First-Rib Fracture in a Baseball Pitcher / 대한스포츠의학회지

First-rib fractures may be caused due to high energy direct trauma, violent muscle contracture, or chronic fatigue. Isolated fractures are very rarely noted and may be a potential cause of nonspecific shoulder pain in overhead athletes. Although the exact mechanism underlying first-rib fractures caused by sudden muscular contracture is still not known, many repetitive activities have been associated with with these unique fractures. We present a case of an acute first-rib fracture in a rookie professional baseball pitcher. He returned to the same level of throwing in 5 months with rest and rehabilitation.

Traumatic Posterior Rotator Cuff Tear in the Pre-existing Chronic Supraspinatus Tendon Tear / 대한스포츠의학회지

PURPOSE: This study aimed to evaluate the diagnostic characteristics and clinical results after surgical repair of traumatic superimposed posterior rotator cuff tear in the setting of preexisting retracted supraspinatus tendon tear.METHODS: A total of 20 patients (mean age, 62.1 years) were included and all patients had significant traumatic events mean 3.7 weeks prior to the surgery. Preoperative acromiohumeral distance (AHD, mean 3.2 mm) and arthritis change were analyzed on plain radiograph and magnetic resonance imaging was evaluated for the nature and extent of torn tendon, and fatty degeneration (FD) of all cuff muscles to validate if the tears were traumatic or chronic.RESULTS: Complete repairs were achieved in 15 patients and partial repair including posterior cuff in five. Functional and radiographic results were statistically evaluated and repair integrities were assessed with ultrasound at average 17.3 months. Overall functional outcome scores were significantly improved and 17 patients (85%) were satisfied with their symptoms. AHD was significantly recovered (mean, 6.7 mm), but two patients showed progression of arthritic change. Retears after the complete repair were three patients (20%), who showed poor outcome, with advanced preoperative FD of posterior cuff muscles. Five patients with partial repair of posterior cuff revealed improved functional score with no sign of retear of posterior cuff on ultrasound.CONCLUSION: Early recognition of traumatic superimposed posterior cuff tears and surgical repair can reliably restore shoulder function, and partial repair of posterior cuff also can be expected favorable outcomes in supraspinatus tear with advanced FD.

Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players / 대한스포츠의학회지

PURPOSE: The purpose of this study is to identify bilateral differences of physeal closure of the lateral compartment of the elbow in osteochondritis dissecans (OCD) and related factors with premature physeal closure. METHODS: Initial radiographs of the bilateral elbows in 40 baseball players with OCD (group I) were reviewed for the status of physeal closure of the lateral compartment; capitellum, radial head, lateral epicondyle. Forty baseball players with medial epicondylar apophysitis (group II) were enrolled as a control. Relative status of physeal closure of dominant elbow was defined as early, same, and delayed. Bilateral differences of the status of physeal closure were analyzed between groups, and according to the radiographic stages, extent of the lesions and demographic factors in group I. RESULTS: Significant early physeal closures of dominant elbows were identified in group I in capitellum (group I, 55%; group II, 3%), radial head (group I, 53%; group II, 3%), and lateral epicondyle (group I 37%; group II, 5%). In group I, advanced stage and extended lesion showed early lateral compartment physeal closure especially in capitellum and radial head, and players with longer career length and limitation of motion showed early closure. CONCLUSION: Over the half of the adolescent baseball players with OCD demonstrated early radiocapitellar physeal closures of dominant elbow in initial presentation. Because premature physeal closure contributes to the development of arthritis without appropriate radiocapitellar remodeling, early detection of OCD is essential for prevention of arthritis and successful conservative management.

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.

Scapulothoracic Bursitis in a Amateur Baseball Pitcher / 대한스포츠의학회지

Scapulothoracic bursitis refers to inflammation of the bursae secondary to trauma or overuse owing to sports activities or work. It usually causes persistent pain and scapulothoracic crepitus by irritation of bursa but can be presented as painless mass around chest wall. We report a case of scapulothoracic bursitis in a baseball pitcher presenting as rapidly growing chest wall mass confused with a soft tissue tumor. Computed tomography and magnetic resonance imaging revealed as a well-demarcated cystic mass situated between the scapula and chest wall. Incisional drainage resulted in complete resolution of the mass within a couple of weeks. Scapulothoracic bursitis may be presented as painless huge mass in overhead sports athlete and one of the differential diagnoses of soft tissue tumor of the chest wall.

Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results

BACKGROUND: To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS). METHODS: A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined. RESULTS: The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (+/- 3.5) and 2.3 (+/- 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm). CONCLUSIONS: With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.

Effects of Leptin on Proliferation, Anabolic and Catabolic Metabolism in Chondrocytes / 대한정형외과연구학회지

