Treatment of typical trampoline fracture of the proximal tibia in children: results of minimum 1 year follow-up.

PURPOSE: To evaluate the results of trampoline fracture of the proximal tibia treated with either external fixator or conservative management at a minimum 1-year follow-up. METHODS: A retrospective review was performed on 22 children who between January 2005 and November 2013 presented with proximal metaphyseal fracture due to trampoline injury. Proximal metaphyseal fractures in 22 pediatric patients were clinically and radiologically evaluated. Of 22 subjects, 9 were male, 13 were female, and mean age was 4.2 years (range 2-7). RESULTS: In terms of comorbid injury, 1 proximal humerus fracture, two distal humerus fractures were present. Injury mechanism-wise, jumping with companions who had a weight difference accounted for 16, similar age, but jumping with multiple companions were three, direct crush were three. There were no differences in the valgus angle or length of the legs during the 2 year follow-up period. However, epiphyseal tibia shaft angle significantly decreased and proximal epiphysis was found to be flat compared to the contralateral side. CONCLUSION: Jumping with companion with a large difference in body weight, the first experience of jumping on trampoline and state of extension of knee at the time of injury was revealed to be risk factors for trampoline fractures. During a follow-up period of 1 year or longer, it was concluded that valgus deformity of lower extremity or leg length discrepancy were not noticeable.

High prevalence of sarcopenia among binge drinking elderly women: a nationwide population-based study.

BACKGROUND: Alcohol consumption is considered a risk factor for sarcopenia, but the association between alcohol consumption and the prevalence of sarcopenia has not been evaluated in detail. This study was to identify the relationship between alcohol drinking patterns and the prevalence of sarcopenia in the elderly Korean population. METHODS: The cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. Participants were excluded if they were under the age of 65, or if data was not available regarding skeletal muscle mass or dietary intake. After these exclusions, a total of 4020 participants (men: 1698; women: 2322) were analyzed in the present study. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia (AWGS). Binge drinking was defined as consuming ≥5 standard alcoholic drinks (≥4 drinks for women) consecutively on one occasion. This data was subcategorized into two groups based on presence of binge drinking: Social drinking (≤1 time/month) and binge drinking (>1 time/month). RESULTS: Women binge drinkers with weekly or daily consumption had 2.8 times higher prevalence of sarcopenia than social drinkers (Odds Ratio [OR] = 2.84; 95% Confidence Interval [CI] = 1.12-7.29). However, there were no associations between binge drinkers and sarcopenia in men. After adjusting for age, body mass index (BMI), energy intake, moderate physical activity, and energy intake, women binge drinkers with weekly or daily alcohol consumption had 3.9 times higher prevalence of sarcopenia than social drinkers (OR = 3.88; 95% CI = 1.33-11.36). CONCLUSIONS: The prevalence of sarcopenia in elderly women was related to binge drinking frequency and amounts of drinking after adjusting for covariates. Elderly Korean women who binge drink once or more per week may be associated with sarcopenia, as seen with the observed 3.9 times higher prevalence compared to social drinkers.

Morphologic Changes and Outcomes After Arthroscopic Acetabular Labral Repair Evaluated Using Postoperative Computed Tomography Arthrography.

