Jae-Jung Jeong

An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy

HYPOTHESIS The combination of suprascapular nerve block (SSNB) and axillary nerve block (ANB) has been reported to provide safe and effective analgesia for arthroscopic shoulder surgery. This study was designed to identify anatomic landmarks of the suprascapular nerve (SSN) and axillary nerve (AN) and to evaluate the effects of SSNB and ANB using the identified landmarks. MATERIALS AND METHODS This study included 52 cadaveric shoulders and 30 patients in the anatomic and clinical studies, respectively. After the exact location of the SSN and AN was identified from the cadavers, the clinical study at the end of the operation and at 8, 16, 24, 32, 40, and 48 hours postoperatively was performed in 2 groups: without both SSNB and ANB (group I) and with both SSNB and ANB (group II). RESULTS The SSN was located at a length of one-half (2/5-3/5, 88%) from the anterior tip of the acromion to the superior angle of the scapula and at a length of two-fifths (1/3-1/2, 100%) from the anterior tip of the acromion to the medial border of the spine. The AN was located at a length of three-fifths (2/5-4/5, 98%) from the acromial angle to the inferior insertion of the teres major muscle. The depth from the skin was 3.20 ± 0.58 cm for the SSN and 2.07 ± 0.45 cm for the AN. The clinical study showed that the total amount of analgesic for patient-controlled anesthesia was markedly decreased at the end of the operation and at 8 hours postoperatively in group II compared with group I. CONCLUSIONS The SSNB and ANB were considered to provide safe and effective analgesia in terms of early postoperative pain in arthroscopic shoulder surgery.

Nonfusion method in thoracolumbar and lumbar spinal fractures.

Study Design. A retrospective study of surgically managed patients. Objective. To evaluate the results of posterior stabilization of thoracolumbar fracture using nonfusion method followed by the removal of metal implants within an appropriate period. Changes in the sagittal alignment and the restoration of segmental motion were also investigated. Summary of Background Data. Posterior fusion using a transpedicular screw system remains the treatment of choice for the management of thoracolumbar and lumbar fractures. However, fusion methods result in the permanent loss of segmental motion. If both stability and motion could be achieved, functional results would improve considerably. Methods. Twenty-three patients under 40 years of age (mean, 28.0 years) with thoracolumbar or lumbar spine fractures were managed by this nonfusion method. Implants were removed at a mean 9.7 months after initial fracture fixation, and patients were observed for more than 18 months. Sagittal alignments of metal fixed segments, heights of vertebral bodies, recovered motion ranges in flexion/extension, right-left bending view were measured radiologically. Clinical aspects, such as gross deformities and functional abilities, were also investigated. Results. Heights of fractured bodies were well maintained at final follow-up. Initial mean sagittal angle was 17.2° kyphosis, which became 2.8° lordosis after fixation of fractures. This angle was 1.7° kyphosis just before implant removal, 2.4° kyphosis just after implant removal, and showed 5.9° kyphosis at final follow-up. Mean segmental motion was 14.2° in the sagittal plane and 13.1° in the coronal plane at final follow-up. Most patients were satisfied with final gross appearance and functional outcome. Conclusion. The described nonfusion method appears to be effective in achieving favorable sagittal alignment and regaining motions of fixed segments. The present study suggests that the nonfusion method is one of the most effective methods for managing thoracolumbar fractures, especially in young active people.

Intratendinous Rotator Cuff Tears Prevalence and Clinical and Radiological Outcomes of Arthroscopically Confirmed Intratendinous Tears at Midterm Follow-up

