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Background@#Negative effects of extracorporeal shock wave therapy (ESWT) on vulnerable tendon structures have been reported. Meanwhile, tears of the posterior rotator cuff tendon, which is thinner than the anterior, are not common, and the clinical features remain poorly understood. Therefore, we evaluated the relationship between ESWT and posterior rotator cuff tears (RCTs) by investigating the risk factors. @*Methods@#Of 294 patients who underwent rotator cuff repair between October 2020 and March 2021, a posterior RCT more than 1.5 cm from the biceps tendon or an isolated infraspinatus tear was identified in 24 (8.1%, group P). Sixty-two patients (21%) with an anterior RCT within 1.5 cm of the biceps tendon were analyzed as a control group (group A). Preoperative clinical characteristics were assessed to determine the risk factors of posterior RCTs. @*Results@#Calcific deposits were more frequently observed in group P (n = 7, 29.2%) than group A (n = 6, 9.7%, p= 0.024). Further, those in group P were more likely to undergo ESWT (n = 18, 75.0%) than those in group A (n = 15, 24.2%, p < 0.001). Of these, 7 patients experiencing calcific tendinitis from group P (29.2%) and 4 from group A (6.5%, p= 0.005) underwent ESWT for calcification removal. Furthermore, 11 patients experiencing tendinopathy from group P (45.8%), and 11 from group A (17.7%,p = 0.007) underwent ESWT for pain relief. The mean level of fatty infiltration of the supraspinatus was significantly higher in group A than group P (1.8 vs. 1.0, p < 0.001). @*Conclusions@#Since a high prevalence rate of posterior RCTs was related to ESWT, it should be carefully considered when treating calcific tendinitis or pain in patients experiencing tendinopathy.
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Purpose@#This study was performed to verify affecting factors to Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score (KJOCS) in Korean professional baseball league pitchers at preseason by assessing related variables for throwing. @*Methods@#Twenty-seven pitchers from the Korean professional baseball league were enrolled in January 2017. The Korean version of KJOCS was administered to each pitcher, and demographics as well as pitching-related indexes such as innings pitched, earned run average in 2016 were collected. Regarding the assessment of the throwing arm, total rotational motion, horizontal adduction, and abduction were measured. Related shoulder physical examinations were also evaluated. The side-to-side difference was evaluated between the throwing and non-throwing arms, and the glenohumeral internal rotation deficit was also calculated. The correlation analyses between KJOCS and variables regarding throwing shoulders as well as demographics and pitching-related indexes were performed. @*Results@#Regarding the throwing shoulder, the total rotational motion (r=0.45), internal rotation at 90° abduction (r=0.492), and abduction (r=0.446) of the throwing shoulder were positively correlated with the KJOCS (all p＜ 0.05). Among demographics, age (r=−0.637) and career (r=−0.549) were negatively correlated with the KJOCS (p＜ 0.05).In multiple regression analysis, age was a single associated factor to the KJOCS inversely (r2 =0.466, p=0.001) in Korean professional baseball league pitchers at preseason. @*Conclusion@#Age was the only affecting factor on KJOCS of pitchers in the Korean professional baseball league and KJOCS could not reflect subtle changes in range of motion and any positive findings of physical examinations in pitchers at preseason.
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Background@#The transosseous anchorless repair (ToR) technique was recently introduced to avoid suture anchor-related problems. While favorable outcomes of the ToR technique have been reported, no previous studies on peri-implant cyst formation with the ToR technique exist. Therefore, this study compared the clinical outcomes and prevalence of peri-implant cyst formation between the ToR technique and the conventional transosseous equivalent technique using suture anchors (SA). @*Methods@#Cases with arthroscopic rotator cuff repair (ARCR) between 2016 and 2018 treated with the double-row suture bridge technique were retrospectively reviewed. Patients were divided into ToR and SA groups. To compare clinical outcomes, 19 ToR and 57 SA cases without intraoperative implant failure were selected using propensity score matching (PSM). While intraoperative implant failure rate was analyzed before PSM, retear rate, peri-implant cyst formation rate, and functional outcomes were compared after PSM. @*Results@#The intraoperative implant failure rate (ToR, 8% vs. SA, 15.3%) and retear rate (ToR, 5.3% vs. SA, 19.3%) did not differ between the two groups (all P>0.05). However, peri-implant cysts were not observed in the ToR group, while they were observed in 16.7% of the SA group (P=0.008). Postoperative functional outcomes were not significantly different between the two groups (all P>0.05). @*Conclusions@#The ToR technique produced comparable clinical outcomes to conventional techniques. Considering the prospect of potential additional surgeries, the absence of peri-implant cyst formation might be an advantage of ToR. Furthermore, ToR might reduce the medical costs related to suture anchors and, thereby, could be a useful option for ARCR.Level of evidence: III.
