Little Leaguer Shoulder with Contralateral Thrower's Fracture of the Humerus in Adolescent Baseball Pitchers / 대한정형외과학회잡지

Baseball-related injuries are on the rise due to its increasing popurity as an international sports. Among them, Little League Shoulder is characterized by pain when pitching and is associated with specific roentgenographic changes in adolescent baseball pitchers. Ball thrower's fracture is defined as a fracture of the humeral diaphysis resulting from overhead throwing without any external contact but it is rare in adolescents. We report a case of Little League Shoulder with a contralateral thrower's fracture of the humeral shaft related to baseball pitching in an ambidextrous adolescent baseball pitcher with a review of the relevant literature.

Septic Arthritis of the Hip Caused by Brucella abortus: A Case Report / 대한정형외과학회잡지

Brucellosis is a glbally distributed zoonotic infection of the Brucella genus that can involve multiple tissue and organ. In Korea, Brucellosis is caused mainly by B. abortus. but there is no reported case of pyogenic hip joint infection due to Brucella infection in Korea. The authors report a rare case of B. abortus infection in a 40-year-old male cattle breeder male who presented with septic arthritis of the hip joint as the first clinical manifestation.

Tenosynovial Chondromatosis on Plantar Area: A Case Report / 대한족부족관절학회지

Tenosynovial chondromatosis is a multinodular cartilaginous proliferation that arises from the tenosynovial membranes. It is rare, benign neoplasm, most commonly affects the tendon of the wrist and hand. It is clinically important because of its high rate of recurrence with a unique histopathological pattern which not infrequently displays considerable focal cellular atypia and hypercellurality nevertheless it is benign, but it has not been well recognized because of its rarity. We report here a rare case of tenosynovial chondromatosis of the tendon sheath of flexor hallucis longus and flexor digitorum longus in plantar area.

Femoral Nerve Palsy caused by Iliopsoas Bursitis Associated with Osteonecrosis of the Femoral Head : A Case Report

Iliopsoas bursitis is known to occur in relation to hip joint lesions such as osteoarthritis, rheumatoid arthritis, synovial chondromatosis, pigmented villonodular synovitis and rarely osteonecrosis of the femoral head, but femoral nerve palsy due to iliopsoas bursitis is a very rare condition. A patient visited to the emergency room because of anesthesia of the anterior thigh. A mass had developed and this enlarged to 3x5 cm in size after 2 weeks, and this was probably due to progression of osteonecrosis of the femoral head. The patient was finally diagnosed with femoral nerve palsy that was caused by a distended iliopsoas bursa, which was detected by ultrasonography and enhanced MRI. Total hip arthroplasty via the posterior approach was done and the connected iliopsoas bursa was removed. After operation, the anesthesia of the anterior thigh and the motor power were improved. We report here on a case of femoral nerve palsy due to iliopsoas bursitis that was related to osteonecrosis of the femoral head, and we review the relevant medical literature.

Treatment of Subtrochanteric Femur Fractures Using Intramedullary Devices

PURPOSE: The purpose of this study is to compare the result between closed reduction and minimal open reduction in case of difficult reduction for subtrochanteric fractures fixed with intramedullary nail. MATERIALS AND METHODS: From Jan. 2001 to May 2005, 35 cases of subtrochanteric femur fracture treated by intramedullary nail and followed up for more than a year were selected out of 42 subtrochanteric femur fractures. Fielding classification and Russel-Taylor classification were used, and according to the fracture classification and method of reduction, the patients were grouped into closed or open reduction group. Fracture with minimal displacement or anatomical reduction was fixed by closed reduction, but in case of failed closed reduction or loss of reduction, minimal incision was made for open reduction and internal fixation, and the result between two groups were compared. RESULTS: In total of 35 cases, 15 cases were fixed by closed reduction and the rest 20 cases required open reduction. Operation time, amount of transfusion, total hospital days, partial weight bearing ambulation, and union time did not show significant differences between two groups. Ambulation and range of motion after the operation were satisfying in both groups. CONCLUSION: In treatment of subtrochanteric femur fracture with intramedullary nail, both closed and open reduction shows satisfying result, therefore when anatomical reduction is difficult to achiev by closed reduction, minimal incision open reduction and additional fixation is strongly recommended to obtain anatomical reduction and firm fixation.

