Humeral Shaft Fracture Sustained during Arm Wrestling in Young Males / 대한스포츠의학회지

Humeral shaft fracture sustaining arm wrestling is rare, but occurs intermittently. We treated 15 cases of humeral shaft spiral fractures occurred during arm wrestling for fun since 2007. Average age was 22.47±2.69 years, average body mass index was 22.67±2.06 kg/m2. There was no prominent tendency for the fractures to occur at a certain phase of the match. Fractured level and length of each case were measured in the plain radiographs and compared with those of previous reports. Eight cases (53.3%) had an associating medial butterfly fragment, and the time taken until the fracture occurred was longer than that of simple spiral fracture (15.62±9.03 seconds vs. 7.85±2.67 seconds, p=0.048). Fractures were distributed mid to distal one third of humerus, the length of fracture was 7.93±2.69 cm and involved 25.43%±8.24% of humeral length. All cases except one treated surgically using plate and screws and returned their full activities within postoperative 3 months. Although arm wrestling is a simple and joyful sport, participants should be aware of the risks of injury during arm wrestling, especially for the amateur players.

Locating Femoral Insertion of Superficial Medial Collateral Ligament and Posterior Oblique Ligament Using Adjacent Structures: Magnetic Resonance Imaging Study / 대한정형외과학회잡지

PURPOSE: Anatomical medial knee reconstruction is crucial to the recovery of the knee joint. Our purpose is to determine the location of femoral insertion of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) from the attachment site of the adductor magnus and medial gastrocnemius tendon with MRI results. MATERIALS AND METHODS: A total of 200 knee magnetic resonance imaging results were retrospectively measured. The boundary of femoral insertion of sMCL and POL was marked and measured on the sagittal image. The attachment site of the adductor magnus tendon and medial gastrocnemius tendon was identified. The lineal, anterior-posterior and proximal-distal distances were measured from the attachment site to the center of the femoral insertion of sMCL and POL. RESULTS: The average size of sMCL and POL was as follows—sMCL: length of 13.5±1.7 mm, width of 10.9±0.3 mm and POL: length of 9.4±1.3 mm, width of 6.1±0.5 mm. The lineal distances from the insertion of the adductor magnus tendon and medial gastrocnemius tendon to the center of the sMCL and POL were measured—distances to the sMCL: 17.1±3.8 mm, 15.9±3.2 mm; distances to the POL: 11.9±2.9 mm, 8.2±2.7 mm. CONCLUSION: This study will help determine the location of the femoral attachment site of sMCL and POL by identifying the attachment section of the adductor magnus tendon and medial gastrocnemius tendon. Moreover, this study will guide the reconstruction of sMCL and POL when palpation of the bony structures become difficult.

Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the treatment outcomes of conservative treatment, early vertebroplasty (EVP), and delayed VP (DVP) of patients with osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: VP is regarded as an effective treatment for osteoporotic compression fractures. Few studies have compared the outcomes of each of the following treatments: conservative treatment, EVP, and DVP. MATERIALS AND METHODS: A total of 202 patients who presented with thoracolumbar osteoporotic vertebral compression fractures between January 2008 and December 2013 were divided into three groups: group 1 (conservative treatment), group 2 (VP within three weeks), and group 3 (VP after three weeks). We compared the collapse rate and the visual analog scale (VAS) score immediately after the trauma and at the 1-week, 3-week, 6-week, and 1-year follow-ups. RESULTS: The three abovementioned groups consisted of 89 patients, 60 patients, and 53 patients, respectively. The bone mass density (BMD) score of group 1 was statistically significantly higher than that of the others (p<0.05). In group 2, the average VAS score was high immediately after the trauma and low at the 1-year follow-up. Only group 2 showed a significantly high vertebral compression rate immediately after the trauma (p<0.05). Although there were no statistically significant differences in the incidence between the adjacent and the non-adjacent vertebral compression fractures, more patients underwent additional VP in groups 2 and 3 (p=0.980). CONCLUSION: The treatment method of performing EVP seems to yield the best clinical outcomes for patients with osteoporotic compression fractures who exhibit a relatively low BMD, high collapse rate, and high VAS score. Conservative management is the treatment of choice for osteoporotic compression fracture patients with a relatively high BMD, low collapse rate, and low VAS score.

Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training / 대한고관절학회지

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.

Motor Weakness of Right Ankle Dorsiflexion Caused by Increasing Size of Sacroiliac Joint Cyst after Posterior Lumbar Interbody Fusion in a Patient with Spinal Stenosis: A Case Report

STUDY DESIGN: Case report OBJECTIVES: To report a case of motor weakness caused by the increasing size of a sacroiliac joint cyst after spinal fusion. SUMMARY OF LITERATURE REVIEW: There have been no reports on the increased size of a sacroiliac joint cyst and motor weakness after spinal fusion. MATERIALS AND METHODS: A 63-year-old female was admitted with low back pain and right sciatica. Magnetic resonance imaging (MRI) findings showed the spinal canal narrowing at L4-5 and a cystic lesion on the right sacroiliac joint. After surgery, the symptoms were relieved. RESULTS: One month after the operation, motor function had worsened to grade 4. Follow-up MRI revealed an increase in the size of the cystic lesion. Selective nerve root blocks were performed. There was gradual improvement, and the motor grade reached grade 5 seven months after the operation. CONCLUSIONS: We recommend that surgeons evaluate the adjacent segmental lesion by MRI before performing spinal fusion.

Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip / 대한고관절학회지

PURPOSE: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. MATERIALS AND METHODS: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1+/-0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0+/-19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. RESULTS: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). CONCLUSION: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.

An Intratendinous Tophaceous Gout Mistaken for Cellulitis in the Patellar Tendon / 대한정형외과학회잡지

Gout is characterized by recurrent attacks of arthralgia, and deposition of monosodium urate crystals in and around the joints of the extremities and soft tissues. Monosodium urate crystals are observed most frequently at the 1st metatarsophalangeal joint and usually presented in the ankle and wrist joint. However, no case of an intratendinous tophus in the patellar tendon has been reported in Korean literature. In this report, we found monosodium urate crystals in the patellar tendon on magnetic resonance imaging images and intratendinous tophus were visible to the naked eye by excision. We reported on the case of a patient who experienced an unusual intratendinous tophus in the patellar tendon.

Cement Leakage after Vertebroplasty; Correlation with Patterns of Compression Fractures and Bone Mineral Density (BMD)

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the influence of fracture patterns and the result of bone mineral density on cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: Leakage of bone cement after vertebroplasty has known to be related with the direction of cortical disruption of fractured vertebral body and low bone mineral density (BMD). MATERIALS AND METHODS: One hundred eighty-two patients with osteoporotic vertebral compressions were studied from January 2009 to August 2013. The patients' fracture levels and patterns were compared. Among them, the cement leakage patterns were analyzed in 105 patients who had undergone vertebroplasty. The findings were compared with fracture patterns including cortical disruption and BMD. RESULTS: Seventy-five cases of cement leakage were observed. Among them, intradiscal leakage was the most common type of leakage. In the patient group with low BMD, there was a high incidence of lower and posterior cortical disruption in the fractures. Patients with posterior cortical disruption demonstrated a higher incidence of leakage into the spinal canal and anterior cortex. No significant correlation was observed between fracture patterns and leakage. CONCLUSIONS: A surgeon should use caution in performing vertebroplasty in patients with low BMD and posterior disruption of the vertebral cortex.

Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report / 대한고관절학회지

As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

Diagnostic Utility of Magnetic Resonance Imaging for the Patients with Problems Confined to Cross-Legged Posture / 대한스포츠의학회지

This study was conducted to evaluate the diagnostic utility of magnetic resonance imaging (MRI) for the patients having problems confined to cross-legged posture. The study subjects were 128 cases (male 87.5%) and 120 patients from October 2008 to June 2013. Average age of male patients was 50 years old (range, 21-72 years old), and female 45 years old (range, 18-76 years old). The rate of positive MRI findings was compared according to abnormal physical findings. The average duration of symptoms was 11.7 months. The most frequent complains was on the back (41.9% at rest, 57% when taking the posture). Patrick test was positive for 33.6% of cases, simple radiography was abnormal only for 20% of cases. Bone scan was normal for all 98 cases. Only 21.9% of 128 cases showed abnormal MRI findings which were managed with conservative treatment. Limitation in the range of hip joint motion was not statistically associated with abnormal findings of MRI (p=0.148). Normal Patrick test was associated with normal MRI finding (p=0.001). Among normal cases on both physical and simple bone X-ray film, 88.6% were normal at MRI. In conclusion, for patients with physical complaints from the cross-legged posture, diagnostic utility of MRI is relatively low when they show normal on both physical examination and simple radiography.

The Short Term Results of Selective Nerve Root Block in Spinal Stenosis by Contrast Pattern

STUDY DESIGN: Retrospective study. OBJECTIVES: To observe the short term effect of selective nerve root block (sNRB) depending on the contrast pattern and spinal canal size. SUMMARY OF LITERATURE REVIEW: A number of studies have demonstrated that sNRB is quite effective not only for patients with herniated intervertebral discs but also for those with spinal stenosis. MATERIALS AND METHODS: The Visual Analog Scale(VAS) score was collected before and after the procedure from 217 subjects with lumbar spinal stenosis and underwent sNRB. Two types were classified after observing the contrast's spreading pattern, Type I contrast reaching the spinal canal and Type II not reaching the spinal canal. Efficacy of the treatment for each type was also compared. In addition, the spinal canal size was classified into three categories. Treatment efficacy depending on the contrast pattern was also compared in each category. RESULTS: When divided into two types based on the contrast pattern, type I showed a more significant reduction in VAS score according to T-test although both types showed a decrease in VAS score after the procedure. In regards to spinal canal dimension, both types showed decreased VAS scores after the procedure in patients with spinal canal size larger than 172.2mm2; however, there were no changes in VAS score before and after the procedure for those with spinal canal size smaller than 73mm2. CONCLUSIONS: There was a short term effect of selective nerve root block (sNRB) in patients with spinal stenosis regardless of their contrast pattern, type I group showing a stronger correlation. In regards to spinal canal dimension, patients with larger spinal canal sizes not only showed a significant decrease in VAS score after selective nerve root block (sNRB) but also showed differences depending on the contrast pattern. On the contrary, there was no significant difference in VAS score before and after selective nerve root block (sNRB) in patients with small spinal canal sizes, and there was also no difference in the outcome depending on the contrast pattern in patients with small spinal canal sizes. Therefore, when performing selective root nerve block (sNRB), the operator should remember to manipulate the angle and position of the spinal needle when injecting the appropriate drug after confirming that the contrast material reached the spinal canal. The operator should also consider surgical management when performing selective nerve root block (sNRB) in patients with severe central spinal stenosis.

Multiple Giant Tumoral Calcinosis in Pelvic Region / 대한정형외과학회잡지

Tumoral calcinosis is a very rare disease in which calcium deposit is accumulated on soft tissue around joints without specific metabolic disorder of calcium or predisposing illnesses. Its causes have not been revealed clearly, and the disease has been known to occur rarely among Asian patients. We report a case of a multiple giant tumoral calcinosis patient who complained of painful masses in the groin region as well as in both buttocks and sacral area. The patient was evaluated to differentiate with other causes and have been treated with surgical excision. We present this case with a review of literature.

