Detection of Rotator Cuff Tears by Ultrasound: How Many Scans Do Novices Need to Be Competent?

Background@#Ultrasound is commonly used for evaluating rotator cuff tears. However, little training in ultrasound imaging is provided during orthopedic residents’ training period. Therefore, we performed this study to determine how many ultrasound scans are required for orthopedic residents to be competent and self-confident in the diagnosis of supraspinatus tendon tears and to investigate whether senior residents outperformed junior residents. @*Methods@#We studied two third-year residents who had no previous experience of shoulder ultrasound and evaluated their ability to detect rotator cuff pathologies. Their learning curves were plotted using a cumulative summation analysis with a 20% acceptable failure rate compared to arthroscopic findings. Downward, upward, and horizontal cumulative summation trends indicated incompetence, exceptional competence, and competence, respectively. The diagnostic accuracy of third-year residents was compared with that of second-year residents and the number of cases required to gain self-confidence was evaluated. @*Results@#Cumulative summation analysis showed that after 26–28 scans, residents achieved the competence to correctly diagnose supraspinatus tears: an upward trend was observed from the beginning for full-thickness tears and a downward trend was observed for partial-thickness tears. Sensitivity and specificity were 0.95 and 0.79, respectively, for third-year residents and 0.91 and 0.58, respectively, for second-year residents. Residents reported self-confidence after 30 ultrasound scans for the detection of rotator cuff tears. @*Conclusions@#The number of scans that novices needed to be competent for detecting rotator cuff tears was approximately 30 cases, and the diagnostic accuracy of third-year residents was significantly higher than that of second-year residents.

Femoral Nerve Palsy due to Noninfectious Iliopsoas Bursitis and Hematoma after Total Hip Arthroplasty: A Case Report / 대한고관절학회지

Femoral nerve palsy after total hip arthroplasty is an uncommon complication. We present a case report of delayed-onset femoral nerve palsy associated with iliopsoas hematoma and bursitis 10 years after primary total hip arthroplasty in a 57-year-old male patient with avascular necrosis of the femoral head. The patient visited our clinic due to swelling of the inguinal area with sudden-onset knee extension weakness. Radiologic examination at admission revealed suspicion of bursitis and hematoma on iliopsoas muscle. After evacuation of the hematoma and bursitis debridement, the patient's clinical symptoms improved dramatically. This is a rare report of femoral nerve palsy due to noninfectious iliopsoas bursitis and hematoma after total hip arthroplasty.

Non-osseous Coalition of the Third Metatarsal-Lateral Cuneiform Joint: A Case Report / 대한족부족관절학회지

This paper reports a rare case of the symptomatic third metatarsal (MT3) - lateral cuneiform (LC) in a 55-year-old male who presented with complaints of severe intermittent pain in his right foot. Plain radiographs and computed tomography scans revealed sclerosis and irregularity at this joint. The intraoperative findings demonstrated a fibrocartilaginous coalition. The pain had improved one year after removing the MT3-LC joint by en bloc and arthrodesis.

Surgical Results of the Cephalomedullary Nail for the Femoral Intertrochanteric Fracture: Comparison between Non-experienced Surgeons and Experienced Surgeon / 대한고관절학회지

PURPOSE: Cephalomedullary nail (CM nail) in the treatment of femoral intertrochanteric fractures is in the lime light in recent years. The purpose of this study is to compare surgical outcomes between experienced surgeon and non-experienced surgeons in respect of CM nail for femoral intertrochanteric fractures. MATERIALS AND METHODS: The 129 patients underwent CM nail for femoral intertrochanteric fracture more than six months of follow-up from April 2011 to March 2014 in Seoul Medical Center (Seoul, Korea) were participated in this study. For this study, group A consisted of experienced surgeons who performed more than 500 times of CM nail, and group B consisted of non-experienced surgeons who performed less than 50 times of CM nail. Clinical and radiologic outcomes, complications and the need for reoperation between both groups were compared in the study. RESULTS: According to clinical result, both the mean operation time and transfusion volume were significantly longer and greater in group B (P<0.05). In the radiologic outcomes, adequacy of reduction, tip-apex distance and numbers of case placed in the Cleveland zones 5, 6 and 8; there was no statistical difference between both groups. Moreover, rate of complication and reoperation had same results as radiologic outcomes. CONCLUSION: There was no significant difference with statistical data in complications from CM nail for femoral intertrochanteric fractures between experienced surgeon and non-experienced surgeon. Although the operation time and transfusion volume were significantly longer and greater in the case of operation by non-experienced surgeon, satisfactory performance was seen in the complications and the need for reoperation.

