Simultaneous ipsilateral Monteggia fracture-dislocation and distal radius fracture: A report of a pediatric case and review of the literature.

We present the case of a 12-year- old boy who suffered from a combination of Monteggia fracture-dislocation along with ipsilateral distal radius fracture. The patient underwent closed reduction of the Monteggia lesion and the distal radius followed by percutaneous pinning. The postoperative course was satisfactory. Associated Monteggia fracture-dislocation and ipsilateral distal forearm fracture are rare. Our case and the literature review highlight the presence of common clinical features in pediatric patients with these particular injuries, including male dominance, age around 9 years, fall from a height, and lateral displacement of the dislocated radial head.

Radiocapitellar cartilage injuries associated with tennis elbow syndrome.

PURPOSE: A recent anatomical study has suggested that considerable contact between the undersurface of the extensor carpi radialis brevis (ECRB) and the lateral edge of the capitellum is the cause of tendon injury in lateral epicondylosis. We hypothesized that this contact might concurrently induce cartilage injuries of the capitellum. The purpose of the present study was to determine the prevalence, location, and severity of cartilage lesions of the radiocapitellar joint accompanying lateral epicondylosis and to identify their correlation with ECRB status. METHODS: Arthroscopic assessment of the articular cartilage was performed for 31 elbows in 31 patients with lateral epicondylosis who had surgery. The study group consisted of 18 women and 13 men with a mean age of 50 years (range, 35 to 67 y). The relationship between the presence of the cartilage lesions and patient demographics, preoperative pain visual analog scale score, number of cortisone injections, and surgical findings including ECRB tears were investigated. RESULTS: Cartilage injuries of the capitellum were found in 20 (65%) and cartilage injuries of the radial head were found in 25 (81%) of 31 elbows. Most of the lesions were located on the lateral aspect of the capitellum and radial head. Multivariate logistic regression analysis revealed that the absence of ECRB tears was independently associated with a higher risk of cartilage injuries of the capitellum. CONCLUSIONS: Cartilage injury was frequently found in the lateral edge of the capitellum and radial head. Lesions of the capitellum were related to the absence of ECRB tears. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

New method of assessing pinch function in children with anomalies of the hands.

We designed a method for the evaluation of pinch function in children that uses a tape measure, which is suitable in size and weight for the infant's hand. Our aim was to investigate the value of the tape measure in the evaluation of pinch function in children. Thirty-two hands of 27 children with congenital anomalies that we operated on in our hospital were included. The assessment of pinch function was made using a tape measure. The criteria were evaluated as follows: grasp = 1; push button = 2; pinch the end of the measuring tape = 3; pull out tape by side pinch = 4; and pull out tape by pulp pinch = 5. We assessed the relation between the scoring by tape measure and parents' preoperative assessment. We also examined the relations between the increase in score evaluated by the tape measure method and parents' assessment of postoperative improvement in pinch function. The mean preoperative score by the tape measure assessment of pinch function in the unimpaired group according to the parents' evaluation was significantly higher than that in the impaired group. Preoperative evaluation using the tape measure method correlated with the parents' evaluation. The increase in score in the "remarkably improved" group was significantly higher than that of those in the "no change" and "improved" groups. The tape measure method reflected the parents' evaluation, and could be a useful test for the evaluation of pinch function in children.

The detection of the capsular tear at the undersurface of the extensor carpi radialis brevis tendon in chronic tennis elbow: the value of magnetic resonance imaging and computed tomography arthrography.

HYPOTHESIS: This study compared the diagnostic efficacy of magnetic resonance imaging (MRI) and computed tomography arthrography (CTA) in the assessment of capsular tears at the undersurface of the extensor carpi radials brevis tendon in chronic tennis elbow using arthroscopy as a gold standard. Because of the higher spatial resolution of CT, we hypothesized that CTA is superior to MRI for assessing capsular tears. MATERIALS AND METHODS: We retrospectively reviewed 19 consecutive patients with chronic tennis elbow with preoperative MRI and CTA studies who underwent arthroscopic surgery. Three observers with different levels of training and experience (musculoskeletal radiologist, experienced elbow surgeon, and hand fellow) evaluated the capsular tear by MRI and CTA in a blinded manner. The results of the MRI and CTA were compared and the agreement among the 3 observers was determined using an intraclass correlation coefficient (ICC). Then, the results of the MRI and CTA examinations were compared with the intraoperative findings of the arthroscopic examination. The sensitivity, specificity, and κ value were calculated. RESULTS: The ICC of CTA (0.855) was superior to MRI (0.645). The sensitivity, specificity, and κ value of CTA were superior to those of MRI in each of the 3 observers. The κ value was 0.79, 0.89, and 0.79 for CTA, and 0.48, 0.48, and 0.27 for MRI for the radiologist, surgeon, and fellow, respectively. CONCLUSIONS: CTA was a reliable and accurate diagnostic modality compared with MRI to detect the capsular tear in patients with chronic tennis elbow. CTA was less influenced by the observer's experience.

Cup-neck impingement due to the malposition of the implant as a possible mechanism for metallosis in metal-on-metal total hip arthroplasty.

The metal-on-metal bearing total hip prosthesis is expected to reduce the risk of debris-related osteolysis. However, several reports demonstrated that the socket-stem impingement in the metal-on-metal prosthesis due to the implant malposition results in titanium wear debris and secondary metallosis. In this article, we presented a case of massive metallosis due to metal-on-metal impingement. A 60-year woman had severe hip pain due to fracture of the greater trochanter. We planned a revision of the metal-on-metal inlay. Intraoperatively, the trochanteric bursa and joint space were found to be stained black. Black stained granulation tissue was observed between the femoral stem and the great trochanter. Intraoperatively, notching was noticed on both the posteroinferior aspect of the neck of the femoral component and the anterior aspect of the metal liner and polyethylene core. The notch corresponded to the position of impingement between the socket and the femoral neck during the maximum extension of the hip. To clarify the mechanism of cup-neck impingement, the alignment of the prosthesis and pelvic tilt were evaluated. The cup was placed in too much anteverted position. In addition, increased posterior tilt of pelvis in the standing position made the anteversion of the acetabular cup more significant, which enhanced the cup-neck impingement during the gait. Careful attention is necessary for implant alignment and pelvic tilt especially in metal-on-metal-bearing total hip arthroplasty.