Jeong Hyun Yoo

Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

Background Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. Methods MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. Results Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. Conclusions MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

Risk factors and clinical outcomes of delirium in osteoporotic hip fractures

Purpose: This study is performed to identify risk factors for delirium in osteoporotic hip fractures and to evaluate the hospitalization cost and clinical outcomes of delirium in osteoporotic hip. Methods: A total of 221 patients with osteoporotic hip fractures were assessed for eligibility between 2010 and 2014. Among them, 37 patients with delirium were allocated into the delirium group (group D) and 37 patients without delirium were allocated into the non-delirium group (group ND) by matching demographic factors. Risk factors such as time between admission and operation, body mass index, American Society of Anesthesiologists status, cognitive impairment, preoperative urinary catheter, electrolyte imbalance, preoperative hemoglobin, polymedication (medications > 5), pneumonia, anesthesia time, operation time, estimated blood loss, and total amount of transfusion were evaluated for correlation with incidence of delirium. The hospitalization cost was evaluated, and clinical outcomes such as readmission, mortality, and activity level at 1-year follow-up were evaluated. Results: In multivariate analysis, polymedication (p = 0.028) and preoperative indwelling urinary catheter insertion status (p = 0.007) were related to the incidence of delirium in patients with osteoporotic hip fractures. Group D showed a significantly higher hospitalization cost compared to group ND. However, delirium did not have a significant effect on length of hospital stay, readmission rate, postoperative 1-year mortality, and activity level. Conclusions: Polymedication and preoperative urinary catheter were related to perioperative delirium. In addition, delirium in osteoporotic hip fractures may not have a detrimental effect on clinical outcomes; however, hospitalization cost seemed to be increased due to delirium.

The Effect of Distal Location of the Volar Short Arm Splint on the Metacarpophalangeal Joint Motion

Background The goals of this study were to compare maximal metacarpophalangeal joint (MCPJ) flexion angles after application of a volar short arm splint at 3 different locations and verify the relations between the three different physical and radiological locations. Methods Forty dominant hands of healthy subjects were analyzed in the study. We defined a transverse skin folding line as a line drawn from the radial aspect of the thenar crease to the ulnar aspect of the distal transverse palmar crease. The distal end of the volar short arm splint was applied on 3 parallel locations to this line. Location A was on this transverse skin folding line; location B was 1 cm proximal to location A; and location C was 1 cm distal to location A. Two orthopedic surgeons measured the maximal MCPJ flexion angles of each finger except the thumb with the application of a volar short arm splint at 3 different locations as well as without a splint as a control. Radiological locations of the 3 different distal ends of the volar short arm splint were also assessed by anteroposterior radiographs of the wrist. Results When the splint was applied at location A and C, the maximal MCPJ flexion angle decreased to a mean of 83° (91% of control value) and 56° (62% of control value), respectively (compared to the control, p < 0.001). At location B, the maximal MCPJ flexion angle was a mean of 90° (99% of control value); no significant difference was observed compared to the control or without the splint (p = 0.103). On radiography, the average length from the metacarpal head to the distal end of the splint at all fingers decreased in the order of location B, A, and C (29 mm, 19 mm, and 10 mm, respectively; p < 0.001). Conclusions We recommend applying the distal end of a volar short arm splint at proximal 1 cm to the transverse skin folding line to preserve MCPJ motion perfectly, which is located at distal 44% of the whole metacarpal bone length radiologically.

A Schwannoma Originating from Median Nerve at Proximal Forearm Caused Ulnar Nerve Symptom by Compression

A 77-year-old male visited the orthopaedic clinic at our institution with hard palpable mass at volar aspect of proximal forearm occurred 10 years ago. The patient complained about mild pain and discomfort on proximal forearm and described the size of mass seemed to be increasing recently. On physical examination, the patient presented tingling sensation at ring and little finger by percussion on the mass. However, Tinel’s sign of the ulnar nerve at the cubital tunnel and the elbow flexion test were both negative. There was no evidence of suspicion for anterior interosseous nerve or other median nerve disturbance. However, Froment’s test implying chronic ulnar nerve damage was positive. To evaluate the neuropathy, nerve conduction velocity (NCV) study was carried out. On NCV study, mild elongated latency of ulnar nerve below elbow level was revealed. Magnetic reasonance imaging (MRI) was performed to determine the exact location and the origin of the mass and to make sure there were no other lesions that might have caused similar symptoms. On preoperative enhanced MRI study, lesion was well circumscribed along the median nerve at proximal forearm. The mass showed similar intensity with muscle on T1-wighted images. Old hemorrhages or calcifications-like heterogenic signals were found on T2-weighted images (Fig. 1A, B). Contrastenhanced T1-weighted images revealed irregularly moderate enhancement of the lesion (Fig. 1C). On T2-weighted axial image, it seemed to be clear that the mass was originated from the median nerve. High signal change around the ulnar nerve was found. The mass was occupying a great amount of space on proximal forearm. The structures around the mass were A Schwannoma Originating from Median Nerve at Proximal Forearm Caused Ulnar Nerve Symptom by Compression