UNWANTED RADIATION EXPOSURE TO RADIOSENSITIVE ORGANS DURING HAND CT.

This study aimed to investigate unwanted radiation exposure of radiosensitive organs during computed tomography (CT) scans of the hand. Furthermore, we investigated the effectiveness of a shield in reducing unwanted radiation exposure. In a prospective observational study, the patients were randomized to receive a shield during the hand CT scan. Two group of patients were further randomized to undergo multi-detector CT (MDCT) or cone-beam CT (CBCT). The radiation dose was measured in the target point and the nearest skin surface of radiosensitive organs by attached the thermoluminescent dosemeter chips. When shielding was performed, the radiation doses had decreased significantly with a mean of 79% (65-91%) in the MDCT group and 88.6% (85-93%) in the CBCT group. In the non-shielded group, the radiation doses to the radiosensitive organs decreased inversely with increasing distance, which means that the closer the target point is, the more unwanted radiation exposure increases. It is important to keep radiosensitive organs as far as possible from the target point during CT scan. In particular, it is necessary to shield the radiosensitive organs closer to the target point. Level of Evidence: Level II, Prospective observational study.

Fractures of the distal femur in elderly patients: retrospective analysis of a case series treated with single or double plate.

INTRODUCTION: We evaluated the radiologic and clinical outcomes of a lateral incision single plate with and a single-incision double plating in elderly patients with osteoporotic distal femoral fractures. MATERIALS AND METHODS: We performed a retrospective study of 82 cases of distal femoral fractures from May 2004 to June 2018. Group A consisted of 42 patients who underwent single-plate fixation. Group B consisted of 40 patients who underwent double-plate fixation. The mean patient age was 77 years (67-87 years) and 76 years (64-86 years) in groups A and B, respectively. All patients were evaluated for procedure duration, time to union, range of knee motion, Lysholm knee score, and presence of complications. RESULTS: The average procedure time was 81 min (66-92 min) and 110 min (95-120 min) in groups A and B, respectively (p = 0.33). One case in group B required bone grafting after 5 months. The average time to union was 14 weeks (9-19 weeks) and 12.2 weeks (8-19 weeks) (p = 0.63), and the mean range of knee motion was 105° (90-125°) and 110.7° (90°-130°) (p = 0.37) in groups A and B, respectively. There was no significant statistical difference between the two groups in the Lysholm knee score (p = 0.44) and knee society score (p = 0.53). CONCLUSION: The clinical and radiological outcomes were similar in the 2 groups. In elderly patients, double plate fixation for distal femoral fractures is an useful method for several advantages such as adequate exposure, easy manipulation, anatomical reduction and stable fixation.

Arthroscopic Superior Capsular Reconstruction by the Mini-Open Modified Keyhole Technique Using an Achilles Tendon-Bone Allograft.

The treatment of massive and irreparable rotator cuff tears remains a challenge for shoulder surgeons. When treating patients with chronic rotator cuff tears, especially those with severe fatty degeneration, severe tendon retraction, or muscle atrophy, the risk of re-tear and persistent severe pain persists. Therefore, surgeons can choose from numerous options. Superior capsular reconstruction (SCR) was introduced as a technique to maintain the stability of the upper shoulder and stabilize the muscles without repairing the supraspinatus and infraspinatus. Various autograft and allograft techniques have been developed. SCR performed using an autograft has the disadvantage of requiring harvesting the tensor fascia lata. Although allografts reduce harvest time, they also increase donor-site morbidity and the time required for healing. To solve the healing problem, we have introduced an SCR technique through grafting with the Achilles tendon-bone. Although this is an unproven technique for patients with chronic irreparable rotator cuff tears, our short-term outcomes seem promising. Further studies and follow-ups are needed to determine the success of this technique.

Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach?

BACKGROUND: As the frequency of total knee arthroplasty (TKA) is increasing, long-term follow-up of patients has become essential, and the frequency of revision total knee arthroplasty (R-TKA) due to the occurrence of various complications has also increased. There is controversy regarding which approach has minimal complications and an adequate visual field in R-TKA. Therefore, we compared the clinical and radiological results between the extensile medial parapatellar (EMP) approach and tibial tubercle osteotomy (TTO) for R-TKA. METHODS: Between March 1, 2000, and December 31, 2015, we compared 35 patients who underwent the EMP approach and 31 who underwent the TTO approach for R-TKA. In this study, the preoperative range of motion (ROM) was an important criterion for the choice of approach in R-TKA. The EMP approach was applied to patients with a ROM above 60°. The TTO approach was applied to patients with knee flexion limited to 0°-30°. We clinically assessed knee ROM, Knee Society scores, and Hospital for Special Surgery scores at the time of the last follow-up. We radiographically measured femorotibial alignment and patellar height. We also examined the complication rates. The average length of the TTO was 1.0 × 2.5 cm × 10 cm. We used 3 or more 3.5-mm half-threaded screws. RESULTS: The mean postoperative ROM of the knee joint at the time of the last follow-up was 103° (flexion contracture 5° and further flexion 108°) in the group that underwent the EMP approach and 101° (flexion contracture 4° and further flexion 109°) in the group that underwent the TTO approach. The mean Knee Society scores were 86 (71-96) and 85 (72-94), and the mean Hospital for Special Surgery scores were 82 (70-93) and 83 (68-92) for the 2 groups, respectively, with no statistically significant difference. The mean femorotibial angles were 0.6° (±3.3°) and 0.1° (±2.9°), and the mean Insall-Salvati ratios were 1.0 (±0.34) and 0.8 (±0.14), respectively, with no statistically significant difference. The group that underwent TTO achieved bone union at an average of 11.8 weeks after surgery. In the group that underwent the EMP approach, 2 patients had extensor lag of more than 10°. In the group that underwent TTO, 2 subjects had skin necrosis at the operative site. CONCLUSION: The clinical and radiological outcomes were similar in the 2 groups after R-TKA. To increase the ROM and obtain adequate exposure, TTO is also considered a useful surgical approach. However, complications related to TTO should be minimized. LEVEL OF EVIDENCE: Therapeutic level III, retrospective comparative study.

Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear.

BACKGROUND: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. PURPOSE: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. RESULTS: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. CONCLUSION: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.