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Introduction: The aim of this study is to illustrate a case in which the use of a dorsal spanning plate followed by volar plating may be indicated in the setting of a complex intra-articular distal radius fracture. Combined dorsal spanning plate and volar plating is a rare procedure reserved typically for comminuted fractures of the distal radius. This case highlights the first reported incidence in which a dorsal spanning plate of a distal radius fracture resulted in the volar displacement of the fragments, requiring subsequent volar plating. In the end, the outcome was favorable, as the follow-up imaging displayed good bone healing and union with minimal complications., Case Report: A 52-year-old male presented to the ED at our institution following a traumatic fall onto his left upper extremity. Radiographic imaging revealed fractures at the midshaft of the humerus as well as a very distal three-part intra-articular radius fracture. Due to the nature of the patient's distal radius fracture, initial fixation with a dorsal spanning plate was planned. However, follow-up imaging 3 weeks postoperatively revealed volar displacement of his fracture, so the patient underwent open reduction internal fixation with a volar distal radius plate. Follow-up over the next few months displayed a union of the fracture fragments and the dorsal spanning plate was removed 4 months postoperatively with imaging showing no complications., Conclusion: We present this case to highlight the complication of volar displacement that may follow initial dorsal spanning plate fixation of a three-part intra-articular distal radius fracture that can be resolved with the addition of a volar plate, as well as possible indications for combined dorsal spanning plate and volar plate fixation of complex distal radius fractures at the time of initial fixation., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Background/objective: The deltoid muscle is impacted by common injuries and clinical procedures. This study aims to summarize the anatomy, injuries, and clinical considerations involving the deltoid muscle., Method: A literature search was performed using PubMed and Google Scholar using keywords that focused on the deltoid muscle in the shoulder. Primary research articles and appropriate summary articles were selected for review., Results: Reduced deltoid muscle function can be caused by axillary nerve injury, rupture of the deltoid itself, or iatrogenic damage to the muscle. The deltoid muscle has an intimate relationship with the axillary nerve and neighboring rotator cuff muscles. Injury to these nearby structures may be masked by compensating deltoid strength. Examination maneuvers in clinic such as the Akimbo Test should be used to isolate the deltoid muscle to determine if the presenting weakness is from the deltoid itself or from other surrounding injury. Additionally, prior to performing clinical procedures, it is important to be cognitive of the injuries that can occur. For example, incisions that extend distally from the acromion should not extend beyond 5-7 cm as this is the common location of the axillary nerve and vaccine administration should take measures to avoid misplaced injections to avoid unnecessary trauma., Conclusion: Deficiency of the deltoid muscle can be debilitating to patients and it is best clinical practice be aware of the anatomy, various causes, tests, and avoidance measures to help diagnose, restore or preserve normal functioning., Competing Interests: The authors have no conflicts of interest to declare.

Introduction: The aim of this study was to report a patient with refractory prosthetic joint infection (PJI) and severe peripheral arterial disease that necessitated hip disarticulation (HD), a rare and aggressive procedure. While this is not the first HD performed due to PJI, this is the first reported incidence that deals with profound infection burden along with immense vascular disease that has failed all other treatment options., Case Report: We report a case of an elderly patient with a prior history of the left total hip arthroplasty, PJI, and severe peripheral arterial disease who underwent a rare HD procedure and was discharged with minimal complications. Before this major surgery, several surgical revisions and antibiotic regimens were attempted. The patient had also failed a revascularization procedure to treat an occlusion stemming from the peripheral arterial disease and had developed a necrotic wound at the surgical site. Irrigation and debridement of associated necrotic tissue was unsuccessful and due to concerns such as cellulitis, HD was performed with patient consent., Conclusion: HD is a rare procedure that comprises only 1-3% of all lower limb amputations and is reserved for extremely deleterious indications such as infection, ischemia, and trauma. Complication and 5 year mortality rates have been reported to be as high as 60% and 55%, respectively. Despite these rates, the patient case illustrates a situation, in which early detection of indications for HD prevented further negative outcomes. Based on this case, we believe that HD is a reasonable treatment of choice in patients with severe peripheral arterial disease who fail revascularization and prior moderate treatment options. However, the limited availability of data involving HD and variety of comorbid conditions necessitate further analysis in terms of outcomes., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Sacroiliitis is an inflammation of one or both of the sacroiliac (SI) joints, most often resulting pain in the lower back that can extend down the legs. Pain arising from the SI joint can be difficult to diagnose and treat due to the intricate surrounding ligamentous structure, nerve innervation, and its role in transferring weight from the upper body to the lower limbs. SI joint dysfunction accounts for up to 25% of cases of lower back pain and has a debilitating effect on patient functionality. This review aims to provide comprehensive coverage of all aspects of SI joint pain, with a specific focus on differential diagnosis and treatment., Methods: Current literature on SI joint pain and inflammation, other etiologies of lower back pain, and new treatment options were compiled using the databases PubMed and Cochrane and used to write this comprehensive review. There were no restrictions when conducting the literature search with regard to publication date, study language, or study type., Results: The diagnosis protocol of SI joint pain arising from sacroiliitis usually begins with the presentation of lower back pain and confirmatory diagnostic testing through fluoroscopy joint block. Reduction in pain following the anesthetic is considered the golden standard for diagnosis. The treatment begins with the conservative approach of physical therapy and analgesics for symptom relief. However, refractory cases often require interventional methods such as corticosteroid injections, prolotherapy, radiofrequency ablation, and even SI joint fusion surgery., Conclusion: SI joint pain is a complex problem that can present with varying patterns of pain due to uncertainty regarding its innervation and its prominent surrounding structure. It is therefore especially important to obtain a thorough history and physical on top of diagnostic tests such as a diagnostic block to properly identify the source of pain. Conservative treatment options with physical therapy and analgesics should be attempted first before interventional strategies such as ablation, injections, and prolotherapy can be considered. SI joint fusion surgery is a solution to cases in which previous methods do not provide significant relief., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Anderson Lee et al.)

Case: Combined medial and lateral patellar instability is exceptionally rare with only 3 reported cases to date. Here, we present the case of a 37-year-old White woman with multiple recurrent medial and lateral patellar instability. After failure of conservative care with bracing and therapy, she underwent surgical stabilization with medial and lateral allograft reconstruction., Conclusion: This case provides an example of the condition and successful surgical follow-up., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B634)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Case: We report on 2 patients with atypical femur fractures that initially presented as painful total knee arthroplasties. There was a history of long-term bisphosphonate use in each case. Knee radiographs and laboratory studies were normal, and the patients were managed conservatively. Both subsequently sustained atypical femur fractures and underwent surgical stabilization., Conclusions: Referred pain from a bisphosphonate-related femoral stress fracture can masquerade as pain about a total knee arthroplasty. This should be included in the differential diagnosis in at-risk patients because it can result in an atypical femoral shaft fracture above the prosthesis if not properly treated.