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Introduction: The floating shoulder has an incidence of 0.1% of all fractures, the result of high-energy trauma. There is still no consensus in the literature on the best treatment: surgical versus conservative., Material and Methods: Patients with floating shoulder diagnosis were evaluated from January 2013 to December 2018, collecting initial data from the electronic file. The morphological types of fractures were described using the Allman and AO classifications. Patients were evaluated using the UCLA scale for shoulder functionality., Results: From 14 patients, 4 were excluded due to lack of follow-up. Of the remaining 10, 9 were men, 1 woman. The average age was 29 years (range 15-42 years). Three patients had left injury, and 7 patients, right; 6 patients hurt the dominant limb. The most common morphological pattern was glenoid neck fracture + clavicle fracture in 7 patients. Surgical treatment was indicated in 7 patients; and in 3, conservative. Of the 7 patients treated surgically, 6 were with clavicle and scapula osteosynthesis; 1 just the clavicle. Patients with conservative management used a universal shoulder immobilizer for 4-8 weeks. There were no cases of consolidation delay, pseudoarthrosis, or vicious consolidation. Rehabilitation began in the first 4 weeks, and lasted up to 8 weeks., Conclusion: Surgical treatment was predominant due to instability. Conservative treatment was used when injuries are minimally displaced. Both treatments generate a favorable functional result.

The congenital pseudoarthrosis of the clavicle is a rare and benign malformation, characterized by the absence of the middle third of the clavicle. It is usually unilateral and the majority on the right side. The etiology is unknown, postulating diverse etiopathogenic theories (vascular, embryological and genetic). It can be detected in the neonatal period or, more frequently, during childhood. Occasionally it can be symptomatic. It may require treatment by surgical reconstruction by bone graft. Two cases are presented, one of neonatal diagnosis and another one of 3 years of age performed with 24 hours of difference. We emphasize on its consideration as a differential diagnosis of obstetric or post-traumatic fracture, cleidocranial dysplasia and neurofibromatosis type I., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

Tumors of the carotid body are uncommon neoplasms that originate in the neuroectoderm. These tumors are slow growing but well vascularized and very destructive. Between 5% and 13% of carotid body tumors are malignant, behaving aggressively at the local level, invading the adjacent lymph nodes, and resulting in remote metastases. We present the case of a 60-year-old man who was examined for pain and paresthesias in his arm. Magnetic resonance imaging showed a large tumor in the left carotid space. Histologic study of a biopsy specimen from the tumor revealed that it was a paraganglioma. Further studies to determine the extent of disease detected metastases in bone and lung, confirming the tumor's malignancy., (Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b)., Material and Method: A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up., Results: The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity., Conclusion: Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware., (Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Functional and radiographic evaluation at midshaft clavicle fractures is better with surgical than conservative management. The aim of this paper is to describe the functional and radiological evaluation of patients with midshaft clavicle fracture surgery at the Hospital de Traumatología y Ortopedia of the Instituto Mexicano del Seguro Social., Methods: Descriptive studies, conducted during the period June 2014 to June 2015, patients undergoing surgical treatment for midshaft clavicle fracture were included. Constant-Murley and Montoya Scales were used to evaluate the functionality and radiological consolidation 6 months after the treatment., Results: There were 90 patients, average age was 33.63 years, 78.9% were men, left side affected in 53.3% patients. At 6 months after surgery, functional results were excellent in 87.8% of patients, in 91% there was disappearance of fracture line regardless callus. The group of patients aged 18 and 40 years present better functional and radiographic results compared to the other groups (p <0.05)., Conclusions: The management of patients with diaphyseal clavicle fracture should be surgical, ages between 18 to 40 years and between 61 to 76 years have better functional outcomes with greater consolidation of fracture line regardless of the callus.

We report two cases, one 23 and one 27 year old man, with several years background of sternal and sternoclavicular joints pain, respectively. The laboratory tests were normal. Based on the clinical, radiologic and scintigraphic findings, SAPHO syndrome was diagnosed. Bone scintigraphy makes it possible to obtain a whole body scan in a single whole body scan, and can be used for differential diagnosis of other osteoarticular diseases and for evolutive control and therapeutic response.

Introduction: The vagal nerve stimulation is a new technique for the treatment of drug resistant epilepsies., Development: In 1997, it was approved in United States by the FDA to be used in adults with refractory focal epilepsies not candidates for epilepsy surgery. Its mechanism of action is unknown. The results in the controlled studies indicated a decrease of 30 50% in the seizure frequency in around 50% of the patients. Although more experience is needed to corroborate these results, it seems reasonable as a treatment for patients with difficult epilepsies, especially when the response to the antiepileptic drugs is poor or they are producing secondary effects, and the resection of the focus is not possible.

The presence of neck metastasis in patients with testicular germ cell neoplasms in a rare but well known phenomenon. The incidence of neck metastasis in testicular carcinoma has been reported to be present in a 5% of cases. When cervical metastasis occurs, surgical resection of the residual disease following chemotherapy and using a specific technique of modified neck dissection results in a surprisingly improvement of the prognosis.