Background: Intratendinous tears of the rotator cuff are rare, and little has been written about them. Purpose: To investigate the prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 33 patients (16 male, 17 female; mean age, 53.4 years) with arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair from March 2006 to July 2012. A history of trauma was found in 10 cases (30.3%). The dominant arm was involved in 26 cases (78.8%). The mean follow-up duration was 56 months. Preoperatively, a thorough physical examination was performed; at final follow-up, shoulder range of motion (ROM) in forward flexion, abduction, external rotation (ER) at the side, and internal rotation (IR) at the back was noted, and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analog scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded and compared with the preoperative data. Postoperative magnetic resonance imaging (MRI) was performed at 6 months to investigate rotator cuff healing status and repair integrity. Results: The prevalence of arthroscopically confirmed intratendinous tears was 4.7% among all arthroscopically treated partial-thickness rotator cuff tears. Impingement signs were positive in most of the patients (positive Hawkins-Kennedy test result in 78.8%, positive Neer sign in 66.7%, and either positive Hawkins-Kennedy test result or Neer sign in 84.8%). At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from a preoperative mean of 51.4, 18.9, 6.0, and 5.4, respectively, to a postoperative mean of 90.6, 32.9, 1.4, and 10.8, respectively (P < .001). According to the UCLA rating scale, outcomes were excellent in 17, good in 13, and fair in 3 cases. Shoulder ROM in forward flexion, abduction, ER at the side, and IR at the back improved from a preoperative mean of 135°, 129°, 25°, and L2, respectively, to a postoperative mean of 161°, 160°, 29°, and T10, respectively (P < .001 for all except ER). As per the Sugaya classification, on postoperative MRI, type I healing status was found in 10 (30.3%), type II in 18 (54.5%), and type III in 2 (6.1%) cases. None of the patients showed any evidence of retears. Conclusion: Transtendon suture bridge repair yielded satisfactory clinical and radiological outcomes in patients with intratendinous rotator cuff tears.

Post-traumatic pseudoaneurysm of the medial plantar artery combined with tarsal tunnel syndrome: two case reports

Pseudoaneurysms in the foot are more often reported in the lateral plantar artery than the medial plantar artery, most likely because of its more superficial location. There are no reports of pseudoaneurysm of the medial plantar artery after trauma. We present two cases of pseudoaneurysm of the medial plantar artery after blunt foot trauma and foot laceration. This pseudoaneurysm compressed a posterior tibial nerve, resulting in tarsal tunnel syndrome. The patients were treated successfully using transcatheter embolization without the need for surgical intervention. The tarsal tunnel syndrome also subsided. Here, the authors report these cases and provide a review of literature.

Hallux valgus deformity of foot with tumoral calcinosis: An unusual presentation

Tumoral calcinosis is an uncommon disorder and characterized by development of calcified masses within the soft tissues near the large joints such as the hip, elbow, and shoulder and rarely occurs in the foot. We report a case of tumoral calcinosis at the first meta-tarso-phalangeal (MTP) joint of foot with hallux valgus deformity associated with bunion which required resection. Surgical excision of the calcific mass alone, without surgery to the minimal hallux valgus, resulted in resolution of symptoms, without recurrence of the lesion. Subsequently, speculative etiology, differential diagnostic considerations as well as the therapeutic interventions for tumoral calcinosis are discussed taking into consideration the current literature. We conclude that tumoral calcinosis should be considered in the differential diagnosis of a painful mass that develops in the small joints of the foot.

Double triggering of extensor digiti minimi: a case report

Extensor tendon triggering is a rare disease entity. Even less common is a case of extensor digiti minimi (EDM) double triggering caused by impingement on the extensor retinaculum. Herein, we describe one patient with EDM double triggering developed at the extensor retinaculum and over the metacarpal head caused by its impingement on the extensor retinaculum.

Underestimated Sacroiliac Joint Lesion on Computed Tomography in Pelvic Open-book Injury: A Case Report

The classification of anteroposterior compression (APC) injury type is based on using static radiographs, stress radiographs are known as a useful adjunct in classifying type of APC pelvic injuries. According to a recent article, the intraoperative stress examination has led to a change in the treatment plan in more than 25% of patients on 22 patients presumed APC type I (symphyseal diastasis <2.5 cm) injuries. Here authors present a case demonstrating a necessity of intraoperative stress test for excluding concealed posterior ring disruption.

