Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report

Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.

Coil Embolization of a Pseudoaneurysm of the Anterior Tibial Artery: A Case Report / 대한족부족관절학회지

Development of a pseudoaneurysm around the ankle is an uncommon complication after surgery. We experienced a case of a pseudoaneurysm, which developed from the anterior tibial artery. A 44-year-old woman had sustained painful swelling of her right ankle after the removal of implants for a distal fibular fracture. The pseudoaneurysm was confirmed by ultrasonography and angiography. The patient was treated with an intervention using a coil and recovered without further complaints. This case report aims to increase the awareness of this complication with review of literature.

Rapidly Progressive Osteonecrosis of the Humeral Head after Arthroscopic Bankart and Rotator Cuff Repair in a 66-Year Old Woman: A Case Report

Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.

Rapidly Progressive Osteonecrosis of the Humeral Head after Arthroscopic Bankart and Rotator Cuff Repair in a 66-Year Old Woman: A Case Report

Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.

Avulsion Fracture of the Talar Attachment of the Anterior Talofibular Ligament in Pediatric Patient: A Case Report / 대한족부족관절학회지

Inversion injury of the lateral ankle ligaments is very common. Few studies, however, have focused on avulsion fracture of the lateral ankle ligaments. A fracture producing a small fragment usually avulsed from lateral malleolus and may be easily misdiagnosed as a sprain because the fragment is superimposed on the lateral malleolus and goes undetected on early radiographs, especially in skeletally immature patients. We present a case of isolated avulsion fracture of the talar attachment of the anterior talofibular ligament in 13-year-old male patient. Diagnosis was confirmed by computed tomography and avulsed fragment was fixed to original talar footprint with suture anchors. A high level of suspicion must be maintained to obtain an accurate diagnosis of avulsion fracture in inversion ankle injury because of the high incidence in children and to prevent recurrent instability.

Relationship between Osteoarthritis and Leptin Concentrations in Synovial Fluid / 대한정형외과연구학회지

PURPOSE: Leptin may play an important role in the pathophysiology of osteoarthritis. This study investigated whether leptin concentration in synovial fluid is related to the radiographic severity of osteoarthritis. MATERIALS AND METHODS: Synovial fluids were obtained from 29 osteoarthritis patients who underwent knee surgery and 10 who had no abnormality on articular cartilage during arthoscopic examination. The progression of osteoarthritis was classified by Kellgren Lawrence grading scale. The concentrations of leptin was measured with commercial enzyme-linked immnosorbent assay kits. RESULTS: A significant increase in synovial fluid concentrations was observed in osteoarthritis patients (6.7+/-4.1 ng/ml) compared to the control (2.4+/-1.3 ng/ml). Leptin levels were increased with advancing osteoarthritis stage, resulting in the highest level in stage IV patients(10.7+/-4.9 ng/ml; range 4.7-15.8) compared to that of stage I patients (4.0+/-2.0 ng/ml; range 1.2-7.3). In osteoarthritis patients, age showed a significant correlation with leptin concentrations. CONCLUSION: This study shows that synovial fluid leptin concentrations were closely related to the radiographic severity of osteoarthritis, and suggests that the age of patient may influence synovial fluid leptin concentrations during osteoarthritis progression.

The Results of the Endoscopic Decompression for the Treatment of Haglund's Disease / 대한족부족관절학회지

PURPOSE: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. MATERIALS AND METHODS: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than 75degrees and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). RESULTS: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and 82degrees to postoperative 2.3 and 57degrees, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. CONCLUSION: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.