Osseous Erosion by Spinoglenoid Ganglion Cyst in Adolescent Baseball Player: A Case Report / 대한스포츠의학회지

Spinoglenoid notch cysts, a certain expansion form of paralabral ganglion cyst, are often associated with superior labrum anterior to posterior (SLAP) lesions in overhead athletes. We report a unique case of spinoglenoid notch cyst that extended to posterosuperior bony glenoid in a 16-year-old high school male baseball fielder. Magnetic resonance imaging showed multilobulated spinoglenoid notch ganglion cyst associated with posterosuperior SLAP lesion, and computed tomography (CT) revealed distinct osseous erosion of posterosuperior glenoid. The cyst was enlarged on serial follow-up imaging, and his symptoms were continued, arthroscopic decompression was performed via posterosuperior capsulotomy. The concomitant SLAP lesion was not repaired, but only marginal debridement was performed. At 6 months after surgery, he returned to game without symptoms, and the bony glenoid lesion was almost remodeled on follow-up CT. In adolescent athletes, significant osseous erosion by spinoglenoid notch cyst may be accentuated due to the skeletal immaturity of posterosuperior glenoid.

Atypical Spondylolysis of the Fifth Lumbar Vertebra in Baseball Players:Two Cases Report / 대한스포츠의학회지

Lumbar spondylolysis is a frequent cause of low back pain especially in adolescents involved in sporting activities. It is considered as a fatigue-type defect in the pars interarticularis or isthmus resulted from repetitive hyperextension and rotation on the spine; however, there is still confusion in regard to imaging findings of the location and direction of the defect. We report two unique cases of fifth lumbar spondylolysis in professional baseball hitter and adolescent pitcher; early-stage unilateral incomplete isthmus fracture and bilateral fracture in a different configuration, respectively. Computed tomography demonstrated vertical and more coronally oriented fracture lines compared with typical spondylolytic defect, and repetitive rotation in the same direction of pitching might cause a different type of fracture on the contralateral isthmus with the preexisting unilateral defect. Intriguingly, early-stage unilateral fracture in hitter was united after only 6 weeks of rest and rehabilitation and able to return to the game.

Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures

Purpose@#This study was designed to evaluate the radiological and clinical outcomes of a new surgical technique—customized staple fixation using K-wire—in displaced metacarpal neck or base fractures. @*Materials and Methods@#From November 2016 to May 2017, 13 unstable metacarpal neck and base fractures (10 patients) were treated with II-shaped customized K-wire staples fixation, after performing open reductions through minimal dorsal incisions. The radiological and clinical outcomes were retrospectively evaluated. @*Results@#A mean of 2.6 staples were used for each fracture fixation. Preoperative angulation of 36.3°was reduced to 3.1° postoperatively. A week after surgery, the volar short arm splint was replaced with a dorsal splint to initiate active range of motion exercise, and the splint was subsequently removed after 3 weeks. The radiologic union was achieved at a mean of 5.1 weeks, and total active motion was recovered at a mean of 7.4 weeks. On a mean, K-wire staples were removed at 16.5 weeks after the surgery, and the mean treatment took 18.6 weeks. At the final follow-up (at mean 27.3 weeks), no significant difference was observed for total active motion of the digits and grip strength, when compared to the contralateral hand. Complete union was achieved in all fractures without deformity, or complications such as infection or nerve injury. All patients were satisfied with the cosmetic and functional outcomes. @*Conclusion@#K-wire stapling is an effective alternative modality in treating unstable displaced metacarpal neck or base fractures. It requires minimal incision to enable open reduction. In addition, early mobilization is ensured through the rigid fixations. Moreover, it prevents postoperative joint stiffness and reduces the time needed for treatment.

Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?

Purpose@#This study evaluated the usefulness of a silicone ring tourniquet by analyzing the changes in the perioperative hemoglobin (Hb) levels or amount of perioperative bleeding compared to those of a pneumatic tourniquet or no usage during minimally invasive plate fixation for distal femoral fractures. @*Materials and Methods@#From January 2017 to December 2019, 30 patients who underwent minimally invasive plate fixation using a locking compression plate for distal femoral fractures were evaluated and classified as a silicone ring tourniquet (Group 1), a pneumatic tourniquet (Group 2), and no usage (Group 3). The variables for analysis were age, sex, preoperative Hb (preHb), postoperative 72-hour Hb (postHb), differences between preHb and postHb (preHb-postHb), amount of intraoperative and overall transfusion, estimated unit of transfusion corrected by preHb-postHb and total transfusion (Hb-lost), amount of intraoperative and postoperative and total bleeding. One-way ANOVA was used to identify the differences between the groups. @*Results@#The age, sex, operation time, preHb, preHb-postHb, amount of intraoperative and overall transfusion and Hb-lost were similar in the two groups. The amount of intraoperative bleeding was significantly lower in Group 1 than Group 3 (p=0.004), but there was no difference in the amount of postoperative and total bleeding between the two groups. @*Conclusion@#The use of a silicone ring tourniquet in the minimally invasive plate fixation for distal femoral fractures decreased the amount of intraoperative bleeding compared to no use of a tourniquet.

Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.

Posterior Glenoid Lesions on Magnetic Resonance Imaging in Adolescent Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the characteristics of posterior glenoid lesion (PGL) on magnetic resonance imaging (MRI) in adolescent baseball players. Seventy-two adolescent baseball players (mean age, 15.1 years) who underwent MRI scan for dominant shoulder pain were enrolled and the location and morphologic features of PGLs were assessed on MRI. All players were divided into three groups based on the physeal status of proximal humerus: group I, open; group II, partial closure; and group III, complete closure. Of the 72 players, posterior glenoid rim rounding (69%) and periosteal thickening (88%) were the main PGL on axial imaging. Osteochondritis dissecans (OCD) of glenoid (10%), Bennett lesion (6%), and posterior labral tear (21%) were also identified. On oblique sagittal imaging, bony PGL including OCD involves mid-portion of posterior glenoid consistent with the level of the infraspinatus muscle, but Bennett lesion was located relatively lower than PGL. Posterior glenoid rim rounding was more prevalent in younger players (group I, 86%; group II, 78%; group III, 43%; p=0.015), and posterior labral tears were in older players (group I, 0%; group II, 19%; group III, 38%, p=0.027). Factors related with prevalence of posterior glenoid rim rounding were increased body mass index (p=0.016), pitchers (p=0.024), and players with posterior shoulder tightness (p=0.023), but career length was not statistically significant (p=0.089). Decreasing the rate of posterior glenoid rim rounding with skeletal growth implies that it may be recovered through the remodeling process, and labral tears are increasing internal impingement lesion after physeal closure.

Ulnar Collateral Ligament Tear Combined with Medial Epicondylitis of the Elbow / 대한스포츠의학회지

Medial epicondylitis, also known as “golfer's elbow,” is a common overuse syndrome of the elbow and predominantly affects the origin of the common flexor tendon. We report two unique cases of medial epicondylitis complicated by chronic complete tear of the ulnar collateral ligament and common flexor tendon origin. Physical examination showed a focal huge swelling of medial epicondylar region of the dominant elbow and magnetic resonance imaging revealed complete tear of the ulnar collateral ligament and common flexor tendon and extravasation of intra-articular effusion. Satisfactory results were achieved with ulnar collateral ligament reconstruction and simultaneous repair of the common flexor tendon origin.

Ultrasonographic Findings of Little Leaguer's Shoulder / 대한스포츠의학회지

The purpose of this study is to evaluate the ultrasonographic findings of little leaguer's shoulder among adolescent baseball players. Forty-two little leaguer's shoulder patients (age, 11–16 years; mean, 13.8 years; right, 39; left, 3), based on plain X-ray, were examined by bilateral shoulder ultrasonography. All patients were divided into groups on the basis of sonographic abnormalities and bilateral differences of physeal gap were measured in the cases of significant physeal widening. Sonographic abnormalities of dominant shoulder were physeal irregularity (45%), physeal fragmentation (21%), periosteal thickening (36%) and physeal widening (83%) that was the most common abnormalities. Seven of 42 patients (group A) had only physeal irregularity with minimal physeal widening, 26 patients (group B) had more than 1-mm physeal widening compared with nondominant shoulder. Nine patients (group C) had both physeal widening and fragmentation. Mean physeal gaps of the dominant and nondominant shoulders in 35 patients (group B and C) were 3.4±0.8 mm and 1.4±0.1 mm, respectively (p=0.013) and increased average physeal gap of dominant shoulder was 2.0±0.8 mm. Among three groups of patients, the duration of symptom was significant longer in group C (p=0.011). Physeal widening and fragmentation were associated with progression of the disease, but physeal irregularity was relatively early sonographic finding. Ultrasonography is a useful tool to evaluate the status of proximal humeral epiphysis and can aid early diagnosis of little leaguer's shoulder in the field.

Intra-Apophyseal Avulsion Fracture of Medial Epicondyle in a Adolescent Baseball Player / 대한스포츠의학회지

Overuse elbow injuries in young throwing athletes are generally defined as 'Little Leaguer's elbow'. Repetitive submaximal valgus forces on the medial epicondylar apophysis in such athletes can result in apophyseal separation or chronic apophyseal fragmentation, which would usually take over more than a year to heal. We report of a unique case of a 13-year-old male baseball pitcher who, due to the traction of the medial collateral ligament, presented with an acute intra-apophyseal avulsion fracture of the medial epicondyle. The fracture was successfully healed using a long arm cast, and correct union was confirmed by 3 dimensional computed tomography at 8 weeks post-trauma. This acute avulsion fracture is a variant of Little Leaguer's elbow and should be distinguished in terms of diagnosis and treatment from common lesion such as chronic fragmentation of the medial epicondylar apophysis.