Double Tension Band Wiring for Olecranon Fractures

PURPOSE: To evaluate the clinical results of double tension band wiring for communited olecranon fractures involving proximal 1/3. MATERIALS AND METHODS: We reviewed 9 cases of communited olecranon fractures involving proximal 1/3 treated with double tension band wiring followed for minimum 10 months. There were 2 cases of olecranon fractures involving only proximal 1/3, 6 cases of olecranon fractures involving from proximal 1/3 to middle 1/3 and 1 case of olecranon fractures involving from proximal 1/3 to distal 1/3. We analyzed the bone union time, radiologic results for gap, reduction loss, pin migration, pain, range of motion, complications and functional outcomes at last follow up. RESULTS: All patients had solid bone union without additional surgery and average union time was 10.3 weeks. Anatomical reduction could be obtained in 8 of 9 cases but there was 1 mm step off in one case. 36 pins were used to fix the fractures, 1 pin of 18 distal pins and 2 pins of 18 proximal pins were migrated to backward but there was no reduction loss. Only 1 distal pin needed early removal due to skin irritation. Average range of motion ranged from flexion contracture 3.3 degrees to further flexion 137.8 degrees. On functional analysis, we got 8 cases of good result, 1 case of fair result and there was no poor result. CONCLUSION: Double tension band wiring for comminuted olecranon fracture involving proximal 1/3 was concluded to give a firm fixation of the fracture site as bone union could be acquired without serious pin problems.

Irreducible Dislocation of the Interphalangeal Joint of the Thumb: A Case Report

Dislocations of the interphalangeal joint of the thumb are rather uncommon as a result of the inherent stability of the interphalangeal joint. Irreducible dislocations of these joint are rare. The authors report a case of irreducible dislocation of the interphalangeal joint of the thumb with interposed palmar plate, and reduced by open reduction.

Treatment of the Hip Fractures in the Elderly over 80 years old

PURPOSE: The aim of this study was to determine if aggressive surgical treatment for hip fractures in elderly patients over 80 years of age is reasonable despite the many complications. MATERIALS AND METHODS: From Jan. 2000 to May 2005, 36 cases of femur neck and intertrochanteric fractures in patients over 80 years of age, who were followed up for more than one year after surgery, were selected. According to the fracture types, the patients were treated with cemented bipolar endoprothesis, compression hip screw (CHS) or an intramedullary hip screw (IMHS). The underlying disease, postoperative complications, functional status and the level of activity in their daily routine were measured on the follow up examination. RESULTS: There were 10 and 26 cases of neck and intertrochanteric fractures, repsectively, and all femur neck fracture patients were treated with a cemented bipolar endoprosthesis. In the intertrochanteric fractures, CHS and IMHS were used for the stable and unstable fractures according to the Evans classification, respectively. The Harris hip score measured one year after surgery was 84.1 points for the bipolar endoprosthesis group, 83.1 points for the compression hip screw group and 79.9 points for the intramedullary hip screw group. The dependency of daily living according to the K-ADL increased after surgery. The functional status measured using the Halpin's classification showed that 7 cases remained in the same grade, 21 cases stepped down one grade and the remaining 8 cases stepped down two grades. There was total of 3 deaths one year after surgery due to an aggravation of CHF in 2 cases and pneumonia in one case. CONCLUSION: Hip fractures in patients more than 80 years of age have many complications. However, aggressive surgery is a reasonable treatment.

Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture

The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.

Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture

The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.

