Introduction: Degenerative disorder involving the acromioclavicular joint (ACJ) is quite common especially in the elderly. One of the surgical modalities of treatment of this disorder is the Mumford Procedure. Arthroscopic approach is preferred due to its reduced morbidity and faster post-operative recovery. One method utilizes the anteromedial and Neviaser portals, which allow direct and better visualization of the ACJ from the subacromial space. However, the dangers that may arise from incision and insertion of instruments through these portals are not fully understood. This cadaveric study was carried out to investigate the dangers that can arise from utilization of these portals and which structures are at risk during this procedure. Materials and Methods: Arthroscopic Mumford procedures were performed on 5 cadaver shoulders by a single surgeon utilizing the anteromedial and Neviaser portals. After marking each portals with methylene blue, dissection of nearby structures were carried out immediately after each procedure was completed. Important structures (subclavian artery as well as brachial plexus and its branches) were identified and the nearest measurements were made from each portal edges to these structures. Results: The anteromedial portal was noted to be closest to the suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal was noted to be closest also to the SSN at 1.60 cm. The suprascapular nerve was the structure most at risk during the Mumford procedure. The anteromedial portal was noted to be the most risky portal to utilize compared to the Neviaser portal. Conclusion: Extra precaution needs to be given to the anteromedial portal while performing an arthroscopic distal clavicle resection in view of the risk of injuring the suprascapular nerve of the affected limb.
urgical Procedures, Operative ; General Surgery

Infection is a dreaded complication in patients who have underwent arthroplasty and often very challenging to treat. It accounts for lesser than 1% of arthroplasty cases and although low in occurrence, requires appropriate investigations and management to successfully treat the condition. This case demonstrates a case of a rare microorganism with unusual antibiotic susceptibility causing a prosthetic joint infection and the use of serum procalcitonin level as guide in management of the patient.

Introduction: Bertolotti’s syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease. Methods: A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22. Results: The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%). Conclusion Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.
Low Back Pain