Atraumatic Spinal Interdural Hamatoma: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To investigate the outcomes of recapping laminoplasty for the treatment of atraumatic spinal interdural hematoma. SUMMARY OF LITERATURE REVIEW: There are several causes for a spinal hematoma. The occurrence of spinal hematoma is rare; in particular, the ones arising atraumaticaly are considered extremely rare. MATERIALS AND METHODS: We studied a 33 year old male patient without any known risk factor. Magnetic resonance image has revealed an intraspinal epidural cyst compressing on the spinal nerve. After performing recapping laminoplasty, followed by partial excision of dura mater and resection of hematoma, we were able to observe another layer of dura mater, confirming the location of hematoma within two epidural layers, i.e., an interdural hematoma. RESULTS: Performing recapping laminoplasty is a more effective and less invasive procedure for removing cyst than conventionally used laminectomy. Patients were found to have synostosis after three months post-op, and they have exhibited neither lumbosacral pain nor lower limb motor weakness after six months follow-up. There were no recurrences or complications reported on our study. CONCLUSION: There are a few reported cases of atraumatic spinal interdural hematoma. Our study shows that performing pars osteotomy with recapping laminoplasty yield good clinical outcome for the treatment of atraumatic spinal interdural hematoma.

The Treatment of Transverse Fracture of The Upper Sacrum According to Roy-Camille Classification (Suicidal Jumper's Fracture): 4 Cases Report

STUDY DESIGN: A Case report. OBJECTIVES: We report 4 cases of transverse fracture of upper sacrum with good clinical results. SUMMARY OF LITERATURE REVIEW: There is no clear guideline for the treatment of transverse fracture of upper sacrum. MATERIALS AND METHODS: Four patients, who visited our institute for transverse fracture of upper sacrum, were reviewed from January 2006 to July 2009. RESULTS: All patients had good clinical results after treatment. CONCLUSIONS: In all cases, patients were managed conservatively without reduction or internal fixation. Only for Roy-Camille type 2 and 3 transverse fracture of the upper sacrum with neurologic deficit, decompression was performed, yielding good clinical results.

The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We will discuss clinical outcomes of adult traumatic atlantoaxial rotatory subluxation (Fielding type I) and verify the correlation between the clinical outcomes and radiological reduction rate. SUMMARY OF LITERATURE REVIEW: Atlantoaxial rotatory subluxation which usually occur in children by non-traumatic sources or minor trauma has been discussed persistently. However, studies of atlantoaxial rotatory subluxation which occur in adults over 20 years old, especially by traumatic injury is rare. MATERIALS AND METHODS: From October 2004 to April 2011, thirty patients diagnosed of traumatic atlantoaxial rotatory subluxation with 6 months follow-up period were enrolled in the study. After diagnosis, we started treating Halter traction with 5 lbs. We discontinued traction when the patient recovered over 90% of ROM and applied Philadelphia collar to the patient. We measured visual analogue scale (VAS) for cervical pain and ROM. We measured atlanto-dens interval (ADI) and lateral mass-dens interval (LDI) difference using three-dimensional computed tomography (3D-CT) to validate radiological reduction rate. RESULTS: At the end of follow-up, none of the patients complained over pain and all recovered to full ROM. ADI was in normal range during the whole treatment period. LDI difference gradually decreased during treatment period, however, only 8 cases (26.7%) came back to normal range. CONCLUSIONS: In traumatic atlantoaxial rotatory subluxation (Fielding type I), satisfactory clinical outcomes such as pain relief or ROM improvement using traction and the radiological reduction rate was also improved but it failed to achieve a complete reduction of LDI difference in radiography.

Incomplete Anterior Interosseous Nerve Palsy That Accompanied a Monteggia Fracture / 대한정형외과학회잡지

The anterior interosseous nerve innervates the flexor pollicis longus, the flexor digitorum profundus and the pronator quadratus. There are no sensory fibers from the anterior interosseous nerve leading to the skin. Paralysis of the anterior interosseous nerve that accompanies a Monteggia fracture has rarely been reported, and incomplete paralysis of the anterior interosseous nerve has almost not been reported. We experienced a patient with incomplete anterior interosseous nerve palsy involving the flexor pollicis longus as a complication of a Monteggia fracture. The paralysis of the flexor pollicis longus recovered 4 months after the surgery for the Monteggia fracture.

