Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Erratum: Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments / 대한스포츠의학회지

The corresponding author of the article should be corrected as Hyeung-June Kim.

Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments / 대한스포츠의학회지

First aim of this study was to compare the results of the intramedullary nail fixation and plate fixation for the management of humeral shaft fracture with butterfly fragments. Second aim of this study was to appraise the necessity of anatomical reduction and fixation for butterfly fragment in humeral shaft fracture. Thirty-one patients with comminuted humeral shaft fracture were treated by reduction and internal fixation with intramedullary nail or plate. The criteria for inclusion were AO classification type B, follow-up period more than 12 months, diaphyseal fracture without involvement of joints. Eighteen patients underwent intramedullary nail fixation and 13 by plate fixation. The outcome was assessed in terms of the union rate, union time, incidence of complications, and functional outcome of shoulder joint. The union rate was 94.4% in intramedullary nail group and 100% in plate group. The average union time was found to be no significant difference between two groups (p>0.05). There was no significant difference in the American Shoulder and Elbow Surgeons' score and range of motion of shoulder and elbow joint between the two groups in last follow-up (p>0.05). The union rate and average union time and functional outcome of shoulder joint was no significant difference between the intramedullary nail fixation and plate fixation for the management of humeral shaft fracture with butterfly fragments. It is recommended to select skillful technique to avoid technical errors rather than technique to fix of butterfly fragments.

Concomitant Osteochondral Autograft Transplantation and Fixation of Osteochondral Fragment for Treatment of a Massive Osteochondritis Dissecans: A Report of 8-Year Follow-up Results

Numerous procedures exist to treat osteochondritis dissecans (OCD); however, it remains a topic of debate which procedure is most ideal. When restoring a massive osteochondral defect, the use of only one procedure may not always allow complete filling of the defect. This case report presents a massive OCD with displaced osteochondral fragment and loose body in the knee joint that occupied almost all of the weight bearing area of the medial femoral condyle and was treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. To our knowledge, this is a rare report on OCD treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. At 8 years after surgery, the clinical outcome was excellent, and radiographs revealed congruence of the medial femoral condyle. The patient returned to sports activities. In massive and complex OCD lesions, individual techniques have limitations. Two or more techniques are needed to increase the rate of success.

Comparison of Magnetic Resonance Imaging of Remnant Preserving versus Remnant Sacrificing Technique after Anterior Cruciate Ligament Reconstruction; Clinical Results and Second-Look Arthroscopic Findings: Pilot Study / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to clarify the difference between the remnant-preserving and remnant-sacrificing techniques in anterior cruciate ligament (ACL) reconstruction using stress test, functional score, 2nd look arthroscopy and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Among 66 patients having anatomical ACL reconstruction with the fourstrand hamstring autograft using outside-in technique (FlipCutter(R)) for the femoral tunnel from April 2012 to April 2014, 23 patients who underwent 2nd look arthroscopy and MRI were included. The remnant-preserving group included 12 patients and the remnant-sacrificing group included 11 patients. The two groups were compared and analyzed with regard to stability (Stress test using GNRB(R), pivot shift test), functional assessment (International Knee Documentation Committee [IKDC] scale, Lysholm score, one leg hoop test), and the result of second-look arthroscopy and signal to noise quotient (SNQ) ratio of the graft in MRI. RESULTS: The two groups did not differ significantly in the stability test, IKDC scale, and Lysholm test. The remnant-preserving group showed significant improvement in one leg hoop test compared with the remnant-sacrificing group (p0.05). CONCLUSION: More than 12 months after surgery, the graft of the remnant-preserving group showed lower signal intensity compared to that of the remnant-sacrificing group by MRI evaluation. The remnant preserving technique has biological difference compared with the remnant sacrificing technique in human study.

Rupture of the Pectoralis Major Muscle during Exercise / 대한스포츠의학회지

Rupture of the pectoralis major muscle may occur in youngers or athletes associated with extreme sports, especially during the weight training. It is uncommon, but the incidence is increased by the recent growth of athletic population. In young active individuals, ruptures of the pectoralis major muscle have the best results after surgical repair. However, if diagnosis of the pectoralis major muscle rupture is missed or delayed, the patient will be limited to return to sport activity. The object of this paper is to report our experience of pectoralis major muscle rupture in 3 cases.

Recurred Multiple Intraarticular Synovial Hemangioma of the Knee: Case Report / 대한정형외과연구학회지

Synovial hemangioma is a rare benign intraarticular tumor. Synovial hemangioma of the knee joint has unspecific symptoms, which are pain, limitation of motion and hemarthrosis, often seen as an internal derangement of the knee. A 24-year-old woman presented with intermittent joint effusion and pain of the left knee joint and physical examination revealed slight atrophy of the quadriceps and tenderness around lateral joint line of knee. The patient was performed arthroscopic surgery due to synovial hemangioma about 17-years ago. Magnetic resonance imaging (MRI) showed the synovial hemangioma from Hoffa fat pad to anterior aspect of lateral meniscus, and thus surgical treatment was planned. Arthroscopic excision was performed and additional lesion was observed in lateral gutter, suprapatellar pouch of the knee. The biopsy confirmed the diagnosis of synovial hemangiomas. After 3 year, the patient was completely asymptomatic and showed no signs of recurrence.

Orthopaedic Surgical Treatment of Hip Fractures

Hip fracture is much more common after the age of 65 year old, and this malady has increased because to the longer average life span with the advances of medical care. Despite the development of the treatments and rehabilitation techniques, hip fracture is well known for having high rates of complications and mortality. The risk factors, mechanisms of injury and the underline disease of hip fracture are also well known, and this has helped these patients to recover as soon as possible and to walk and move earlier after appropriate surgical operations. Most fractures must be treated by an open operation and performing rigid internal fixation or arthroplasty. We report here on the major operational treatments for femur neck fracture and intertrochanter fracture.