Femoral Neuropathy caused by Iliopsoas Hematoma: A Case Report / 대한정형외과학회잡지

There are a few reports of femoral neuropathy caused by an iliopsoas hematoma combined with trauma, hemophilia, and anticoagulation therapy. There is some debate as to whether conservative treatment or surgical management is the treatment of choice for femoral neuropathy. In some cases, surgical management is used to minimize the level of nerve damage and for better functional recovery. We report a case of femoral neuropathy on the other side of a total hip replacement arthroplasty (THRA) caused by an iliopsoas hematoma during heparin anticoagulation therapy.

A Comparison according to Insertion Method for Intramedullary Nailing in Proximal Tibial Fractures

PURPOSE: To compare clinical and radiological results between standard insertion method and semiextended method which was designed to improve proximal fixation and alignment in proximal tibia fracture. MATERIALS AND METHODS: A retrospective review from May 2000 to February 2004, identified 24 extraarticular fractures in proximal tibia, initially treated with locked intramedullary nails at least 1 year follow up. There were 12 open injuries, 4 segmental, 3 butterfly fragments and 17 comminuted. Semiextended method was used in 10 fratures and standard insertion method which is cephalad to tibial tubercle in 14. Follow up clinical assessment consisted of review of associated injuries and complications and these two methods were compared by postoperative angulation and displacement in anteroposterior and lateral radiographs. Data were analysed by t-tests. RESULTS: In semiextended group, average angulation was 2.3 degrees in coronal and 2.8 degrees in sagittal plane and average displacement was 4.5 mm in coronal and 5.3 mm in sagittal. In ordinary group, average angulation was 5.1 degrees in coronal and 7.4 degrees in sagittal plane and average displacement was 6.1 mm in coronal and 5.3 mm in sagittal. In semiextended group, there were significant reduction in coronal angulation (p=0.006) and sagittal angulation (p=0.001), but there was no significant difference in coronal (p=0.344) and sagittal (p=0.99) displacement. Both groups showed anterior, valgus angulation and posterolateral displacement in most cases. There were 14 associated injuries and one patient developed nonunion and was treated by nail exchange with autogenous bone graft. CONCLUSION: Our retrospective analysis demonstrated that semiextended method is effective for reducing coronal and sagittal angulation, but is not helpful for reducing displacement in both planes.

Transverse Fracture through Screw Site after Cannulated Screw Fixation in Vertical Patella Fracture: A Case Report

Many complications after operative treatment of patella including redisplacement of fracture, refracture, weakness of extensor muscles, patellofemoral joint arthritis, metal failure, malunion, infection, avascular necrosis were reported. We report a case of transverse fracture of patella through the cannulated screw fixation site used to fix previous vertical patella fracture with a review of the literatures.

Operative Treatment in Midshaft Fractures of Clavicle using Reconstruction Plate and Interfragmentary PDS Suture

PURPOSE: We are reporting the result of comminuted midshaft fractures of clavicle treated by reconstruction plate fixation and PDS augmentation easily fixing butterfly fragments with minimal soft tissue dissection. MATERIALS AND METHODS: We reviewed 42 cases of operatively treated displaced comminuted midshaft fractures of clavicle at our hospital from March, 2001 to May 2004 whom were followed up for more than one year after the operation. According to Robinson classification, we grouped simple fractures as group A, and comminuted fractures as group B. Internal fixation using reconstruction plate has been chosen for type A fracture. Type B has been treated by reconstruction plate fixation with PDS augmentations. Shoulder function, union time and complications has been studied according to the fracture type retrospectively. RESULTS: All cases had complete bone union with average union time of 8.6 weeks for type A and 8.9 weeks for type B. Weitzman functional evaluation did not show significant differences. CONCLUSION: PDS augmentation in comminuted midshaft fracture of clavicle easily fix the butterfly fragments with least soft tissue damage and lessen the bone graft. Therefore it considered to be one of the available treatment methods for comminuted midshaft fracture of clavicle.

