Arthroscopic stabilisation of an acute acromioclavicular dislocation grade III in a patient with ectopic insertion of the pectoralis minor: technical considerations

The different approaches used in arthroscopic stabilisation of the acromioclavicular joint are well known. However, and despite a great incidence of ectopic pectoralis minor insertion, an alternative choice for the use of arthroscopic portal has not being sufficiently described. Here, we describe a case of acute acromioclavicular dislocation grade III. The arthroscopic stabilisation was achieved using the TightRope (Arthrex, Naples, USA) implant. Through this technique, the approach to the articular portion of the coracoid process can be made intra-articularly or from the subacromial space. We accessed intra-articularly, by opening the rotator interval to reach the coracoid process from the joint cavity. After opening the rotator interval, an ectopic insertion of the pectoralis minor was observed. The choice of approach of the coracoid process from the subacromial space would have complicated the intervention, making it necessary to sever the ectopic tendon to complete the technique, lengthening the surgical time and increasing the chance of complications. For this reason, the use of a standard posterior portal providing intra-articular arthroscopic access through the rotator interval is recommended since the aforementioned anatomical variation is not infrequent. Level of evidence Therapeutic studies—investigating the results of treatment, Level V.

En torno a la imagen literaria de Alfonso V de Aragón: Fortún García de Ercilla y su traducción castellana del De dictis de Antonio Beccadelli. Edición y estudio

Alfonso V of Aragon (1396-1458), who won from his contemporaries the title “the Magnanimous”, became one of the most brilliant fifteenth century monarchs, not only because of being a shrewd politician and king of one of the main kingdoms in the Iberian Peninsula, but also due to his cultural activity. Thanks to him the Aragonese territories were extended throughout the Mediterranean up to Naples, where he established a magnificent court that turned into maybe the most remarkable centre of intellectual vitality and development of Humanism. His patronage attracted a considerable number of leading poets of the period, as well as the most important Italian humanists. The presence of so many writers and outstanding scholars, together with the academic environment that the monarch encouraged, promoted an enormous literary production in four languages: Latin, Spanish, Catalan and Italian. Additionally, the valuable library gathered by the king and the Academy founded in order to spread knowledge illustrate part of his intellectual concerns. This way, through his love to literature and generosity to men of letters, Alfonso the Magnanimous boosted the culture of that time. The principal protagonist in the cultural activities of the circle of erudites formed around the sovereign was Antonio Beccadelli, called Panormita (1394-1471). He, one of the most prominent personalities of Italian Humanism, assumed the role of main royal advisor. His work De dictis et factis Alphonsi regis (The sayings and deeds of king Alfonso), which will be studied in our dissertation, became a very popular text about Alfonso’s personality, as a kind of biography based on anecdotes of the Magnanimous’ life by way of exempla to be imitated. The success of these episodes lasted for a long time and they are appreciated even nowadays. The work was valued as specula principum and had great impact in sixteenth century, when De dictis was republished several times and translated from Latin into Spanish. One of these translations, the one by Fortún García de Ercilla, caught our interest since it is in a manuscript signed by Ercilla himself and this version is still unpublished...