Hand amputation is known to be one of the most debilitating injuries. Its impact on the patient results in multiple diverse outcomes and affects daily life activities and career. With that in mind, we understand how devastating upper limb amputations can be. In this case, we report a middle-aged male who suffered an amputation at the level of the distal forearm and underwent replantation at King Saud Medical City in Riyadh, Saudi Arabia. Dealing with an amputated limb requires knowledge and awareness, starting with the patient and moving on to all healthcare providers involved.

Introduction The unilateral transforaminal lumbar interbody fusion (TLIF) signifies a different surgical method, circumventing both the anterior method and the method via the spinal canal. Due to the shortage of literature available for clinical outcomes and consequences post-TLIF, we undertook the current study to assess the TLIF technique's clinical outcomes among patients with low back pain showing type 1 Modic changes on MRI. Material and methods A cross-sectional study was conducted between January 2019 and March 2021. All patients included in the study had Modic type 1 change and disabling low back pain as the main complaint and/or leg pain. Data were collected on age, body mass index (BMI), gender, and other risk factors like diabetes mellitus, steroid use, and smoking. Pain intensity was evaluated using a visual analog scale (VAS) before and after surgery. A radiographic evaluation was also performed. Pre and post-operative pain scores and differences in disc height were assessed using the Wilcoxon rank sum test. A p-value of less than 0.05 was considered significant. Results The mean length of stay in the hospital was 4.3±1.61. The mean pre-operative lower back pain score was 8.78±0.79. The mean post-operative score was substantially lowered to 0.83±0.7. There was a significant difference between pre- and post-operative lumbar pain (p-value < 0.001). There was a significant increase in mean disc height from pre-operative (7.14 mm) to post-operative (11.02 mm) and also at one year (10.21 mm) with a p-value of <0.001. Of the patients, 82.14% did not have any complications, and 3.57% each had either delayed wound healing without any infection or transient post-operative radiculopathy that improved in six weeks. Conclusion TLIF procedure can be considered safe to provide anterior and posterior column support by adopting a unilateral posterior approach. The outcomes were favorable in terms of no prolonged length of stay, less blood loss, no mortality, reduction in the severity of pain, and improvement in disc height. However, the appropriate selection of patients for this technique is pivotal for the success of the procedure.

» Subacromial balloon spacer (SBS) implantation has been proposed as a minimally invasive treatment for massive irreparable rotator cuff tears (MIRCTs), particularly in elderly patients with preserved glenohumeral articulation and limited functional demands. » Across observational studies, SBS has been associated with short to midterm improvements in pain and shoulder function, reflected by increases in ASES and Constant-Murley scores. » Evidence from randomized controlled trials is mixed; the SPACE trial showed SBS is noninferior to partial repair, while the START:REACTS trial found it less effective than debridement alone. » Complications are uncommon and primarily include balloon migration, synovitis, and rare infections, supporting SBS's safety profile when patient selection is appropriate. » Based on current high-level evidence, SBS is not recommended for routine treatment of MIRCT. Its use should be restricted to carefully selected elderly patients with chronic, nonarthritic MIRCT who are poor candidates for other reconstructive procedures.

The treatment strategies for rotator cuff tears have grown more sophisticated in recent years. Over the past decade, arthroscopic superior capsular reconstruction (SCR) has become popular for treating irreparable rotator cuff tears. Despite the popularity, the literature on the clinical outcomes of SCR is limited. Several surgical procedures using variable graft materials and different techniques have been proposed promising early clinical results with improvements in shoulder pain, range of motion, and overall function. In this paper, we present a case of bilateral massive irreparable rotator cuff tears, with a full description of our surgical technique and the successful outcome of our management.