Entry Point and Approaching Angle of Working Cannula in Endoscopic Lumbar Disecectomy / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: We report the efficacy of the entry point and approach angle of a working cannula using preoperative prone abdominal computer tomography (PACT). SUMMARY OF LITERATURE REVIEW: To date, there are no reports on the entry point and approach angle of a working cannula when performing transforaminal percutaneous endoscopic lumbar discectomy (TPELD) with consideration of the individual anatomic variations and characteristics of herniated disc and surgical instruments. MATERIALS AND METHODS: Cases of herniated intervertebral discs from L4-5, who have previously undergone PACT before TPELD, were included. A total of 25 patients were observed over a 1 year period. The entry point and approaching angle of the working cannula with PACT were calculated, and the results were applied to the TPELD. The clinical results were assessed 1 month after surgery using the VAS, ODI and MacNab criteria, and were confirmed by a radiology and MRI examination. RESULTS: The preoperative measured data using PACT showed that the mean approaching distance and mean approaching angle of the working cannula were 12.4 cm and 75.4 degree, respectively. The VAS improved from a mean of 8.1 preoperatively to a mean of 2.3 12 months after surgery. The ODI improved from a mean of 59 preoperatively to a mean of 24 at 12 months after surgery. According to the MacNab criteria, all patients were classified as either excellent and good during the follow up periods. The extruded disc of all patients had been well removed according to the MRI scan performed 1 month after surgery. CONCLUSIONS: The scientific approach method using PACT based on the characteristics of patients and surgical instruments can be performed easily and accurately, and access and decompress the extruded disc directly.

Synovial Osteochondroid Metaplasia of the Elbow Joint Mimicking a Fracture: A Case Report / 대한정형외과학회잡지

We present here a case of synovial osteochondroid metaplasia of the elbow joint that was almost mistaken for a fracture. A 21-year-old military recruit complained of pain at the elbow after a minor direct injury. Since the imaging studies, including simple radiographs and CT scans, showed a small bony fragment, an operation was performed under the impression of fracture of the elbow joint. There was no evidence of acute injury such as bleeding or swelling, and excisional biopsy was done. The histopathological findings of osteochondroid metaplasia surrounded by fibrous tissue and synovium led to the pathologic diagnosis of synovial osteochondroid metaplasia. Clinicians should include this tumorous entity in differential diagnosis when a bony fragment is seen on the radiographs of an acutely injured subject.

Acromioclavicular Separation with the Fracture of the Coracoid Process: 2 Cases report

The acromioclavicular separation (AC separation) is a common injury, which is often accompanied by the rupture of the coracoclavicular ligament (CC ligament) in severe occasions. In rare forms of AC separation, the fracture of the coracoid process would occur rather than the rupture of the CC ligament. Only 31 cases of such injury have been reported in the English literature. We present 2 additional cases with literature review. The fracture of the coracoid process is not readily seen on anteroposterior shoulder radiograms. Severe AC separation without widening of CC distance on anteroposterior shoulder radiogram heralds the fracture of the coracoid process.

Posterior Double PCL Sign; A Case Report of Unusual MRI Finding of Bucket-handle Tear of Medial Meniscus: A Case Report / 대한정형외과학회잡지

Among the MRI signs of meniscal bucket handle tears, a double posterior cruciate ligament (PCL) sign manifests on the sagittal images as a low signal band anterior and parallel to the PCL. The mesially displaced fragment may be confined to the intercondylar notch. However, the torn fragment is rarely displaced to the posterosuperior region of the PCL. If it does occur, separation at the anterior horn may be assumed. We propose this type of lesion be called the posterior double PCL sign in contrast to the ordinary double PCL sign. We present a case showing the 'posterior double PCL sign' accompanying an anterior cruciate ligament injury.