Characteristics of Elbow Dislocation in Patients with Preexisting Cubitus Varus

Background@#The aim of this study was to investigate the clinical presentations, patterns of soft-tissue injuries, and outcomes of treatment of elbow dislocations in patients with preexisting cubitus varus. @*Methods@#Four cases of elbow dislocation in patients with preexisting cubitus varus, which were treated at 3 residency training hospitals, were retrospectively reviewed. Soft-tissue injury patterns were investigated using magnetic resonance imaging (MRI).Clinical outcomes were assessed at an average of 50.8 months (range, 34–82 months) after treatment using the Mayo Elbow Performance Score (MEPS) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. @*Results@#The mean patient age was 49.5 years (range, 33–57 years). All patients had a posteromedial elbow dislocation, which was an indirect injury caused by a fall onto an outstretched hand. One patient had failed closed reduction; 3 others had redislocation or gross instability after closed reduction. Significant tears of the lateral collateral ligament complex and common extensor group were shown in MRI. All patients had surgical treatment including lateral complex repair only (n = 2), repair of both sides’ complexes (n = 1), and corrective osteotomy with lateral complex repair (n = 1). At the final follow-up, the mean MEPS was 92.5 ± 8.7 and the mean QuickDASH score was 4.5 ± 6.4. @*Conclusions@#Elbow dislocation in patients with preexisting cubitus varus may present as posteromedial dislocation with acute instability. Surgical treatment of this injury led to acceptable clinical outcomes.

Atypical Fracture of the Ulna Associated with 3 Years of Bisphosphonate Medication / 대한정형외과학회잡지

There have been many studies regarding the relationship between long-term use of bisphosphonate and atypical femoral fractures in the literature. However, studies regarding atypical fractures of the upper limbs are severely limited, especially in Korea. Here, we report an atypical fracture of the ulna in a patient with bisphosphonate medication for a relatively short period of 3 years without any history of fractures at other sites.

New Skeletal Muscle Mass Index in Diagnosis of Sarcopenia

BACKGROUND: We sought to develop a novel index based on the skeletal muscle mass that reflects the change of quality of life (QOL), and is the most appropriate index for the body composition of the elderly in Korea. Whether lower extremity skeletal muscle mass index (LESMI) is an appropriate novel new index to diagnose patients with sarcopenia was also evaluated. A cut-off value for each index was reported to facilitate the diagnosis of patients with sarcopenia in a Korean population. METHODS: We used the 5th Korean National Health and Nutrition Examination Survey data from 2010. We analyzed 409 elderly patients, including 231 men and 178 women, aged ≥65 years. Patients were diagnosed by calculating their skeletal muscle index based on the skeletal muscle mass measured using dual energy X-ray absorptiometry. Obesity and osteoporosis were used to screen data and EuroQOL-5 dimension as a health questionnaire. RESULTS: The prevalence of sarcopenia in each index was obtained based on its cut-off value for diagnosing sarcopenia. There was a significant difference between the obesity rate of elderly patients diagnosed with sarcopenia and those who were not based on each index. There was no significant difference in the prevalence of osteoporosis between the groups. Sarcopenia diagnosis based on the LESMI was significantly correlated with QOL. CONCLUSIONS: LESMI, a novel index based on skeletal muscle mass, reflects changes in QOL and is appropriate for the body composition of elderly people in Korea.

Arthroscopic Excision of Delayed Diagnosed Intra-articular Osteoid Osteoma of the Elbow: A Case Report

An intra-articular osteoid osteoma is a very rare cause of elbow pain, and its diagnosis and treatment remain challenging. Delayed diagnosis may lead to arthritic change of the joint. In this study, the authors present the occurrence of intra-articular osteoid osteoma in the right elbow of a 15-year-old male patient who presented with prolonged pain and limited motion owing to delayed diagnosis. After confirming the nidus of osteoid osteoma from radiographic evaluation, the lesion was completely removed arthroscopically. The patient presented a complete relief of symptoms and full range of motion. This is the first domestic report of successful arthroscopic treatment of an intra-articular osteoid osteoma of the elbow.