PURPOSE: Leptin may play an important role in the pathophysiology of osteoarthritis. However, the effect of letpin on the anabolic and catabolic metabolisms in chondrocytes remains unclearly elucidated. Therefore, the purpose of this study was to investigate the effect of leptin on proliferation, anabolic and catabolic metabolism of chondrocyte using ATDC5 chondrogenic cell line. MATERIALS AND METHODS: The effects of leptin on chodnrocyte proliferation, anabolic and catabolic meatabolism were examined in ATDC5 cells treated with leptin at varying concentrations(10, 100, 300, 600 ng/ml) for 24, 48, and 72 hours. The cell proliferation was evaluated by MTT assay. The anabolic and catabolic activities were assayed by RT-PCR for transforming growth factor-beta(TNF-alpha), proteoglycan-4 (PRG4), type- I collagen (type- I Col) and tumor necrosis factor-beta(TNF-alpha), matrix metalloproteinase -2 (MMP-2), respectively. RESULTS: Leptin treatment did not influence cell proliferation of chondrocyte regardless of concentration. TGF-beta expression was increased until 48 hours of leptin treatment compared to controls. Especially, it was significantly increased in leptin of 10 ng/ml and 100 ng/ml (P<0.05). PRG4 expression was not different between letpin treatment and controls. Type-I Col expression was decreased in dose- and time-dependent manner. Leptin of 10ng/ml significantly inhibited MMP-2 and TNF-alpha expressions compared to controls (P<0.05). CONCLUSION: This study shows that leptin at low concentration increases TGF-beta expression, but inhibits the expression of TNF-alpha and MMP-2. Also this study shows that leptin do not affect the cell proliferation of chondrocytes. These results suggest that leptin at low or physiological level contributes to the prevention of cartilage damage by stimulating anabolic activity and inhibiting catabolic activity of chondrocyte rather than chondrocyte regeneration by increasing cell proliferation.

Relationship between Osteoarthritis and Leptin Concentrations in Synovial Fluid / 대한정형외과연구학회지

PURPOSE: Leptin may play an important role in the pathophysiology of osteoarthritis. This study investigated whether leptin concentration in synovial fluid is related to the radiographic severity of osteoarthritis. MATERIALS AND METHODS: Synovial fluids were obtained from 29 osteoarthritis patients who underwent knee surgery and 10 who had no abnormality on articular cartilage during arthoscopic examination. The progression of osteoarthritis was classified by Kellgren Lawrence grading scale. The concentrations of leptin was measured with commercial enzyme-linked immnosorbent assay kits. RESULTS: A significant increase in synovial fluid concentrations was observed in osteoarthritis patients (6.7+/-4.1 ng/ml) compared to the control (2.4+/-1.3 ng/ml). Leptin levels were increased with advancing osteoarthritis stage, resulting in the highest level in stage IV patients(10.7+/-4.9 ng/ml; range 4.7-15.8) compared to that of stage I patients (4.0+/-2.0 ng/ml; range 1.2-7.3). In osteoarthritis patients, age showed a significant correlation with leptin concentrations. CONCLUSION: This study shows that synovial fluid leptin concentrations were closely related to the radiographic severity of osteoarthritis, and suggests that the age of patient may influence synovial fluid leptin concentrations during osteoarthritis progression.

Percutaneous Transphyseal Intramedullary K-wire Fixation for the Diaphyseal Forearm Fractures in Children

PURPOSE: Although the standard treatment of diaphyseal forearm fractures in children is conservative treatment with closed reduction and cast immobilization, unstable or irreducible fractures are usually needed by surgical intervention. The aim of this article is to determine the efficacy of the percutaneous transphyseal intramedullary K-wires fixation for the forearm diaphyseal fractures in children. MATERIALS AND METHODS: In this retrospective study, we reviewed 18 cases of forearm diaphyseal fractures in children, which were treated with percutaneous transphyseal intramedullary nailing using K-wires from January 2001 to December 2004. We analyzed the period for radiologic bone union and the complications until the last follow-up. RESULTS: The average period of follow-up was 15 months with mean age of 7.8 years. The average time to bone union was 6.2 weeks and nonunion, malunion, radio-ulnar synostosis and refracture were not found, just 2 local pin site infections were seen but healed by conservative treatment. Postoperative scar was small and the complications until the last follow-up were not found. CONCLUSION: In the operative treatment of the forearm diaphyseal fractures in children, we think percutaneous transphyseal intramedullary K-wire fixation is one of the effective methods because of the minimal invasiveness, simplicity and easiness in removal.

Osteolysis of the Distal Clavicle: Two Cases Report / 대한정형외과학회잡지

Osteolysis of the distal clavicle is a rare disease and its etiology and pathogenesis are poorly understood. We report two cases of the osteolysis that were resulted from acute blunt shoulder trauma and chronic repetitive one. After diagnosis, the two patients did not have shown the response to conservative management, so we performed distal clavicle resection on them and the results were satisfactory. Through these cases, we discuss the pathogenic mechanism, differential diagnosis and treatment options for the osteolysis of the distal clavicle.

Clinical Results after Percutaneous Surgical Treatment of Intra-articular Fracture of the Distal Radius

PURPOSE: To evaluate the clinical and radiologic results of percutaneous surgical treatment of the intra-articular fractures of the distal radius, we have compared the results of percutaneous pinning and the combination of percutaneous pinning with external fixation after closed reduction. MATERIALS AND METHODS: We analysed the results of 52 patients with intra-articular fracture who received the operative treatment with closed reduction in the period of June, 1995 to June, 2001 and also were in regular follow-up at least one year. We used the subjective analysis by Cole & Obletz and the objective analysis by Scheck. RESULTS: We have found the outcome that 83.3% of percutaneous pinning were graded above "Good" in type B and C1 and 82.2% of the combination treatment of percutaneous pinning with external fixation were graded above "Good" in type C2 and C3. CONCLUSION: The percutaneous pinning and external fixator after closed reduction in intra-articular fractures of the distal radius are considered useful to restore the articular congruity and make good clinical results.