PURPOSE: To investigate smaller sized labra after acetabular labral repair comparing preoperative and postoperative computed tomography arthrography (CTA) and to assess the correlation between the anatomic changes and clinical outcomes. METHODS: The design and protocol of this retrospective study were approved by the institutional review board of our hospital. The inclusion criteria included age older than 18 years and hip pain associated with mechanical symptoms. Patients with previous hip surgery, avascular necrosis, rheumatologic disorders, or advanced arthritis were excluded. All tears with femoroacetabular impingement were treated with bumpectomy or acetabuloplasty and repaired using arthroscopic suture anchors. We evaluated clinical outcomes using the modified Harris Hip Score (mHHS) and the morphologic changes and radiologic outcomes (labral retear and leakage of dye) using CTA at a minimum 2-year follow-up. The paired t test was performed to detect changes in labral height, labral width, and mHHS. RESULTS: Forty labral tears in 40 patients (mean age, 32.1 ± 9.2 years) underwent labral repair, with femoroplasty in 20 hips and acetabuloplasty in 17 hips, and no patients required capsular repair after capsulotomy. No leakage of contrast dye was detected during the follow-up CTA procedure. No labral retears were observed after labral refixation at the postoperative CTA evaluation. However, the mean width and height of the labrum changed from 8.1 mm and 4.9 mm, respectively, preoperatively to 6.7 mm and 4.4 mm, respectively, at the postoperative follow-up (decreasing by 19% and 11%, respectively; both P < .001). In addition, the mean mHHS for the 36 patients in the complete repair group improved from 61 ± 16.0 to 90 ± 9.6 (P = .01). Four hips showed incomplete repairs. CONCLUSIONS: Repaired labra are well maintained after capsulotomy based on follow-up CTA after arthroscopic labral repair. In addition, decreased height and width of the labra do not affect the clinical outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic study (case series [no, or historical, control group]).

Teriparatide Treatment in Elderly Patients With Sacral Insufficiency Fracture.

Context and Objective: Pain-related immobility because of insufficiency fractures may result in serious complications and a high mortality rate in senile patients with preexisting comorbidities. This study aimed to evaluate the efficacy of teriparatide in patients with sacral insufficiency fractures. Design, Setting, and Participants: This retrospective, case-controlled, single center study, performed from 2009 to 2014, included 41 patients who underwent radiographs, magnetic resonance imaging, and/or bone scans to document sacral insufficiency fractures. Intervention: The intervention involved teriparatide at a once-daily subcutaneous dose of 20 µg within 2 days of hospital admission (21 patients). Twenty patients (control group) did not receive teriparatide. Main Outcome Measures: Functional outcome was assessed using a visual analog scale for pain and the time to mobilization. Pelvic anteroposterior radiographs were repeated at 0, 1, 4, 8, 12, and 16 weeks until radiographic evidence of cortical bridging at the fracture site was confirmed. Results: From the date of admission to 4 weeks, the mean visual analog scale score improved between the 2 groups. The mean time to mobilization was 1.2 ± 0.4 weeks in patients who received teriparatide treatment, compared with 2.0 ± 0.3 weeks in controls (P < 0.001). At 8 weeks, all fractures in the teriparatide treatment group and 4 fractures in the control group had healed. Conclusions: In senile patients with preexisting comorbidities who have sacral insufficiency fractures, teriparatide treatment may achieve earlier pain reduction and mobilization and reduce healing time.

Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results.

PURPOSE: To evaluate the radiologic and functional outcomes of medial open wedge high tibial osteotomy (HTO) combined with arthroscopic procedure in patients with medial osteoarthritis. MATERIALS AND METHODS: From June 1996 to March 2010, 26 patients (32 knees) who underwent medial open wedge osteotomy and arthroscopic operation for medial osteoarthritis were retrospectively reviewed. Measurements included hip-knee-ankle (HKA) angle, femorotibial angle, medial proximal tibial angle, posterior tibial slope angle, and Kellgren-Lawrence grade. Clinical evaluation was performed using Lysholm knee scoring scale and knee and function score of the American Knee Society. RESULTS: Differences between the mean preoperative and postoperative measurements were significant in all angles including the HKA angle (-5.7° and +5.5°), femorotibial angle (-1.9° and +9.8°), and medial proximal tibial angle (82.9° and 90.5°) (p<0.05). Mean Lysholm knee scoring scale was 63.6 preoperatively and 88.7 at the last follow-up, mean Knee Society knee score was 61.2 and 86.6, and mean function score was 59.3 and 87.2, respectively. All differences were significant (p<0.05). CONCLUSIONS: Medial open wedge HTO in combination with arthroscopic procedure is an effective treatment method for medial osteoarthritis to treat varus deformity and an intra-articular lesion.