Cutaneous Cryptococcosis Caused by Intravenous Line in Patient with Rheumatoid Arthritis

Primary cutaneous cryptococcosis is a fungal infection caused by Cryptococ cus neoformans which is frequently occurred in the immunosuppressed host. The treatment of primary cutaneous cryptococcosis is mainly fluconazole, and the prognosis is relatively good. We report a case of primary cutaneous cryptococcosis due to intravenous line on the left forearm after lumbar stenosis surgery in a patient with rheumatoid arthritis, who finally underwent second, fourth, and fifth ray amputation.

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

BACKGROUND: Epidural analgesia (EPA) has been used for postoperative pain control in total knee replacement (TKR). However, many patients have suffered various side effects after epidural blockade. Peripheral nerve block (PNB) has been shown to provide effective pain relief after TKR. We compared the benefits of continuous femoral nerve block (FNB) combined with single-injection sciatic nerve block (SNB) with those of EPA for postoperative pain management after TKR. METHODS: Eighty participants undergoing unilateral TKR were randomized to receive either EPA (EPA group) or continuous FNB combined with SNB (PNB group). All patients received general anesthesia for TKR. Ropivacaine 2 mg/ml plus fentanyl 2 µg/ml was administered for EPA. Ropivacaine 2 mg/ml was administered through the femoral nerve catheter. The pain score, side effects (dizziness, sedation, nausea, vomiting, pruritus, hypotension and urinary retention), motor blockade, knee range of motion, and rehabilitation were measured postoperatively. The primary outcome measure was the number of patients experiencing side effects. RESULTS: The incidence of patients with side effects was 86.8% in the EPA group but only 35.1% in the PNB group (P < 0.001). There were no significant differences between the two groups in terms of pain score, motor blockade of the operative limb, knee range of motion, or rehabilitation. CONCLUSIONS: Continuous FNB combined with SNB can be an effective alternative to EPA for postoperative pain management in TKR.

Could immediate treatment change the management method of digital tendon musculotendinous junction avulsion?: a systematic review / 영남의대학술지

BACKGROUND: We conducted a systematic review of the literature to investigate the correlation between the interval to treatment and management of tendon avulsion ruptures in the musculotendinous junction (MTJ) of the forearm. METHODS: A thorough literatures search for studies of tendon avulsion injuries at the forearm was conducted using PubMed, MEDLINE, CINAHL, and Cochrane databases in accordance with the PRISMA guidelines. In total, five case series and 15 case reports accounting for 87 injured tendons involving 60 patients were selected for the analysis. RESULTS: Twenty-six patients had 44 tendon injuries associated with avulsion amputations, 31 patients had 38 tendon ruptures associated with closed avulsion injuries and three patients had five tendon ruptures associated with open avulsion injuries. Eighteen of the 49 (37%) patients were immediately treated for tendon ruptures and one of the 32 (3%) tendon ruptures treated via elective surgery was directly repaired. Additionally, 18 of the 30 (60%) tendons were directly repaired and 12 of the 30 (40%) tendons were transferred or side-to-side repaired in the immediately treated series. In contrast, one of the 28 (4%) tendon ruptures were directly repaired and 27 of the 28 (96%) tendons were transferred or side-to-side repaired in the electively treated series. CONCLUSION: In managing digital tendon avulsions at the MTJ, an immediate treatment could provide an opportunity to repair the ruptured tendon directly to the muscle.

Impaired Bone Healing Metabolic and Mechanical Causes

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.

Impaired Bone Healing Metabolic and Mechanical Causes

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.

Could immediate treatment change the management method of digital tendon musculotendinous junction avulsion?: a systematic review / 영남의대학술지

BACKGROUND: We conducted a systematic review of the literature to investigate the correlation between the interval to treatment and management of tendon avulsion ruptures in the musculotendinous junction (MTJ) of the forearm.METHODS: A thorough literatures search for studies of tendon avulsion injuries at the forearm was conducted using PubMed, MEDLINE, CINAHL, and Cochrane databases in accordance with the PRISMA guidelines. In total, five case series and 15 case reports accounting for 87 injured tendons involving 60 patients were selected for the analysis.RESULTS: Twenty-six patients had 44 tendon injuries associated with avulsion amputations, 31 patients had 38 tendon ruptures associated with closed avulsion injuries and three patients had five tendon ruptures associated with open avulsion injuries. Eighteen of the 49 (37%) patients were immediately treated for tendon ruptures and one of the 32 (3%) tendon ruptures treated via elective surgery was directly repaired. Additionally, 18 of the 30 (60%) tendons were directly repaired and 12 of the 30 (40%) tendons were transferred or side-to-side repaired in the immediately treated series. In contrast, one of the 28 (4%) tendon ruptures were directly repaired and 27 of the 28 (96%) tendons were transferred or side-to-side repaired in the electively treated series.CONCLUSION: In managing digital tendon avulsions at the MTJ, an immediate treatment could provide an opportunity to repair the ruptured tendon directly to the muscle.

Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports

Some proximal humeral fractures in elderly patients are accompanied by medial metaphyseal comminution and quality of the bone is so poor that head preserving osteosynthesis seems to be amenable. In cases of medial metaphyseal comminution, lateral locking compression plate (LCP) fixation also has a tendency to become a matter of screw cut out or loss of fixation. The author reports on successful treatment of two osteoporotic proximal humeral fractures combined with medial meta-physeal comminution, with application of additional direct medial supporting plate fixation. Medial plate fixations were added when the fractures were still unstable after the conventional lateral LCP fixation and anterior circumflex humeral arteries had been ruptured before. The fixations were stable enough to start exercise immediately after surgery. The inclinations of the humeral neck were not changed until the last follow-up and clinical results were satisfactory without humeral head osteonecrosis which was a concern.

Chronic Instability of the Carpometacarpal Joint of the Thumb after Trauma: A Report of 3 Cases

Posttraumatic instability of the carpometacarpal joint of the thumb are rarely reported. Consequently little is known about clinical and radiologic diagnosis, natural progress or treatment method. We report three cases of chronic instability of the carpometacarpal joint of the thumb treated with Eaton and Littler's ligament reconstruction. Satisfactory thumb functions were restored without arthritic change or recurrent subluxation.

The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur

PURPOSE: This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma. MATERIALS AND METHODS: Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated. RESULTS: The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores. CONCLUSION: The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

Tarsal Tunnel Syndrome Associated with Gout Tophi: A Case Report / 대한족부족관절학회지

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its branches in the fibro-osseous tunnel beneath the flexor retinaculum. This pathology is associated with multiple etiologies, including trauma, space-occupying lesions, and impaired biomechanics. We report a case of tarsal tunnel syndrome associated with gout tophi in a patient with untreated gout along with a review of the relevant literature on tarsal tunnel syndrome.

Minimally Invasive Repair Technique of Achilles Tendon Using Sponge Forceps: A Technical Report / 대한족부족관절학회지

Various minimally invasive repair techniques have been performed for acute Achilles tendon rupture. Despite this, it is difficult to use these techniques in common practice because of the necessity of special instruments. We propose a novel minimal invasive technique using sponge holding forceps, which are commonly used in the operating room for the acute Achilles tendon rupture.

Arthroscopy Assisted 2 Cannulated Screw Fixation for Transverse Glenoid Fracture: A Case Report

Arthroscopy is recognized as an important adjunct in treatment of intra-articular fractures. The author reports on successful treatment of a displaced transverse glenoid cavity fracture, reduced and fixed with arthroscopic assist, using two cannulated screws perpendicular to the fracture surface, in a patient with frail chest. One screw passed through the Neviaser portal, and the other screw passed through the base of the coracoid process. Arthroscopy assisted reduction and 2 cannulated screw fixation through the Neviaser portal and coracoid base appears to be a good method for treatment of transverse glenoid fractures.

Arthroscopy Assisted 2 Cannulated Screw Fixation for Transverse Glenoid Fracture: A Case Report

Arthroscopy is recognized as an important adjunct in treatment of intra-articular fractures. The author reports on successful treatment of a displaced transverse glenoid cavity fracture, reduced and fixed with arthroscopic assist, using two cannulated screws perpendicular to the fracture surface, in a patient with frail chest. One screw passed through the Neviaser portal, and the other screw passed through the base of the coracoid process. Arthroscopy assisted reduction and 2 cannulated screw fixation through the Neviaser portal and coracoid base appears to be a good method for treatment of transverse glenoid fractures.