Assessment of Noncontiguous Posterior Malleolar Fractures in Distal One-Third Tibia Shaft Fractures with Proximal Fibula Fractures

Purpose@#Posterior malleolar fractures after intramedullary nail surgery rarely occur in distal tibia shaft fractures. The importance of preoperative ankle evaluation in preventing these fractures is also common knowledge. There are no studies in the literature on posterior malleolar fractures in distal onethird tibia shaft fractures except for distal metaphyseal tibia fractures to the best of our knowledge. The purpose of this study was to evaluate the incidence and radiological features of posterior malleolar fractures in distal one-third tibia shaft fractures with proximal fibula fractures. @*Materials and Methods@#Thirty-one patients diagnosed with distal one-third tibia shaft fractures with proximal fibula fractures from January 2016 to May 2021 were retrospectively reviewed. With the aid of plain radiographs and computed tomography (CT) scans, the fracture patterns of the tibia and fibula were classified according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification, and posterior malleolar fractures were identified. The fracture pattern was classified according to the Haraguchi classification, and the angle between the bimalleolar axis and the posterior malleolar fracture line was measured when there was a posterior malleolar fracture. @*Results@#Out of the 31 distal one-third tibia shaft fractures with proximal fibula fractures, 16 cases (51.6%) had noncontiguous posterior malleolar fractures that were confirmed on a CT scan, while 3 cases (18.8%) were visible on initial plain radiographs. There was no statistically significant variation seen in the presence of a posterior malleolar fracture in the tibia (p=0.15) and fibula (p=0.87) fractures.According to the Haraguchi classification, there were 15 posterolateral-oblique fractures (Type I) and 1 medial-extension fracture (Type II), and the mean angle was 24.5°. @*Conclusion@#Noncontiguous posterior malleolar fractures occurred in approximately half of the distal one-third tibia shaft fractures with proximal fibula fractures, and a CT scan was considered necessary to diagnose posterior malleolar fractures before surgery

Infected Epidermoid Cyst Including Multiple Nails at the Amputated Thumb Stump: A Case Report

Fingertip amputation is a common injury among trauma occurring in the upper extremity. After amputation of the fingertip, there are several treatment options according to the degree of damage. Also, the skin flap is sometimes performed when skin defects are accompanied. Among the complications associated with fingertip injury, cyst formation at the amputation stump is rare but some cases have been reported based on the pathologic findings. There was a case of an infected epidermal inclusion cyst containing multiple nail plates at the amputation stump of the thumb, so we would like to report it with a review of the literature.

Difference in the Surgical Approach in Reverse Total Shoulder Arthroplasty for Cuff Tear Arthroplasty: Comparison of the Radiological and Clinical Result according to the Deltopectoral and Anterosuperior Approach / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological results of reverse total shoulder arthroplasty (RSA) using an anterosuperior approach with those using a deltopectoral approach to determine the difference in cuff tear arthroplasty between both approaches. MATERIALS AND METHODS: A retrospective review of 24 consecutive patients who underwent RSA due to cuff tear arthroplasty from February 2014 to November 2015 was performed. The anterosuperior and deltopectoral approaches were 12 cases each. The mean age was 72 years and the mean follow-up period was 13.2 months. The clinical results were assessed using the visual analogue pain scale, American Shoulder and Elbow Surgeon score, Korean shoulder scoring system, and the Constant score. The prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenosphere rim distance (inferior glenosphere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance were assessed, and severity of notching according to the Nerot-Sirveaux classification, were measured from the radiology evaluation. RESULTS: Compared to the anterosuperior approach, the PSNA (9.6°, p=0.018) and inferior glenosphere overhang (2.0 mm, p=0.024) were significantly greater in the deltopectoral approach and the PGRD (2.2 mm, p=0.043) was shorter. The AT and GT distance was similar in the two groups. Two and three cases of implant notching occurred on deltopectoral approach and anterosuperior approach, respectively. No metal loosening, acromion fracture, or nerve injury was noted. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. CONCLUSION: The anterosuperior approach could cause the superior position of the glenoid baseplate and a decrease in the inferior tilt compared to the deltopectoral approach, but the clinical results had improved in both groups and there was no difference between the two groups.