High Prevalence of Sarcopenia in Korean Patients after Hip Fracture: a Case-Control Study.

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height²) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.

The Efficacy and Safety of Autologous Transfusion in Unilateral Total Knee Arthroplasty.

PURPOSE: Although allogeneic blood transfusion is the most common method of transfusion in total knee arthroplasty (TKA), there are reports showing significant decrease in the amount of allogeneic transfusion and incidence of side effects after combined use of autologous transfusion. The purpose of this study is to investigate the efficacy of using an autologous transfusion device in TKA. MATERIALS AND METHODS: Patients who underwent TKA at our institution from January 2003 to January 2014 were divided into two groups: group A (n=127) who received allogeneic transfusion only in TKA and group B (n=118) who received autologous transfusion via an autologous transfusion device and allogeneic transfusion. In both groups, the patients were transfused when the hemoglobin level was below 9 g/dL. In group B, blood collected by the autologous transfusion device was transfused only once after surgery. The total blood loss volume, total transfusion volume, and the presence of side effects were assessed based on medical records. RESULTS: Group A received 294.6 mL more allogeneic transfusion than group B (p<0.001). There were no significant differences with regard to the development of side effects between groups. CONCLUSIONS: Application of an autologous transfusion device during TKA can be effective in reducing the allogeneic transfusion volume. Moreover, allogeneic transfusion was not necessary after autologous transfusion in some patients.

Baker's Cyst Filled with Hematoma at the Lower Calf.

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.

Deformity correction by femoral supracondylar dome osteotomy with retrograde intramedullary nailing in varus deformity of the distal femur after pathologic fracture of giant cell tumor.

Angular deformities of the distal femur occur in congenital diseases or due to acquired causes, such as malunion after a fracture of the distal femur. Angular deformities of the lower extremities affect the mechanical axis, causing changes in the weight pressure on the articular surface. As a result, angular deformities quicken the progression of osteoarthritis. Therefore, correction of deformities should be performed to prevent the progression of osteoarthritis. Distal femoral osteotomy is one of the methods to correct angular deformities in unicompartmental osteoarthritis. However, femoral supracondylar dome osteotomy with retrograde intramedullary nailing in the distal femur with a varus deformity has been rarely reported. Herein, we describe a technique for femoral supracondylar dome osteotomy with retrograde intramedullary nailing in a varus deformity after a pathologic fracture of giant cell tumor in the distal femur with a review of the relevant literature.

Tendon impingement of the extensor digiti minimi: clinical cases series and cadaveric study.

The authors describe two unique clinical cases of closed extensor digiti minimi (EDM) tendon injuries after hyperflexion of the wrist with full finger flexion and one case of chronic tenosynovitis around the EDM tendon. All three cases were thought to be related to the bifurcation of the EDM tendon and synovial septum. Subsequently, variations in EDM tendons were investigated in 49 cadaveric hands with a focus on patterns of tendon bifurcation and their relationships with the surrounding synovial sheath. The EDM tendon was found to be bifurcated in 74% (n = 36) of hands and all of these hands contained a synovial septum. In 9 (25%) hands, the EDM tendon bifurcated proximal to the retinaculum, in 15 (42%), it bifurcated distal to the retinaculum, and in the other 12 hands (33%), the tendon bifurcated at the retinacular level. In 6 of the 15 hands with an infraretinacular bifurcation, the tendon was found to impinge on the synovial septum during passive flexion of the wrist with full finger flexion, and the mean distance between the synovial septum and the bifurcation point in these specimens was 0.6 cm (range, 0.4-0.7 cm), which was differed significantly from hands not showing impingement (P = 0.01). This study shows that distal bifurcation of the EDM tendon may lead to tendon impingement on the septum and suggests that this is a potential etiology of chronic tenosynovitis of the fifth compartment and of acute closed tendon injuries.