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Background@#Given its similar structure and immune response to the human skin, porcine is a good model for dermal studies. Here, we sensitized ovalbumin (Ova) on minipig back skin for 2–4 weeks to induce chronic atopic dermatitis (AD). @*Results@#Gross observation, serum cytokine level, epidermal thickness, and epidermal integrity did not change after 4 weeks of Ova induction compared with the control, indicating AD modeling failure. Only the neutrophils in the blood and macrophages in bronchoalveolar lavage fluid changed slightly until 3 or 2 weeks after Ova sensitization, respectively. The successful and failed Ova-induced AD minipig models only differ in age and body weight of the minipigs. The minipigs, 12 months old with a 30-kg median weight, had a two-fold thicker dermis than minipigs 8–10 months old, with an 18.97-kg median weight, resulting in impaired Ova permeability and immune response. @*Conclusion@#Age and body weight are key factors that should be considered when developing an Ova-induced AD minipig model.
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Endosalpingiosis is a condition that causes the non-neoplastic proliferation of ectopic tubal epithelium. Florid cystic endosalpingiosis is an atypical subtype that is very rarely reported. It presents as a mass-like feature and therefore needs to be differentiated from tumorous conditions. Here, we report the imaging findings of a case of multicentric florid cystic endosalpingiosis in the extraperitoneal pelvic cavity and the retroperitoneal spaces.
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A hemiarthroplasty with biologic resurfacing of the glenoid is one procedure that can be performed in young patients where total shoulder arthroplasty may be difficult. The authors introduced two cases in which this procedure was performed. This approach is one treatment option for young glenoid humeral arthritis patients that addresses some of the shortcomings of an isolated hemiarthroplasty.
ABSTRACT
Endosalpingiosis is a condition that causes the non-neoplastic proliferation of ectopic tubal epithelium. Florid cystic endosalpingiosis is an atypical subtype that is very rarely reported. It presents as a mass-like feature and therefore needs to be differentiated from tumorous conditions. Here, we report the imaging findings of a case of multicentric florid cystic endosalpingiosis in the extraperitoneal pelvic cavity and the retroperitoneal spaces.
ABSTRACT
A hemiarthroplasty with biologic resurfacing of the glenoid is one procedure that can be performed in young patients where total shoulder arthroplasty may be difficult. The authors introduced two cases in which this procedure was performed. This approach is one treatment option for young glenoid humeral arthritis patients that addresses some of the shortcomings of an isolated hemiarthroplasty.
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Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.
ABSTRACT
Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.
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OBJECTIVES@#We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor.SUMMARY OF LITERATURE REVIEW: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported.@*MATERIALS AND METHODS@#A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again.@*RESULTS@#The patient's neurological symptoms improved after delayed hematoma removal.@*CONCLUSIONS@#Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended.
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BACKGROUND@#The present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur.@*METHODS@#Totally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani's type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur.@*RESULTS@#Of the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur.@*CONCLUSIONS@#The heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.
ABSTRACT
BACKGROUND: The present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur. METHODS: Totally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani's type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur. RESULTS: Of the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur. CONCLUSIONS: The heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.
Subject(s)
Humans , Acromion , Heel , Heel Spur , Magnetic Resonance Imaging , Osteophyte , Rotator Cuff , Tears , TractionABSTRACT
STUDY DESIGN: Case report. OBJECTIVES: We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor. SUMMARY OF LITERATURE REVIEW: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported. MATERIALS AND METHODS: A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again. RESULTS: The patient's neurological symptoms improved after delayed hematoma removal. CONCLUSIONS: Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended.
Subject(s)
Aged , Female , Humans , Fractures, Spontaneous , Hematoma , Hematoma, Epidural, Spinal , Magnetic Resonance Imaging , Recurrence , SpineABSTRACT
The rapidly increasing rate of shoulder arthroplasty is certain to increase the number of revision arthroplasties because of parallel increases in complication numbers. It has been widely reported that the causes of revision shoulder arthroplasty include rotator cuff deficiency, instability, glenoid or humeral component loosening, implant failure, periprosthetic fracture, and infection. Revision arthroplasty can be technically challenging, and surgical options available for failed shoulder arthroplasty are limited, especially in patients with glenoid bone loss or an irreparable rotator cuff tear. Furthermore, the outcomes of revision arthroplasty are consistently inferior to those of primary arthroplasty. Accordingly, surgical decision making requires a good understanding of the etiology of failure. Here, we provide a review of indications of revision arthroplasty and of the surgical techniques used by failure etiology.