Analysis of Clinical Outcomes and Prognostic Factors in Bosworth Fractures

Category: Trauma Introduction/Purpose: Unlike routine ankle fractures, Bosworth fracture-dislocation lead to devastating complication such as compartment syndrome, neurovascular injury, and subsequent ankle OA more frequently. However, due to the low incidence of this injury, no study have reported clinical outcomes of Bosworth fracture in comparison to which of routine ankle fractures or these prognostic factors. Therefore this study was performed to assess and compare the outcomes of Bosworth fracture- dislocation to that of routine ankle fractures and understand the prognostic factors in order to prevent the irreversible and severe status. Methods: Twelve patients were followed for more than 1 years after surgical management for Bosworth fracture-dislocation. The mean age was 39.2 years, and the mean follow-up period was 38.4 months. All patients were treated with ORIF including syndesmosis fixation. The clinical evaluation consisted of the AOFAS ankle-hindfoot score, Olerud & Molander scale. Reduction of tibiofibular syndesmosis and restoration of the ankle mortise were evaluated with plain radiographs and 3-D CT. The clinical and radiological outcomes were compared to those of routine ankle fractures (50 patients). To detect prognostic factors affecting the clinical results, age, fixation methods, interval to operation, existence of post. malleolar fractue, shape of fibular fracture, number of syndesmotic screw, frequency of closed reduction trial were studied. Results: Clinical results of Bosworth fracture-dislocation showed improvement including AOFAS score (87.6 on average) and Olerud and Molaner scale (89.7 on average), and corresponded to those results of routine ankle fracture (p = 0.234). All the patients achieved union in 12.6 weeks on average. However, postoperative CT revealed syndesmotic diastasis in 5 of 12 cases As complication, there were two cases of compartment syndrome, 2 cases of posttraumatic OA, 2 cases of ankle stiffness. Interval to operation and frequency of closed reduction trial were foud to be predictive factors of poor outcomes (p = 0.003, 0.011 respectively). Conclusion: The results of our study showed that although the clinical results were comparable statistically, Bosworth fracture are more frequently associated with the development of complications than routine ankle fractures. More specifically, prolonged interval between occurrence of fracture and surgical fixation and repeated attempts of closed reduction are at risk for poor outcomes. A prospective study with sufficient power would be needed to further identify risk factors associated with complications.

Does Flatfoot Deformity Develop After Transfer of Posterior Tibial Tendon for the Foot Drop Secondary to Peroneal Nerve Palsy

Category: Other Introduction/Purpose: Posterior tibial tendon transfer is preferred by many colleagues for cases of drop foot caused by peroneal nerve palsy that are at least a year old with little chance of motor improvement. However, several studies have reported acquired flat foot deformity following tendon transfer, to best of our knowledge, no studies have been performed to assess whether posterior tibial tendon transfer influences occurrence of postoperative flat foot deformity quantitatively. Methods: With IRB approval, a retrospective review was performed. Twenty-four patients were followed for more than 2 years after anterior transfer of TP tendon by one surgeon for the foot drop by peroneal nerve palsy from 2008 to 2013. The mean age was 35.9 years, and the mean follow-up period was 50.5 months. There were 10 female and 14 male patients. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM). The radiological evaluation consisted of the calcaenal pitch, Meary angle, heel alignment angle. As functional evaluation, isokinetic dynamometer muscle function analysis was performed. Results: The overall FAOS demonstrated a significant improvement from preoperative (55.6 on average) to postoperative measurement (89.2 on average) (P < .01), the ADL and sports subsection of FAAM demonstrated a improvement from preoperative to postoperative measurement (ADL: from 45.6 to 87.3; sports: from 32.8 to 81.5 on average, respectively; P < .01). Radiology revealed that there were no changes in the foot alignment from pre- to postoperative measurement. Postoperative isokinetic strength was significantly lower as compared contralateral normal side. Two patients sustained postoperative complications in the WTHG (16.7%). Conclusion: The results of our study demonstrated that there was no evidence that loss of the normal function of the tibialis posterior lead change in foot alignment such as flat foot deformity. Transfer of posterior tibial tendon offers successful result for the foot drop secondary to peroneal nerve palsy in selected cohorts, altough long-term peroids follow up would be needed.

Avulsion fracture of the acromial physis in a 14-year-old boy: a case report.

Scapular fractures are uncommon and among them acromial fractures are even more uncommon. Because the vast majority of acromial fractures are either non-displaced or minimally displaced, symptomatic and nonoperative management was performed. We describe a case of avulsion fracture of the acromial physis displaced by acromioclavicular ligament treated with open reduction and internal fixation, and include a review of the literature.