Osteochondroma associated with complete rupture of the distal biceps tendon: case report.

Osteochondromas are the most common benign bone tumors. However, osteochondromas rarely involve the proximal radius. We present the case of a solitary osteochondroma that occurred in a critical area of the proximal radius near the insertion of the biceps tendon and ultimately led to rupture of the tendon. The lesion was confirmed histologically and resected, followed by successful repair of the distal biceps tendon using a suture anchor.

Surgical treatment of thoracic outlet syndrome secondary to clavicular malunion.

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.

A multi-center, randomized, clinical study to compare the effect and safety of autologous cultured osteoblast(Ossron) injection to treat fractures.

BACKGROUND: We performed a multicenter, open, randomized, clinical study of autologous cultured osteoblast injection for long-bone fracture, to evaluate the fracture healing acceleration effect and the safety of autologous cultured osteoblasts. METHODS: Sixty-four patients with long-bone fractures were randomly divided into two groups, i.e. those who received autologous cultured osteoblast injection and those who received no treatment. The sum of the difference in the callus formation scores after four and eight weeks, was used as the first efficacy variable. RESULTS: The autologous cultured osteoblast injection group showed fracture healing acceleration of statistical significance, and there were no specific patient complications when using this treatment. CONCLUSION: Autologous cultured osteoblast injection should therefore be considered as a successful treatment option for treating long-bone fracture.

Comparison of surgical outcome in impingement syndrome with and without stiff shoulder.

BACKGROUND: In impingment syndrome with associated stiff shoulder the general protocol of management is to conservatively treat the stiff shoulder followed by operative treatment of the impingement syndrome. This consecutive prospective study was carried out to evaluate the functional outcome of surgical management for impingement syndrome associated with stiff shoulder and to compare the results with surgical management of impingement syndrome alone. MATERIALS AND METHODS: We evaluated a total of 100 patients with impingement syndrome, consisting of 76 patients with impingement syndrome alone (Group A) and 24 patients of stiff shoulder associated with impingement syndrome (Group B). Group A patients were treated by subacromial decompression alone and Group B patients were treated by closed manipulation under anesthesia followed by subacromial decompression. RESULTS: According to the American Shoulder and Elbow Surgeons (ASES) evaluation score satisfactory results were obtained in 80% patients of Group A and 67% patients of Group B, while for patients with diabetes [(n = 18), Group A (n = 11), Group B (n = 7)] satisfactory results were achieved in 82% of patients of Group A(9/11) and 43% of Group B(3/7). Overall, Group B patients had a lower range of motion for external rotation postoperatively, thus indicating that procedures to improve the external rotation, such as a release of the rotator interval or anterior capsule, might be considered in conjunction with other surgical procedures in patients with impingement syndrome with associated stiffness to further improve functional outcome. CONCLUSION: Acromioplasty can be performed in stiff shoulder associated with impingement syndrome without fears of further worsening of stiffness from adhesions with the exposed raw undersurface of acromian. Patients with diabetes mellitus and shoulder stiffness tend to have poor clinical outcomes and must receive appropriate counseling preoperatively.

A serial comparison of arthroscopic repairs for partial- and full-thickness rotator cuff tears.

