SLAC wrist treated with 3CA complicated by postoperative osteonecrosis of the lunate. To our knowledge, this complication has not been previously reported. Our patient developed osteonecrosis of the lunate 1 year after 3CA despite a good consolidation of the arthrodesis. In this case study, we discuss reasons this may have occurred, the aetiology of which is likely multifactorial. We are reporting this case to inform surgeons of this potential complication after 3CA. Level of Evidence: Level V (Therapeutic)
We describe the case of a 78-years-old male with dyspnea, inappetence and weight loss over a period of two weeks. The CT scan suggested disseminated tuberculosis and T5-T6 spondylodiscitis. During hospitalization, he developed a left shoulder pain where a reverse total shoulder arthroplasty was implanted 11 years ago. Open debridement and lavage with retention of the implant was performed first and intraveinous antibiotics were administered. 3 months after surgery the patient developed a painful sinus track at the incision site. Resection of the fistula tract, soft tissue debridement and removal of the implants were performed before restarting chemotherapy. As the incidence of reverse total shoulder arthroplasty continues to increase throughout the world, periprosthetic joint infection (PJI) will probably raise as well. Diagnosing and treatment of shoulder PJI with atypical germs remains a challenge and explantation seems to be the safer surgical option to avoid recurrent surgeries on patient with increasing comorbidities.
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