Treatment of Humeral Shaft Fracture with Retrograde Flexible Nail

PURPOSE: To evaluate and report the clinical and radiological results of the intramedullary fixation by retrograde flexible nail in the humeral shaft fracture. MATERIALS AND METHODS: From July 2002 to May 2005, seventeen cases who had the humeral shaft fracture were treated with the intramedullary fixation by retrograde flexible nail. Fifteen cases were followed up and the clinical and radiological results were analyzed. RESULTS: All of the cases had satisfactory fracture union, and none of the patient had limitation in shoulder or elbow joint movement, and shoulder or elbow joint pain, and average ASES was 42.86 point. There was 1 case of delayed union, and 3 cases of distal nail displacement. Another severe complications were not occurred. CONCLUSION: Intramedullary fixation by retrograde flexible nail is one of the effective method in the humeral shaft fracture without nerve or vessel injuries, and also can avoid the complication of wide soft tissue incision or rotator cuff injury.

Interlocking Intramedullary Nailing in Distal Tibial Metaphyseal Fractures

PURPOSE: To evaluate and compare the outcome in fracture of distal tibial metaphyseal fractures involving ankle joint and not involving the ankle joint treated by interlocking imtramedullary nailing. MATERIALS AND METHODS: Twenty six cases of distal tibial metaphyseal fractures treated by interlocking intramedullary nailing whom were able to follow up for more one year were selected and 10 cases involved ankle joint and the rest 16 cases did not. In all cases, more than 2 distal locking screws were inserted after reaming for the nailing, and cannulated screws or K-wires fixation were inserted for 8 cases of fractures involving ankle joint out of 10. We analyzed preoperative fracture type, union time, function of joint, and complications at final follow up. RESULTS: According to Robinson's classification for distal tibial metaphyseal fractures, there were 9 cases of type I, 7 of 2A, 4 of 2B, 6 of 2C. Union time taken for distal tibial fractures involving ankle were average of 17 weeks (12~20 weeks) and for the fractures not involving ankle joint were average of 19 weeks (12~28 weeks). Klemm and Borner's functional evaluation showed above good in 8 cases (80%) of fracture involving ankle joint and 13 cases (81%) of fracture not involving the ankle joint, and functional evaluation did not show significant differences as well as the complication rate in both group. CONCLUSION: Interlocking intramedullary nailing is one of the effective methods for treatment of distal tibial metaphyseal fracture involving articular surface of the ankle.

A Comparison of Vertebroplasty Versus Conservative Treatment in Osteoporotic Compression Fractures

PURPOSE: To compare clinical and radiological results between vertebroplasty and conservative treatment in osteoporotic compression fractures of thoracolumbar spine. MATERIALS AND METHODS: 34 patients were reviewed with at least 1 year follow up. Vertebroplasty was used in 14 and conservative treatment was done in 20 fractures. These groups were compared by clinical results which were evaluated by the scoring system according to pain, mobility and analgesic usage at preoperative, postoperative 1 month and postoperative 1 year. And also compared by the increment of kyphosis and loss of vertebral body height in lateral films at the same time. We compared duration of hospitalization between two groups. RESULTS: Vertebroplasty group showed statistically significant less pain and mobility than conservative treatment (p<0.05), but there was no differences in analgesic usage at postoperative 1 year while significant difference at 1 month. In radiological comparison, vertebroplasty showed less increment of kyphosis and loss of body height significantly (p<0.05). Also vertebroplasty group had shorter hospitalization stay significantly (p<0.05). CONCLUSION: Our retrospective analysis demonstrated that vertebroplasty provided significant pain relief, improvement of motion and reduction of analgesic usage and also provided considerable spinal stabilization that prevented further kyphosis and collapse.