PURPOSE: To compare the outcome of arthroscopic rotator cuff repair and subacromial decompression in partial-thickness rotator cuff tears (PTRCT) with those in full-thickness rotator cuff tears (FTRCT). TYPE OF STUDY: Prospective serial follow-up study. METHODS: Of 46 consecutive patients who were treated with arthroscopic rotator cuff repair, 42 patients who were followed-up serially for 2 years were enrolled as study subjects. The average age of the patients at the time of the operation was 55 years, and the mean duration of follow-up was 34 months. The subjects included 22 cases of PTRCT and 20 cases of FTRCT. RESULTS: At the final follow-up, the PTRCT group showed changes in scores from 7.2 to 0.9 for average pain and from 34 to 91 for the shoulder functional evaluation score of the American Shoulder and Elbow Society (ASES score). The FTRCT group showed changes in scores from 7.6 to 1.2 for pain and from 29 to 88 for the ASES score. There were no significant differences between the 2 groups ( P >.05). The average range of shoulder motion was significantly improved in both groups at the final follow-up versus their preoperative values. Evaluation at the final follow-up showed that 93% of the total subjects showed good or excellent results, and 95% showed satisfactory results with regard to pain reduction and functional outcomes. The 2 fair results were the result of acromioclavicular arthritis. CONCLUSIONS: It may be anticipated that arthroscopic rotator cuff repair and subacromial decompression will give satisfactory postoperative outcomes in both PTRCT and FTRCT in terms of pain relief and functional recovery. However, careful preoperative examination of the acromioclavicular joint is critical to avoid procedural failure. LEVEL OF EVIDENCE: Level IV.

Comparison of surgical outcome between bursal and articular partial thickness rotator cuff tears.

Surgical outcomes after arthroscopic subacromial decompression and debridement in bursal and articular partial thickness rotator cuff tears with a tear depth of < 50% were compared. Twenty-four articular and 13 bursal partial thickness rotator cuff tears were evaluated for pain relief and functional recovery. At 6 months postoperatively, the average pain score decreased from 6.2 to 1.7 in patients with articular tears and from 7.1 to 0.9 in patients with bursal tears. Although pain relief and functional recovery were excellent in both groups, the results were better in patients with bursal partial thickness rotator cuff tears at 6 months postoperatively.

Late sequelae of secondary Haglund's deformity after malunion of tongue type calcaneal fracture: report of two cases.

We are reporting two cases of calcaneal fractures with posterior heel pain due to a prominent superior calcaneal tuberosity impinging on the Achilles tendon after a tongue type fracture. Malunion of the tongue fracture fragment resulted in the symptomatic bony prominence, which we defined as the secondary Haglund's deformity. Both cases were treated with resection of the superior calcaneal tuberosity when symptoms continued after non-surgical treatment. Clinical results after operations were both satisfactory with complete pain relief.

The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy.

BACKGROUND AND OBJECTIVES: The aim of this study was to determine whether an intrabursal morphine and bupivacaine mixed infusion provides useful analgesia for prolonged pain relief after subacromial arthroscopic operation. METHODS: A continuous intrabursal infusion catheter was inserted at the conclusion of the subacromial arthroscopic operation that was performed under general anesthesia. In a prospective, double-blind, randomized trial, 60 patients were divided into 2 groups: an anesthetic group received 5 mL of mixed 0.5% bupivacaine, 2 mg of morphine, 0.05 mL of 1/1,000 epinephrine as a bolus, and a solution of 40 mL of a 0.5% bupivacaine and 8 mg of morphine mixture that was used as a maintenance dose at a constant rate of 0.5 mL/h. This was done by means of a continuous infusion pump (0.5 mL hourly). A saline group (n = 30) received continuous saline infusion. Two patients were eliminated from the study because of catheter leakage or malfunction in the saline group. The intensity of the pain was evaluated preoperatively and postoperatively for 3 days by a graded visual analog scale (score from 0 to 10) for night pain, pain on motion, sleep disturbance, lying on painful shoulder, and the amounts of supplemental analgesics. RESULTS: Pain was decreased on the first and second postoperative day, and there was less sleep disturbance for 3 days postoperatively in the anesthetic group. There was no difference in pain caused by movement postoperatively. In the anesthetic group, lesser amounts of analgesics were used in the first 48 hours postoperatively. CONCLUSIONS: The continuous intrabursal infusion method resulted in a decreased perception of rest pain and reduced supplemental analgesics requirement for 2 days postoperatively.