Introduction. We aim to assess whether radiographic characteristics of the greater tuberosity fragment can predict rotator cuff tears inpatients with anterior shoulder dislocations combined with an isolated fracture of the greater tuberosity. Methods. A retrospective single-centre case series of 61 consecutive patients that presented with anterior shoulder dislocations combined with an isolated fracture of the greater tuberosity between January 2018 and July 2022. Inclusion criteria: patients with atraumatic anterior shoulder dislocation associated with an isolated fracture of the greater tuberosity with a minimum follow-up of 3-months. Exclusion criteria: patients with other fractures of the proximal humerus or glenoid. Rotator cuff tears were diagnosed using magnetic resonance or ultrasound imaging. Greater tuberosity fragment size and displacement was calculated on plain radiographs using validated methods. Results. The case series was composed of 22 men and 39 women with a mean age of 65 years (29 - 91 years). The mean follow-up was 15months and median follow up 8.5 months (3 – 60 months). A rotator cuff tear was diagnosed in 14 patients (16%) and involved the supraspinatus (13), infraspinatus (4) and subscapularis (2). Full-thickness tears occurred in 6 patients and partial-thickness tears in 8patients. The mean time from initial injury to rotator cuff tear diagnosis was 5 months (2 – 22 months). The mean greater tuberosity fragment length was 23.4 mm in rotator cuff tear patients versus 32.6 mm in those without a tear (p = 0.006, CI: -15 - -2). The mean greater tuberosity. fragment width was 11.1 mm in rotator cuff tear patients versus 17.8 mm in those without a tear (p = 0.0004, CI: -10 - -2). There was no significant difference in the super inferior and anteroposterior fragment displacement between the two groups. Conclusion. In patients with shoulder dislocations combined with an isolated fracture of the greater tuberosity, rotator cuff tears are associated with a smaller sized greater tuberosity fragment

The imaging techniques available to aid the diagnosis of ruptures of tendo Achillis, the rotator cuff and the tendon of tibialis posterior in rheumatoid patients are well described. However, ruptures of tendon or muscle at other sites are uncommon and may be overlooked. Diagnosis is often made by localised tenderness, swelling and a lack of active movement associated with a palpable defect. Clinical examination may be inconclusive and can be aided by imaging studies. We report two cases in which ruptures of a tendon were suspected, and ultrasound imaging demonstrated the palpable defect to be a cleavage plane in the subcutaneous fat – a ‘fat fracture’

Background. Overlooked compartment syndrome represents a devastating complication for the patient. Invasive compartment pressure measurement continues to be the gold standard. However, repeated measurements in uncertain cases may be difficult to achieve. We developed a new, noninvasive method to assess tissue firmness by pressure related ultrasound. Methods. Decreased tissue elasticity by means of rising compartment pressures was mimicked by infusion of saline directly into the anterior tibial compartment of 6 human specimens post mortem. A pressure transducer (Codman) monitored the pressure of the anterior tibial compartment. A second transducer was located in a saline filled ultrasound probe head to allow a simultaneous recording of the probe pressure provoked by the user. The ultrasound images were generated at 5 and 100mmHg probe pressures to detect the tissue deformity by B-mode ultrasound. The fascial displacement was measured before and after compression (d). Subsequently, increments of 5mmHg pressure increases were used to generate a standard curve (0–80mmHg), thus mimicking rising compartment pressures. The intra-observer reliability was tested using 10 subsequent measurements. A correlation was determined between d and the simulated intacompartmental pressure (ICP) in the compartment. The Pearson correlation coefficient (r) was calculated. The reliability determined by the kappa value and a regression analysis was performed. Results. With rising compartmental pressure, a concordant consistent correlation between d and ICP occurred. The Pearson coefficient was significant at r=0.979 and the intra-observer value kappa (k) showed a statistically good reliability (k10=0.73 and k70=0.79). Within a pressure ranging from 5–35mmHg there was an almost linear behavior, with decreasing elasticity and tissue movement in case of raising ICP. Conclusions. Pressure related ultrasound emphasized as a reliable tool to determine the correlation between the measured compartmental displacement and the raising intracompartmental pressures. This may help to improve the clinical assessment of the compartment elasticity by the physician. Further studies are required to investigate whether the good correlation also applies for the clinical scenario. However, this new method may be useful to monitor trends in the compartment pressures and may help to avoid delayed decision of fasciotomy