Subject(s)
Humans , Arthroplasty , Decision Making , Periprosthetic Fractures , Risk Factors , Rotator Cuff , Shoulder , Tears , Treatment FailureABSTRACT
PURPOSE: We aimed to evaluate the magnetic resonance imaging (MRI) findings of congenital postaxial polydactyly of the foot. MATERIALS AND METHODS: Three-hundred and forty-seven feet of 288 patients who underwent congenital postaxial polydactyly or polysyndactyly correction were divided into five subtypes according to the radiographic shapes of deformity origins (widened metatarsal head, bifid, fused duplicated, incompletely duplicated, or completely duplicated). MRIs were assessed to determine whether they unrevealed areas were fused or separated. MRI was also used to assess cases with radiographic phalangeal aplasia. RESULTS: Huge variations were noted in MRIs. Fusion or separation at the base or head between original and extra digits were observed, and MRI effectively depicted phalangeal aplastic areas. CONCLUSION: MRI evaluations of congenital postaxial polydactyly of the foot are useful for determining the anatomical statuses which were not visualized by plain radiography (level of evidence: 3).
Subject(s)
Humans , Congenital Abnormalities , Foot , Head , Magnetic Resonance Imaging , Metatarsal Bones , Polydactyly , Radiography , SyndactylyABSTRACT
BACKGROUND: The eating habits of Jeju Island natives are quite different from those of the mainland people because of geographic isolation. Diet is a main factor affecting gallstone disease. We investigated the prevalence of gallstone disease in both Jeju Island natives and migrants and studied the risk factors affecting gallstone disease in the Jeju Island people. METHODS: A total of 20,763 subjects who underwent medical checkups at the Health Promotion Center of Jeju National University Hospital in Korea from January 2003 to December 2015 were enrolled in the study. Ultrasonography was used to determine the presence of gallbladder stones. Body mass index and biochemical parameters, including liver function test results, lipid profiles, and fasting blood glucose levels, were verified, and data on age, birthplace, and sex were collected from medical records. Univariate and multivariate analyses were performed to identify risk factors affecting gallstone disease. RESULTS: The prevalence of gallstone disease in the Jeju Island people was 4.0%: Jeju Island natives, 3.8% and migrants, 4.4% (P=0.047). After multivariate logistic regression analysis, the independent risk factors were older age, Jeju migrants, higher fasting blood glucose and alanine aminotransferase levels, and lower high-density lipoprotein cholesterol levels. CONCLUSION: The prevalence of gallstone disease was significantly lower in natives than in migrants from Jeju Island. Older age, Jeju migrants, higher fasting blood glucose and alanine aminotransferase levels, and lower high-density lipoprotein cholesterol levels contributed to gallstone disease prevalence in the Jeju Island people.
Subject(s)
Humans , Alanine Transaminase , Alcohol Drinking , Blood Glucose , Body Mass Index , Cholesterol , Diet , Dietary Carbohydrates , Eating , Fasting , Gallbladder , Gallstones , Health Promotion , Korea , Lipoproteins , Liver Function Tests , Logistic Models , Medical Records , Multivariate Analysis , Population Groups , Prevalence , Risk Factors , Transients and Migrants , UltrasonographyABSTRACT
Pigmented villonodular synovitis (PVNS) is a proliferative disease that affects the synovial joint, tendon and bursa. PVNS can form a nodular structure in any joint, but it most commonly affects the knee joint and is rare in the foot and ankle joint. PVNS is divided into two types. Localized-type PVNS exhibits focal involvement with a nodular mass, while diffuse-type PVNS involves the entire synovium. Synovitis of the affected joint can also destroy cartilage and bone. Diffuse type accounts for 75% of PVNS and has a reported recurrence rate of 12.2% to 46%; aggressive synovectomy is recommended as the most effective treatment. In localized-type PVNS, only arthroscopic partial synovectomy is effective with a lower recurrence rate. We report a patient with severe ankle joint arthritis induced by diffusetype PVNS. The patient was treated by lateral malleolar ostectomy and ankle arthrodesis with a plate and screws via a lateral approach.
Subject(s)
Humans , Ankle Joint , Ankle , Arthritis , Arthrodesis , Cartilage , Foot , Joints , Knee Joint , Recurrence , Synovial Membrane , Synovitis , Synovitis, Pigmented Villonodular , TendonsABSTRACT
BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.
Subject(s)
Humans , Allografts , Congenital Abnormalities , Follow-Up Studies , Humerus , Methods , Osteonecrosis , Postoperative Complications , Shoulder Fractures , Transplantation, HomologousABSTRACT
BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.