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Abstract Objective To report a new technique for anatomical acromioclavicular (AC) joint reconstruction. Methods In order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing. Results This technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow‐up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture‐button interface, with none of these requiring surgical revision. Conclusion This technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.

Abstract Purpose Little is known about the direct influence of different technical options at the rotator cuff tendon‐bone interface (TBI) and, more specifically, at the medial bearing row (MBR), regarding local contact force, area and pressure. We evaluated the mechanical repercussions of different medial row anchor configurations for that setting using different values of tension in the lateral row anchors. Methods Knotless transosseous equivalent (TOE) rotator cuff repairs with locked versus nonlocked medial anchors and single versus double‐hole suture passage were tested in a synthetic rotator cuff mechanical model, using 2 different values of lateral row tension. Contact force, area, pressure, peak force and MBR force were compared at the simulated TBI using a pressure mapping sensor. Results When compared to locked anchors, medial row sliding configurations generate lower values for all the above‐mentioned parameters. The use of double‐hole suture passage in the medial cuff generated slightly higher values contact area regardless of lateral row tension. At higher lateral row tension values, lower values of the remaining parameters, including MBR force, were found when compared to single‐hole suture passage. Lateral row anchor tension increase induced an increase of all parameters regardless of the medial row configuration and TBI contact force and MBR force were the most susceptible parameters, regardless of the medial row pattern. Conclusion Medial row mechanism, suture configuration and lateral row tension interfere with the mechanical force, area and pressure at by TBI. Lateral row tension increase is a major influencer in those parameters. These results can help surgeons choose the right technique considering its mechanical effect at the TBI.

Abstract Purpose Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success. Methods A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size “repair box” using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box. Results Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage. Conclusion Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.

Dislocation of the pisiform is a rare injury, with only few cases reported in the literature. This condition, in association with terrible triad injury of the elbow, is an even more rare occurrence. We report a case of a 51-years-old right-handed female patient who suffered from a dislocation of the left pisiform in association with terrible triad injury of the elbow, after a ground level fall. It was performed a reinsertion of the coronoid process and radial collateral ligaments with anchors, radial head arthroplasty, and closed reduction and internal fixation of the pisiform with Kirschner wire. At the end of follow-up, the patient had satisfactory range of movement of the wrist and elbow, and no residual pain. This rare injury to the wrist is demanding in diagnostics and treatment. However, with a correct diagnosis and appropriate treatment, an excellent clinical outcome can be achieved.

Extra-articular, transverse, distal phalangeal fractures that involve the physis, are termed Seymour fractures. They are frequently associated with an avulsion of the nail and a laceration of the nail bed. For this type of fractures, sur-gical intervention is needed to explore the fracture site for soft tissue interposition. Its failure may result in several complications. The authors report an adult Seymour-type fracture, which developed an infection due to interposition of the germinal matrix of the nail complex on the fracture site. The purposes of this article are to demonstrate that this rare fracture can also occur in adults, highlight the importance of treating this injury with the basic principles of open fracture treatment, and evidence one of its complications if not well treated.