The Early Result of Cementless Arthroplasty for Femur Neck Fracture in Elderly Patients with Severe Osteoporosis / 대한고관절학회지

PURPOSE: The purposes of the current study were to assess the early results of cementless hip arthroplasty (HA) for femoral neck fractures in elderly patients with severe osteoporosis and to compare the clinical outcomes between those who underwent total HA (THA) or bipolar hemiarthroplasty (BHA). MATERIALS AND METHODS: From April 2011 to May 2012, we performed 87 cementless HAs for displaced femoral neck fractures in elderly patients (> or =65 years) with severe osteoporosis. Among them, we studied 70 hips that were able to be followed-up for >24 months. Of these, 34 underwent THA and 36 underwent BHA. Clinical results were evaluated using the Harris hip score (HHS), Koval classification, and radiographs. RESULTS: Only one instance of femoral stem loosening was observed. Additionally, no dislocations were observed and no revision surgeries were required. The mean changes in the functional items of the HHS scores were 2.8 and 5.2 for those who underwent THA and BHA, respectively (P<0.05). According to the Koval classification used for the ambulatory status analysis, the mean perioperative change in the grade was 0.8 (0-4), with no significant differences noted between the THA and BHA groups. CONCLUSION: The early results of cementless HA for femur neck fractures in elderly patients with osteoporosis were satisfactory, and THA was found to have a functional advantage over BHA.

Giant Intramuscular Lipoma in the Back after a Blunt Trauma: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of a giant intramuscular lipoma after a blunt trauma. SUMMARY OF LITERATURE REVIEW: Lipomas are the most frequent benign tumor of the mesenchymal tissue. Although the etiopathogenesis is not complete understood yet, it is known that lipoma develope with a 1% rate after traumas in the related localizations. Traumata induce hematoma and initiates inflammatory reactions in fatty tissue and can trigger the development of lipoma. MATERIALS AND METHODS: 2 years after a blunt trauma a 56years male patient developed a back mass. A massive lipoma was confirmed clinical and radiological. RESULTS: A total excision was performed and the result was histopathologic confirmed. CONCLUSIONS: Patients who develop hematoma after a trauma need a close lipoma progress observation which decrease the invasive treatment of post-trauma hematoma.

Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years

PURPOSE: To retrospectively analysis of results of operatively treatment for femoral neck fracture occurred in twenties to thirties. MATERIALS AND METHODS: 20 patients were selected whom we were able to follow up at least 2 years after internal fixation for femoral neck fracture in twenties to thirties from 1998 to 2005. Mean age was 32.2 (21~39) and average follow up period was 26.3 (24~45) months. According to preoperative X-ray, there were 6 cases for Garden classification stage I, 10 for stage II and 4 for stage III, and 7 cases for subcapital fracture, 9 for transcervical fracture, 4 for basicervical fracture. In all cases, operations were performed within 12 hours after the injury. The operations were done after satisfying reduction with the Garden alignment index, with three cannulated screws for internal fixation. Postoperative results were analyzed by clinical symptoms and radiological examinations during follow up periods. RESULTS: In immediately postoperative radiological examination, satisfying anatomical reduction with Garden alignment index was obtained in all cases, and unions were obtained within 4.5 months after the operation (3~6 month). Avascular necrosis of femoral head occurred in 7 cases of all patients (35.0%). The average time of occurrence of avascular necrosis of femoral head after operation was 10.7 months (9~15 months). Avascular necrosis was occutted 5 (31.3%) in fracture without displacement (Garden stage I, II), 2 (50.0%) in fracture with displacement (Garden stage III) and 4 in subcapital fracture, 3 in transcervical fracture. CONCLUSION: The incidence of avascular necrosis of femoral head after the operation for displaced and nondisplaced femoral neck fracture between twenties and forty years was no significant difference.

