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Objective: Rare disease Background: Pigmented villonodular synovitis is a rare clinical entity, with 2-3% of all PVNS cases affecting the shoulder. Diagnosis is challenging and can elude clinicians for years, with definitive treatment involving arthroscopic or open synovectomy. Case Report: A 50-year-old woman presented with left shoulder pain persisting for 2 years. She was initially conservatively treated by a rheumatologist, with corticosteroid schemes intra-articularly injected and per os, but no improvement of her symptoms was noted. Two years later, she was referred to the Orthopedics Department of our hospital with constant pain in her left shoulder, refractory to the conservative measures. Physical examination revealed tenderness of her shoulder on palpation and limited range of motion. The diagnosis of PVNS was established by preoperative magnetic resonance arthrography (MRA) and confirmed by biopsy from intra-operative tissue sampling. Arthroscopic debridement and synovectomy were performed, yielding good surgical results, and she now reports pain relief, improved function, and no recurrence of symptoms at 1-year follow-up. Conclusions: The diagnosis of PVNS can be elusive for years. MRI and clinical suspicion along with tissue biopsy can set the diagnosis. Shoulder PVNS follows a similar natural history as knee PVNS, with conservative treatment failing and arthroscopic excision providing definite relief. We report a rare case of shoulder PVNS, underscoring the importance of considering PVNS in cases of shoulder pain refractory to conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. The vast majority of intertrochanteric fractures require surgical treatment to withstand early mobilization and weight bearing, which prevents complications due to prolonged bed rest and aids in fracture healing. Methods: This study is compromised by two parts, the experimental study and the clinical part. In the first part, a standard 130° nail will be used with the appropriate lag screw(s) and dynamic distal locking in synthetic osteoporotic femurs and the transmission of forces in the proximal femur, measured by a cortical surface-strain distribution, will be evaluated using digital image correlation. Finite element parametric models of the bone, the nails and their interface will be also developed. Finite element computations of surface strains in implanted femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the nails by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. In the other part, will set up a prospective, randomized, comparative clinical study among the Gamma3 and IT cephalomedullary nailing, in order to investigate if there are any statistical important differences in the main radiological measurements and functional status in closed unstable intertrochanteric fractures (A21-3) in patients aged over 70 years old at the 24-week follow-up evaluation using patient reported disease-specific outcomes. Discussion: This study will be the first to compare clinical, radiological and biomechanical measurements of the two different cephalomedullary nails. Our main hypothesis is that the IT nail would provide better radiological outcome and probably better clinical results than the Gama3 nail. Clinical trial registration International Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN15588442, registered on 19/4/2022. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Posterior shoulder dislocation is an uncommon injury, accounting for less than 5% of all glenohumeral dislocations. Bilateral locked posterior shoulder fracture-dislocation is an extremely rare entity with an incidence of 0.6 cases/100 000 people/year. A few reports have been published in the literature, predominantly associated with epileptic seizures. Case Report: We present a rare case of a 55-year-old male patient with a history of epileptic seizures, who presented with bilateral, locked, posterior fracture-dislocation of the shoulder following an epileptic seizure. The patient was diagnosed with a cavernous hemangioma, which caused his epileptic episode. He was treated operatively, with a modified McLaughlin procedure performed on both sides, at 1 stage, by 2 surgical teams. The cavernous hemangioma was also resected 2 months later. After a follow-up period of 18 months, no recurrent episodes of instability or dislocation were identified. Full range of motion was present on both sides, with good clinical and radiological outcomes. We also conducted a literature review to elucidate the causes of this rare incidence, along with diagnostic workup and treatment options. We were able to identify 36 cases, involving 72 shoulders of bilateral posterior fracture-dislocations in 30 case reports and 2 case series. Conclusions: Bilateral posterior fracture-dislocation of the shoulder is uncommon. Treatment strategy depends on the chro- nicity, involvement of the humeral head, and the patient's age and functional level. The target is to restore shoulder anatomy and maintain a functional range of motion. [ABSTRACT FROM AUTHOR]