Computed Tomography in Evaluation of Femoral Anteversion: Transverse Section Versus Axial Oblique Section / 계명의대학술지

This study aimed to define a more accurate computed tomography (CT) scanning method for measurement of the anteversion angle of the femoral neck. Five models of the femur, consisting of three models of saw bones and two of cadaveric bones, were used to measure femoral anteversion. Real femoral anteversion was measured with photographs taken from the superior aspect of the femoral neck after placing the specimen in the position that both posterior condyles rested on the surface of the table and the center of the femoral head and center of the intercondylar notch were aligned in a single line. Femoral anteversion using the transverse section of CT (CT1) and the axial oblique section of CT (CT2) were obtained. Three experienced orthopedic surgeons measured the anteversion of five bone models using the photographs and two CT scans, three times each with a week interval between measurements. A total of 45 measurements were obtained. The intraclass correlation coefficient (ICC) was used to compare anteversion measurements between the different methods. Femoral anteversion measured in photographs was correlated with measurements on CT1 and CT2. However, CT2 more closely approximated the real anteversion than did CT1 (ICC; CT1 = 0.824, CT2 = 0.937). Inter-observer and intra-observer biases were not found (ICC ≥ 0.952). The axial oblique image more closely approximated the real femoral anteversion than did the transverse sectional image. Measurement of femoral anteversion using axial oblique CT is recommended over conventional transverse sectional CT.

Computed Tomography in Evaluation of Femoral Anteversion: Transverse Section Versus Axial Oblique Section / 계명의대학술지

This study aimed to define a more accurate computed tomography (CT) scanning method for measurement of the anteversion angle of the femoral neck. Five models of the femur, consisting of three models of saw bones and two of cadaveric bones, were used to measure femoral anteversion. Real femoral anteversion was measured with photographs taken from the superior aspect of the femoral neck after placing the specimen in the position that both posterior condyles rested on the surface of the table and the center of the femoral head and center of the intercondylar notch were aligned in a single line. Femoral anteversion using the transverse section of CT (CT1) and the axial oblique section of CT (CT2) were obtained. Three experienced orthopedic surgeons measured the anteversion of five bone models using the photographs and two CT scans, three times each with a week interval between measurements. A total of 45 measurements were obtained. The intraclass correlation coefficient (ICC) was used to compare anteversion measurements between the different methods. Femoral anteversion measured in photographs was correlated with measurements on CT1 and CT2. However, CT2 more closely approximated the real anteversion than did CT1 (ICC; CT1 = 0.824, CT2 = 0.937). Inter-observer and intra-observer biases were not found (ICC ≥ 0.952). The axial oblique image more closely approximated the real femoral anteversion than did the transverse sectional image. Measurement of femoral anteversion using axial oblique CT is recommended over conventional transverse sectional CT.

Early Clinical Outcomes of Manipulation under Anesthesia for Refractory Adhesive Capsulitis: Comparison with Arthroscopic Capsular Release

Background@#The purpose of this study was to compare early clinical outcomes of manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR) in patients with refractory adhesive capsulitis (AC). @*Methods@#Thirty AC patients who underwent MUA (MUA group) were included. As a control group, thirty AC patients who underwent ACR (ACR group) were matched for age and sex with the MUA group. Visual analog scale (VAS) pain score, American shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were evaluated preoperatively and at 3, 6, and 12 months after procedure. @*Results@#Both groups had significant improvements in the VAS pain score, ASES score, and ROM at 12 months after procedure. VAS pain score and ASES score were significantly better in the MUA group than in the ACR group at 3 months after procedure. Mean forward flexion was significantly greater in the MUA group than in the ACR group at 3 months after procedure. Mean external rotation and internal rotation were significantly greater in the MUA group than in the ACR group at 3, 6, and 12 months after procedure. Two patients required additional steroid injections at 3 and 6 months after MUA because of recurrent stiffness with pain. @*Conclusions@#Compared with ACR, MUA provided equivalent clinical outcomes in the early period after procedure. Our study suggests that MUA is a useful option to be considered as treatment for refractory AC before choosing ACR.

Treatment Strategy for Frozen Shoulder

Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.

Associated Factors of Radial Nerve Palsy Combined with Humerus Shaft Fracture

PURPOSE: The purpose of this study was to analyze associated factors of primary radial nerve palsy and to evaluate clinical outcome for its treatment in patients with humerus shaft fracture. MATERIALS AND METHODS: We divided two groups of patients with (17 patients) and without (116 patients) primary radial nerve palsy and analyzed correlation between radial nerve injury and various parameters, including age, sex, cause of injury, AO classification, fracture type, fracture location, and presence of open fracture. We also evaluated configuration of nerve injury, presence of recovery, and recovery time. RESULTS: The overall prevalence of primary radial nerve palsy after humerus shaft fracture was 12.8% (17 palsies in 133 fractures). Younger age, AO type B, and distal 1/3 fractures showed significantly higher correlation with radial nerve palsy. No significant correlation was observed between radial nerve palsy and other parameters, including sex, cause of injury, fracture type, and presence of open fracture. Thirteen patients (76.5%) underwent early nerve exploration with internal fixation. Intraoperatively, all patients had continuity of radial nerve except one patient with segmental loss. At the final follow-up, 16 patients (94.1%) with radial nerve palsy had made a complete recovery. The mean time to complete recovery was 6.7 months. CONCLUSION: Primary radial nerve palsy after humerus shaft fracture was more common in young age, AO type B, distal 1/3 fractures. Early surgical exploration can be recommended to confirm the condition of the radial nerve if the fracture should be fixed.

A Case of Soft Tissue Recurrence after Wide Resection of Giant Cell Tumor in the Distal Femur

Giant cell tumor of the long bones is a relatively common neoplasm in young age patients, and this tumor usually involves the metaphysis and epiphysis. Due to the high rates of recurrence and the occasional development of pulmonary metastasis, this tumor has a malignant manifestation and it requires long term follow-up observation. Most local recurrences of giant cell tumor after surgery occur in the long bone that was previously curetted; however, the recurrence of tumor in the soft tissue around the long bones is known to be rare. We describe here a case of giant cell tumor that recurred in the soft tissue around the knee after wide resection of the distal femur and we discuss this case along with reviewing the related literature.

Volar T-Locking Compression Plate for Treatment of Unstable Distal Radius Fractures

PURPOSE: To evaluate outcomes volar T-locking compression plate for treatment of unstable distal radius fractures. MATERIALS AND METHODS: We retrospectively analysed the results in 35 cases, which were treated by volar plating with T-LCP. We evaluated the clinical results according to the Mayo wrist scoring system and radiographic results. RESULTS: The mean score was 83.86 respectively. Between preoperative and immediate postoperative radiographic measurements, averaged radial length was improved from 5.75 mm to 11.53 mm, radial inclination from 12.86 degrees to 22.56 degrees, volar tilt from -3.64 degrees to 9.90 degrees and intraarticular step-off from 1.48 mm to 0.42 mm. Between immediate postoperative and latest follow-up radiographic measurements, mean loss of radial length measured 0.43 mm, radial inclination 0.46 degrees, volar tilt 0.89 degrees. CONCLUSION: Treatment of unstable distal radius fractures using a volar T-LCP showed satisfactory outcomes. We think that it is good surgical option to allow return to daily living, result in early postsurgical wrist motion.