Multiple Extradural Arachnoid Cyst : A Case Report / 대한척추외과학회지

Multiple extradural arachnoid cysts of the spine are extremely uncommon in children with only a few cases reported. The authors report a case of multiple extradural spinal arachnoid cysts in children with a review of the relevant literature.

The Effects of Tourniquet Pressure on the Postoperative Thigh Pain and Blood Loss in Total Knee Arthroplasty

PURPOSE: We wanted to analyze the effects of tourniquet pressure on the postoperative thigh pain and blood loss of patients who undergo total knee arthroplasty. MATERIALS AND METHODS: This prospective randomized study focused on one-hundred sixty-one unilateral total knee arthroplasties that were done with using a tourniquet. The tourniquet pressures were 300 mmHg in group I (seventy-four cases) and 100 mmHg higher than the systolic blood pressure in group II (eighty-seven cases). We analyzed the postoperative thigh pain with using a visual analog scale (VAS), and we assessed the hemoglobin levels and the hematocrits. RESULTS: The incidence of postoperative thigh pain in group II was statistically lower than that of group I. The intensity of the postoperative thigh pain of group II was lower than that of group I at both 6 hours and 72 hours after surgery. There were no statistical differences in blood loss between the two groups. CONCLUSION: Using a tourniquet pressure of 100 mmHg above the systolic blood pressure during total knee arthroplasty can reduce the postoperative thigh pain. When comparing the above technique with a TKA using 300 mmHg of tourniquet pressure, there was no statistically significant difference of the postoperative blood loss.

Kimura's Disease of the Distal Arm: A Case Report

Kimura's Disease is a very rare, chronic inflammatory disorder with an unknown etiology, and this illness is primarily seen in young Asian males. The typical clinical features consist of painless subcutaneous masses in the head or neck region, and especially in the salivary gland and submandibular region. It is often accompanied with a regional lymphadenopathy, peripheral blood eosinophilia and elevated serum IgE levels. Histologically, it is characterized by prominent germinal centers in the involved lymph nodes, together with eosinophilic infiltration in these lymph nodes. The treatment modalities for this disease are steroid therapy, radiation therapy and surgical excision. Its clinical course is of a benign nature. We report here on a case of a 28 year old man who had a soft tissue mass in his left arm. We excised this mass and the microscopy confirmed that he suffered from Kimura's disease on microscopic examination in his left distal arm.

Deep Infection after Total Knee Arthroplasty

PURPOSE: To analyze the clinical results of treatment for infected total knee arthroplasty(TKA). MATERIALS AND METHODS: Between October 1993 and March 2003, 20 patients with infection after TKA were treated at our department. The average follow-up period was 3 years 8 months and the average age was 65.5 years(range, 50-79); there were 18 females and two men. Infected TKAs were managed with several methods ; 16 patients were treated two-stage reimplantation, 2 arthrodesis, and 2 debridement and polyethylene insert change. We assessed knee function before and after revision, according to the knee rating system of the Hospital for Special Surgery. RESULTS: Prior to revision operation, the average knee score in 16 reimplantation cases was 49.3 points and the average range of motion was 64.9 degrees. After revision, the average knee score was 80.5 points and the average range of motion was 90.3 degrees. Two of them relapsed within postoperative two weeks, and then we performed debridement. There was one recurrence of infection after debridement and polyethylene insert change and then we performed two stage reimplantation. Two patients had complete union at each 4, 5 months after arhtrodesis. CONCLUSION: Thoughtful method of treatment should be decided and precise operative technique should be performed in managing infected TKA.

The Results of Total Knee Arthroplasty with AGC(R) System(More than 5-Year Follow-up)

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of AGC(R)(Anatomical Graduated Components, Biomet, USA) total knee arthroplasty(TKA) retrospectively. MATERIALS AND METHODS: Out of 121 cases who underwent TKA with AGC(R) knee system, 90 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survial rate were evaluated. RESULTS: Average flexion contracure was improved from 10.4degrees preoperatively to 0.6degrees at final follow-up and average ROM was improved from 107.5 degrees preoperatively to 120.9 degrees at final follow-up (p<0.05). Average HSS score was improved from 52.2 preoperatively to 81.5 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 6.3 degrees varus preoperatively to 4.3 degrees valgus at final follow-up. There were 6 complications, including infection in three cases, patellar dislocation, supracondylar fracture and aseptic loosening in one case respectively. Survival rate was 96.7 percent. CONCLUSION: AGC(R) TKA showed excellent results and good survival rate at more than five years follow-up. However, more long-term follow-up should be necessary.