Treatment of Tibial Shaft Fractures in Children Using K-wires Fixation

PURPOSE: To report the effectiveness of Kirschner wire fixation for the treatment of unstable tibial shaft fractures in children. MATERIALS AND METHODS: We analyzed 15 cases of pediatric tibial shaft fractures treated at our hospital with fixation using K-wire and followed up for more than 1 year from July 1998 to January 2002. The subjects included 11 boys and 4 girls. The ages ranged from 3 to 10 years at the time of injury, with the average age being 7.9 years. We examined the presence of angulation, leg length discrepancy, joint motion limitation, and complications. RESULTS: Bony fusion was obtained in all patients by an average of postoperative 9.5 weeks. At the time of last follow-up (by an average of postoperative 1 year and 4 months), anterior and posterior radiographs showed an average of 4.2degree angulation, and lateral radiographs showed an average of 4.4degree angulation. The affected leg was extended by an average of 3.7 mm compared to the opposite leg according to Bell-Thompson's radiographs. As for complications, infection was developed around the pin in 3 cases but treated with the administration of oral antibiotics and sterilization around the site without progressing to deep infection. We could not observe joint motion limitation, pain and difficulties related with discrepancy in leg length. CONCLUSION: We concluded that fixation using K-wire for children with tibial shaft fractures was a safe and effective method of surgery that could be performed easily, did not require secondary surgery to remove the wire, and showed sufficient stability after fixation.

Treatments of the Nonunion of Femoral Shaft Fractures after Interlocking Intramedullary Nailing

PURPOSE: To investigate and analyze the clinical result in the treatment of aseptic nonunion of femoral shaft fracture after interlocking intramedullary nailing MATERIALS AND METHODS: We reviewed 23 cases of aspetic nonunion of femoral shaft fracture after interlocking intramedullary nail from March 1995 to February 2003 and follow up more than one year. 8 cases were treated by metal exchange, 3 cases by autogenous bone graft and the rest 12 cases by metal exchange and bone graft on the basis of fracture gap and type of nonunion. We evaulated nonunion type, union time and clinical result. Those patients were treated by interlocking intramedullary nail with or without bone graft. Union were accepted when the radiographic evidences showed bridging callus on both end of femoral shaft fracture with clinical evidences showing abscence of pseudomotion or pain. RESULTS: All patients were united by one operation. Average union time were 4.8 months in metal exchange group, 3.9 months in metal exchange with autograft bone graft group, and 4.3 months in bone graft group. 15 patients (65.2%) showed hypervascular nonunion including 7 Elephant foot types (46.7%) and 8 oligotrophic types (53.5%), and 8 patients (34.8%) showed avascular nonunion according to Weber-Brunner classification CONCLUSION: Based on our analysis on clinical outcome and stability of nonunion occuring after initial interlocking intramedullary nailing in femoral shaft fracture, interlocking intramedullary nailing with bone graft made early ambulation possible and promoting returning to normal daily life much earlier, thus based on this data, we recommend interlocking intramedullary nailing for treating femoral shaft fracture along with bone graft.

Treatment of Supracondylar-Intercondylar Femoral Fractures with a Retrograde Intramedullary Nailing

PURPOSE: We analyzed the cases of supracondylar-intercondylar femoral fracture treated with retrograde intramedullary nail and report the clinical results and its usefulness. MATERIALS AND METHODS: We reviewed 17 cases of supracondylar-intercondylar femoral fracture that had been treated with retrograde intramedullary nail and each of patients had been followed up for a minimum one year. Post-operative functional assessment was performed using a scale developed by Sanders et al. The evaluation scale assesses range of motion, pain, walking ability, return to work, and alignment and shortening as measured on radiograph. RESULTS: According to functional assessment of Sanders et al, there were 6 excellent, 9 good, 1 fair, and 1 poor results, that is, 94% showed above excellent results. Bony union was obtained in average 5 months after operation. The post-operative complications were varus deformity in 1 case, wound infection in 1 case, stiffness of knee joint in 1 case, and metal failure in 1 case. CONCLUSION: The treatment of supracondylar-intercondylar femoral fracture with retrograde intramedullary nail is one of the good surgical options for clinically preferable results with the advantages in early joint motion and early ambulation.