Eugene E. Berg

Posterior Shoulder (Glenohumeral) Dislocation

While shoulder dislocations are a common injury, dislocation in the posterior direction is unusual and often missed clinically. A traumatic posterior shoulder dislocation can be caused by a direct blow to the anterior shoulder or if a posteriorly directed force is axially applied through the forward flexed arm. A posterior shoulder dislocation can occur after a violent muscle contraction induced by an electrical shock or grand mal seizure. Posterior shoulder dislocations are commonly associated with posterior glenoid rim fractures and anterior compression fractures of the humeral head. This diagnosis should not be missed if a complete physical and radiographic exam are properly performed.

Calcific Tendinitis of the Shoulder

Calcific deposits in tendinous tissue are common to middle-aged patients. The condition usually resolves spontaneously, but refractory cases can be expedited by needle barbotage or surgery.

Chinese foot binding.

Chinese foot binding embraced several modern principles of brace treatment. It was initiated in childhood while the foot was cartilaginous and moldable. Culturally, the practice attempted to shape the foot into a pointed lotus flower. The resultant cavus foot deformity was dysfunctional and crippling. This curious custom, outlawed by the Communist party, is ironically analogous in some ways to high-heel shoe wear.

Pediatric distal double bone forearm fracture remodeling.

Childrens bones differ from those of adults in their capacity for ongoing growth and their ability to adapt to a changing body habitus. Similarly, pediatric fractures generally heal more rapidly and have the ability to reshape deformities, a process known as remodeling. The following case exemplifies the remodeling process of a distal radius fracture over time.

Elbow dislocation with arterial injury.

Elbow dislocations are most often the result of a hyperextension mechanism with the forearm levered and displaced posterior to the humerus. Recurrent instability and arterial disruption are uncommon sequelae of this injury. Any asymmetry in distal pulses after joint reduction demands a study of arterial anatomy (arteriogram or duplex scan) to rule out avulsion or intimal damage.

Deep muscle contusion complicated by myositis ossificans (a.k.a. heterotopic bone).

One muscle trauma is a common injury in contact sports. The most extensively damaged muscle is that segment closest to the underlying bone. By an unknown mechanism, this injured muscle can become transformed into heterotopic bone, a complication also called myositis ossificans. It is best managed conservately and rarely requires surgery.

Progress in orthopaedic surgery: the 1980s in review.

These are exciting times. Rapid progress has been made in all orthopaedic subspecialty areas over the past decade. The next decade promises to be one of even greater technologic triumph. With each successful development, new attendant problems and questions arise. Careful long-term, follow-up studies and continued scientific scrutiny always temper the intoxicating promise of innovation with the sobriety of scientific realism. But perhaps this is where the ongoing pleasure and challenge of orthopaedics lie.