Total knee arthroplasty (TKA) systems are designed to maximize the longevity of the implant. However, an unusually high rate of aseptic tibial tray loosening was observed in the DePuy ATTUNE ® total knee arthroplasty system (DePuy Synthes, Warsaw, USA). Affected patients noted symptoms of instability and reproducible pain at the bone-implant interface. However, there was no radiographic evidence of lucency or implant failure. Intra-operatively, the tibial component was grossly loose and lacked adhered cement. We hypothesize that the loosening is due to the smooth architecture of the undersurface of the tibial component, lacking either grit blasting or porous coating.

This report presents a previously undescribed case and treatment of bilateral four-part proximal humerus (PH) fracture-dislocations presented in a 61-year-old Caucasian male patient following a first-time seizure episode. The patient was treated with bilateral reverse total shoulder arthroplasty due to pre-existing glenohumeral arthritis and rotator cuff atrophy. The surgery was successful, and the patient's postoperative recovery was uneventful. Fractures of the proximal humerus are a relatively common adult osteoporotic fracture; however, posterior fracture-dislocations of the PH, frequently related to motor vehicle accidents, seizures, or electrical shock, are remarkably scarce. A treatment algorithm for these injuries is lacking.

Compartment syndrome of the hand can be a challenging diagnosis to ascertain. The difficulty in diagnosis is in part due to the absence of an established diagnostic criteria. Additionally, when a patient presents obtunded or with an altered sensorium, the identification of compartment syndrome of the hand can be further complicated. Despite the potential difficulty in diagnosis, it is of upmost importance for orthopedic surgeons to recognize and treat this entity in an expeditious manner. Without prompt treatment, the risk is increased morbidity including possible amputation. Here, we present a unique and thought-provoking case along with a review of the literature. The purpose of sharing this case is to highlight potential clues to aid in prompt diagnosis and improve patient outcomes.

Case: A 38-year-old man developed a nonunion of a comminuted distal phalanx fracture, which resulted in gross instability of the fingertip. To restore stability, a patient-specific 3D-printed distal phalangeal prosthesis was implanted, and the patient was able to return to his occupation with excellent 2-year outcomes. Conclusion: This case highlights the application of 3D printing technology in the development of a patient-specific solution and discusses 6 important considerations for the design and planning process: Patient, Priorities, Point of fixation, Procedure, Problems, and People. Preoperative anteroposterior radiograph of the injured middle finger. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B889).

Compartment syndrome of the hand can be a challenging diagnosis to ascertain. The difficulty in diagnosis is in part due to an absence of an established diagnostic criteria. Additionally, when a patient presents obtunded or with an altered sensorium the identification of compartment syndrome of the hand can be further complicated. Despite the potential difficulty in diagnosis, it's of upmost importance for orthopedic surgeons to recognize and treat this entity in an expeditious manner. Without prompt treatment, the risk to the patient is increased morbidity including possible amputation. Here within, we present a unique and thought-provoking case along with a review of the literature. The purpose of sharing this case is to highlight potential clues to aid in prompt diagnosis and improve patient outcomes.