Pain and Power Doppler Ultrasonographic Evaluation according to Bursal Preservation after Arthroscopic Rotator Cuff Repair: Comparison between Complete and Minimal Bursectomy in Early 3 Months / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and power Doppler ultrasonographic results of arthroscopic rotator cuff repair (ARCR) between using a complete and a minimal bursectomy. Moreover, we aimed to evaluate the pain-relief and neoangiogenesis according to bursal preservation. MATERIALS AND METHODS: Between December 2015 and August 2016, we performed a retrospective review of 78 consecutive patients who underwent ARCR due to full thickness rotator cuff tear (small-large sized tear). Thirty-six patients received ARCR using minimal bursectomy (Group A), while 42 patients received ARCR via complete bursectomy (Group B). The mean age was 57.8 years and the average symptom duration period was 20.3 months. Clinical result was assessed using a visual analogue scale (VAS) pain score due to evaluate the pain-relief and power Doppler ultrasonographic result was classified according to the modified Newman classification due to evaluate the neoangiogenesis. RESULTS: There was no statistically significant difference in operation time, pain-relief, and neoangiogenesis in accordance with bursal preservation between the two groups. Compared to the preoperative values, pain was significantly increased two weeks postoperatively in both groups (Group A: −1.8±1.4, p=0.000; Group B: −1.4±1.7, p=0.000). Compared to the preoperative values using the power Doppler ultrasound, neoangiogenesis was significantly improved at the postoperative 6 weeks (Group A: 0.7±0.9, p=0.000; Group B: 0.9±1.1, p=0.000) and 3 months (Group A: 0.9±1.0, p=0.000; Group B: 1.0±1.1, p=0.000) in both groups. CONCLUSION: Serial follow-up by power Doppler ultrasound before and after ARCR showed a neoangiogenesis of up to 3 months in both groups, but there was no difference in pain-relief and neoangiogenesis between the two groups.

Comparison of Clinical and Radiological Results according to Glenosphere Position in Reverse Total Shoulder Arthroplasty: A Short-term Follow-up Study

BACKGROUND: In a previous biomechanical study, eccentric glenospheres with more inferior position of the center of rotation were shown to improve range of motion and reduce the incidence of scapular notching after reverse total shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and radiological results of RSA using an eccentric glenosphere to those using a concentric glenosphere and to determine the usefulness of the eccentric glenosphere. METHODS: From 2009 to 2015, we performed a retrospective review of 20 consecutive patients who underwent RSA using a deltopectoral approach. Nine patients underwent RSA using a concentric glenosphere (group A) while 11 had an eccentric glenosphere (group B). The average follow-up period was 13.9 months (range, 12 to 18 months). All glenoid components were placed with 15° of inferior tilt. Clinical results were assessed using the visual analog pain scale score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, the Korean shoulder scoring system (KSS), and the Constant score. On radiological evaluation, prosthesisscapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenoshere rim distance (inferior glenoshpere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance, and severity of notching according to the Nerot-Sirveaux classification were assessed. RESULTS: The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. A significant intergroup difference was observed with regard to PGRD (24.8 ± 1.6 mm for group A vs. 22.2 ± 1.9 mm for group B; p = 0.002) and inferior glenosphere overhang (2.0 ± 1.7 mm for group A vs. 5.8 ± 1.6 mm for group B; p = 0.000). Seven of 9 patients in group A developed notching compared with 2 of 11 patients in group B (p = 0.022). The other radiological parameters such as inferior tilt and AT and GT distances were not significantly different between two groups. Complications such as loosening and scapular fractures did not occur. CONCLUSIONS: The eccentric glenosphere in RSA was more effective in reducing the rate of notching than the concentric glenosphere although clinical outcomes were not significantly different in the short-term follow-up.

Proprioception and Clinical Results of Anterolateral Single-Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation

PURPOSE: To evaluate the clinical and radiological results and proprioception following anterolateral single-bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation for PCL injury. MATERIALS AND METHODS: Twenty patients with an isolated PCL injury (16 males and 4 females) were included in this study. The mean follow-up period was 61 months (> or =24 months) and the mean age of the patients was 36 years. Knee joint instability was evaluated using posterior drawer stress radiography. Knee function, level of activities, and individual satisfaction were assessed using the Lysholm knee score, Tegner activity score, and 2000 International Knee Documentation Committee (IKDC) score. Knee proprioception was assessed using an isokinetic machine. RESULTS: The mean ligament laxity assessed using the posterior drawer stress radiography was improved from 10.8-3.2 mm. The mean Lysholm knee score was improved from 70.0-88.9 points, and the mean Tegner activity score was improved from 2.7-6.2 points. Individual satisfaction assessed using the IKDC score was improved from 62.7-85.4 points (p<0.05). Knee proprioception was not significantly different between the treated and the uninjured knees. CONCLUSIONS: Single-bundle PCL reconstruction with remnant preservation for PCL injury exhibited satisfactory outcomes regarding functional outcome, joint stability, and proprioception.