Comparative Study between the Group with Lateral Retinacular Release and the Group without Lateral Retinacular Release Following Total Knee Arthroplasty

PURPOSE: We compared the results of total knee arthroplasties combined with lateral retinacular release with those without lateral retinacular release. MATERIALS AND METHODS: Results of 277 total knee arthroplasties from 1996 to 2002, follow up for at least one year ( average follow-up periods : 32 months). Lateral retinacular release was performed in 190 knees (70.1%) and not performed in 87 knees (29.9%). The clinical results of total knee arthroplasties were evaluated by the Knee Scoring System of hospital for Special Surgery (HSS) and range of motion. The patello-femoral complications were evaluated by tilt and displacement of patella at the last follow-up Hughston 's view. Osteonecrosis and fracture of patella were evaluated by simple x-ray. RESULTS: HSS score and range of motion improved postoperatively in both groups, but there was no sig-nificant difference between the two groups. There were 3 cases (3.4%) with patellar subluxations and 1 case (1.1%) with patellar dislocation in the group without lateral retinacular release. There was no avascu-lar necrosis or fracture of patella in either group. CONCLUSION: We suggest that lateral retinacular release can be performed without great risk of potential patellar complications in total knee arthroplasties requiring lateral retinacular release for proper patellar tracking.

Spontaneous Hemarthrosis after Total Knee Arthroplasty: A Case Report / 대한정형외과학회잡지

Spontaneous hemarthrosis of the knee after a total knee arthroplasty is a rare complication, and thereis no report is available in Korea. We report a case that was cured with an open synovectomy in the spontaneous hemarthrosis, which developed 10 months after the total knee arthroplasty for degenerative osteoarthritis in a 60-year-old woman.

Comparison of the Role of CT and Fiberoptic Bronchoscopy in the Diagnosis of Hemoptysis / 결핵

BACKGROUNDS: To investigate the role of CT as a screening tool and to compare the diagnostic accuracy with that of the fiberoptic bronchoscopy (FOB) in evaluating the causes of hemoptysis. METHODS: The retrospective review of plain chest radiograph, CT and FOB was done in 72 patients with hemoptysis. The diagnosis were confirmed by histology (n=33), bacterial culture (n=6), cytology (n=3), serology (n=2), skin test (n=1), clinical response (n=5), and airway disease mainly by HRCT (n=22). RESULTS: The causes of hemoptysis were shown to be lung cancer (n=29), bronchiectasis (n=19), tuberculosis (n=12), aspergilloma (n=5), invasive aspergillosis (n=1), COPD (n=3) and others (n=3). The sensitivity was 100% and 91,7% by CT and FOB respectively. The diagnostic compatibility was 95.8% and 59.7% by CT and FOB respectively. The diagnostic compatibility in cases with central airway disease was 96.3% and 100% in CT and FOB. In parenchymal disease, CT and FOB showed 91.3% and 43.5% of compatibility, respectively. In airway disease, CT and FOB showed 100% and 31.8% compatibility, respectively. That is to say, CT has higher sensitivity and diagnostic compatibility than FOB for identifying the causes of hemoptysis, and is more helpful for patients with hemoptysis from parenchymal or airway disease. FOB had the advantage in obtaining histologic, cytologic and bacteriologic diagnosis with biopsy or washing. CONCLUSION: CT should be used as the screening method before performing FOB for patients with hemoptysis who have normal or nonspecific findings or 3 peripheral airway disease in plain chest radiograph.

A Case of Meconium Peritonitis Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

Meconium peritonitis is a non-bacterial foreign body and chemical peritonitis caused by meconium contamination resulting from bowel perforation during late intrauterine or early neonatal periods. Prenatal ultrasonographic diagnosis of the meconium peritonitis provides the preparation for proper management and decreasing motality and morbidity of the neonate. We have experienced a case of meconium peritonitis diagnosed by ultrasonography at 34+4 gestational weeks and presented this case with a brief review of the literatures.