Modified Extension Block Technique for Large Mallet Fracture

PURPOSE: To evaluate retrospectively the clinical results of modified extension block technique for large mallet fracture. MATERIALS AND METHODS: From May 2006 to August 2007, we reviewed 16 patients who got surgery with large mallet fracture. Surgical indications included fractures involving more than 33% of the articular surface or fractures associated with subluxation of the distal interphalangeal joint. The average age was 32.6 years old. The average time from injury to surgery was 10days. We performed modified extension block technique in all patients. The pins were removed between 5 to 6 weeks when we confirmed bone union by radiology. Function outcomes were determined by using the Crawford criteria. RESULTS: The average fracture fragment size was 52% of the joint surface. Average time to fracture union was 5.4weeks(4.5~7.5weeks). At a mean follow-up of 8.2months(5-13months) average extension loss was 3degrees (0-10degrees )and average flexion was 77degrees (60-85degrees ). According to Crawford classification, 81.3% of paitents had excellent or good results. There were 2 nail deformity. CONCLUSION: Modified extension block technique can make up for the weak points of traditional techique in the treatment for large mallet fracture.

Radiographic Changes of Adjacent Upper Segment Performed Short Segmental Lumbosacral Fusion: Does Total Laminectomy Influence Adjacent Upper Segmental Instability? / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to compare factors that influence degenerative changes in patients undergoing total laminectomy and patients undergoing partial laminectomy. SUMMARY OF LITERATURE REVIEW: Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent segment problems of the upper segment. However, the differences between the two procedures that may influence adjacent segment instability are still controversial. MATERIALS AND METHODS: We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (at most 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment procedures included total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the intervertebral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and last follow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation. However, we included cases that required revision due to adjacent segmental problems during the follow-up period. RESULTS: The mean age of the patients treated with total laminectomy was 59.0+/-10.9 years, and of the patients treated with partial laminectomy was 58.8+/-10.2 years. The preoperative Thompson grade showed no statistical difference. The difference in disc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical difference between the two groups. CONCLUSIONS: There was no significant difference in the radiographic or clinical outcomes based on removal or preservation of posterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.

Long Level (T4-L1) Spinal Epidural Abscess in a Diabetic Patient: A Case Report

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.

The Function and Symptoms of Ankle Joint in the Distal Tibial Fractures Treated by Nailing / 대한족부족관절학회지

PURPOSE: To evaluate the safety and prognostic factors of intramedullary nailing of distal tibia fractures in terms of function and symptoms of the ankle joint. MATERIALS AND METHODS: We retrospectively analyzed 22 distal tibial fractures with intramedullary nailing. The mean duration of follow-up was 43 months. We reviewed medical records to describe each case. We measured radiographic parameters such as fracture configuration, arthritic change of the ankle joint and status of reduction. We also assessed clinical results by AOFAS ankle hind foot scoring system, degree of pain by VAS and range of motion to find out prognostic factors for functional result of the ankle joint. RESULTS: Bone healing was obtained in all cases without any wound complications. Mean AOFAS ankle score was 94. There were 4 cases with mild (VAS<3/10) ankle pain and 2 cases with mild limitation of ankle motion. The comminution of fracture had a significant relationship with delayed angular deformity of ankle joint (p=0.032). There was no other significant parameter affecting ankle joint function except the location of nail-end. CONCLUSION: Intramedullary nailing in distal tibia fracture is a safe and effective procedure. But further study may need to evaluate the relationship between the position of nail-end and the function of ankle joint.

Results of Ceramic on Ceramic Bearing Total Hip Arthroplasty Using Cemented Femoral Stem and Cementless Femoral Stem

PURPOSE: The purpose of this study was to evaluate the results of ceramic-on-ceramic bearing primary total hip arthroplasty (THA) using cemented femoral stems and cementless femoral stems. MATERIALS AND METHODS: We studied 59 cases (52 patients) of THAs using ceramic-on-ceramic bearing cemented femoral stems and 64 cases (58 patients) of THAs using ceramic-on-ceramic bearing cementless femoral stems. All THAs were performed between January 2004 and February 2005 and were followed up for more than 3 years. The clinical results were evaluated using the Harris hip score (HHS), WOMAC score, sense of discomfort, and thigh pain. Radiographic results were assessed with serial radiographs. RESULTS: The mean HHS improved from 62.7 points preoperatively to 92.4 points at the last follow-up in the cemented stem group and improved from 61.5 points to 91.8 points in the cementless stem group (p>0.05). And mean WOMAC score improved from 37.9 points to 7.0 points in the cemented stem group and from 38.5 points to 12 points in the cementless stem group (p<0.05). There were 5 patients with a sense of discomfort and 9 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There were no instances of acetabular loosening in either group. Subsidence of the cemented femoral stem was less than 1 mm in 57 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. CONCLUSION: Ceramic-on-ceramic bearing THA using a cemented stem showed clinical results superior to those achieved using a cementless stem. Cemented THA is thought to be good for complementing the problems caused by the hardness of ceramic-on-ceramic bearings.

The Value and Limitation of the Modified Mau Osteotomy(30 Cases Follow Up Report) / 대한족부족관절학회지

PURPOSE: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. MATERIALS AND METHODS: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. RESULTS: The mean preoperative HVA and IMA were 40.4degrees, 17.4degrees and the mean amounts of correction were 31.2degrees and 11.5degrees. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. CONCLUSION: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.