The Comparison of LC-DCP versus LCP Fixation in the Plate Augmentation for the Nonunion of Femur Shaft Fractures after Intramedullary Nail Fixation

PURPOSE: The purpose of this study was to evaluate the efficacy of the surgical treatment through the comparison of LC-DCP (Limited Contact-Dynamic Compression Plate) versus LCP (Locking Compression Plate) fixation in the plate augmentation for the nonunion of femur shaft fractures after intramedullary nail fixation. MATERIALS AND METHODS: Twenty-four patients with the nonunion of femur shaft fractures after intramedullary nail fixation who underwent plate augmentation were evaluated from Mar. 2001 to Sept. 2005. The group with LC-DCP augmentation was done bicortical screw fixation and the group with LCP was done monocortical fixation. RESULTS: There was one case of nail breakage in LC-DCP group, but sound bony union were achieved uneventfully in all the cases of both group. LCP fixation was slightly superior to LC-DCP fixation in view of the bony union time, operating time, postoperative Hb down, amount of postoperative transfusion, but there was no statistical difference (p>0.05). CONCLUSION: We got the satisfactory results after monocortical LCP augmentation as well as bicortical LC-DCP fixation and have concluded that monocortical LCP fixation was an effective treatment option for nonunion of femur shaft fracture occurred after Intrmedullary nail fixation.

Treatment Result of Preserving Peripheral Rim of Torn Lateral Discoid Meniscus

PURPOSE: To evaluate the clinical results of preserving the peripheral rim of meniscus in the injuries of lateral discoid meniscus. MATERIALS AND METHODS: We analyzed 38 patients, 40 knees. Mean follow-up period was 17.4 months and mean age was 34.9 years old(10~62). We classified the lesion according to Watanabe and Ahn(classifying the type of tear according to arthroscopic finding). Clinical results were analyzed by Ikeuchi's clinical grading system and the Lysholm knee scoring scale. Radiographic evaluations were analyzed with plain radiographs. The common clinical results were pain in 40 cases(100%), locking in 16. Radiological degenerative arthritis changes were 31 persons(33 cases, 82.5 %) by simple initial X-ray. The common radiological changes were hypoplasia of lateral femoral condyle in 29 cases (72.5%), widening of lateral joint space in 26. RESULTS: Partial meniscectomy was undergone in 14 patients(15 cases) and partial meniscectomy with meniscal repair was undergone in 24 patients(25 cases). The patients were categorized using Watanabe's classification: complete, 25 cases(62.5%) and incomplete, 15 cases(37.5%). There were longitudinal tears(type 2) in 15 cases(37.5%), complex tears(type 7) in 12 cases. The mean Lysholm score was improved from 56.7 points to 86 points postoperatively after the partial meniscectomy, and from 62.7 points to 88 points after the partial menisccectomy with meniscal repair, which were not statistically significant(p>0.05). According to Ikeuchi's grading system, 11 cases(73.3%) had either excellent or good ratings in the partial menisectomy and 21 cases(84%) in the partial menisectomy with meniscal repair, which were not statistically significant(p>0.05). CONCLUSION: We believe that preserving peripheral meniscus by using partial menisectomy and partial menisectomy with meniscus repair lead to good function and satisfactory results.

The Clinical Results After Open Wedge Osteotomy of Proximal Tibia in Degenerative Knee Osteoarthritis

PURPOSE: The purpose of this retrospective study was to analyze the radiological and clinical results following high tibial osteotomy of the degenerative knee osteoarthritis. MATERIALS AND METHODS: This study included 12 patients who had degenerative knee osteoarthritis and had been treated with high tibial osteotomy with TS-OA plate. Mean age was 50.2 years old(43~62) and mean follow up period was 17.7 Months. Clinical evaluation were analysed by HSS score. RESULT: There were 2 cases of grade 2 and 10 cases of grade 3 based upon the radiological Kellgren classifications before surgery. The mean femorotibial angle was corrected from varus 6 degrees before surgery to valgus 8.5 degrees at the last follow up and the mean angle between mechanical axis and tibia long axis was corrected from varus 6.7 degrees to valgus 1.6 degrees. The Insall-Salvati ratio was changed from 1.07 before surgery to 1.04 at the last follow up and tibial posterior inclination was changed from 8.1 degrees to 10.2 degrees. HSS score was improved from 58 before surgery(5 cases fair, 7cases poor) to 86.3 at the last follow up(9 cases excellent, 3 cases good). CONCLUSION: The high tibial osteotomy is an effective treatment option for the management of degenerative knee osteoarthritis on medial compartment patients before total knee arthroplasty.