Soo-Min Cha

Acetabular Labral Tears in Patients with Sports Injury

Background We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. Methods Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. Results The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. Conclusions In spite of the early expression of symptoms and the short duration of the acetabular labral tears, the high rate of degenerative acetabular labral tears in sports patients is likely associated with repetitive injury after the expression of symptoms. Femoroacetabular impingement in sports patients is seemed to be a cause of the early occurrence of acetabular labral tears. Because the possibility of acetabular labral tears is high in femoroacetabular impingement, sports patients may need to undergo early screening for the diagnosis and care of femoroacetabular impingement.

Flexible intramedullary nailing in simple bone cysts of the proximal humerus: prospective study for high-risk cases of pathologic fracture.

We designed and evaluated a modified cyst index using the Picture Archiving and Communication System software for treating simple bone cysts of the proximal humerus by preventive intramedullary flexible nail insertion in symptomatic children or adolescents. From January 2007 to December 2009, cases with a cyst index of at least 4 were enrolled in the study. Of 20 total cases, 19 were prospectively followed-up for at least 2 years. The mean patient age was 10.6 years (range, 7–15 years) and the mean modified cyst index was 6.56 (range, 4.95–8.25). The mean cyst healing period was 8.7 months (range, 4–30 months) and the mean follow-up period was 31.05 months (range, 24–42 months). Seventeen lesions (89%) were classified as completely healed and two (11%) were classified as healed with residual radiolucency. In all cases, no angular deformity was found on the final follow-up radiograph. Therefore, preventive flexible intramedullary nail insertion before the occurrence of a pathologic fracture because of simple bone cysts with a modified cyst index of at least 4 in the proximal humerus is an excellent treatment option. Level of Evidence: Therapeutic Level IV.

Role of the mechanical axis of lower limb and body weight in the horizontal tear and root ligament tear of the posterior horn of the medial meniscus

PurposeTo compare and analyse the relationship between horizontal tear and root ligament tear of the posterior horn of the medial meniscus (PHMM) and the degree of varus in the axis of lower limb and body weight.MethodsOne hundred and nineteen patients underwent surgical treatment as they were diagnosed with medial meniscus tear in our hospital from May 2006 to December 2009. Of these, 19 cases (group 1), underwent partial meniscectomy as they were confirmed to solely have horizontal tear of the PHMM on arthroscopic examination and 27 cases (group 2), underwent subtotal meniscectomy as they were confirmed to solely have root ligament tear of the PHMM on arthroscopic examination, were chosen for retrospective study. Standing radiographs were taken of every case prior to arthroscopic surgery to measure varus angle. Also, we checked body mass index (BMI) of two groups. The difference of varus angle and BMI between two groups were statistically verified using the Levene’s test, paired t-test.ResultsGroup 1 showed mean value of varus angle of 2.30 ± 0.54, and BMI of 25.32 ± 3.23. Group 2 showed mean value of varus angle of 5.64 ± 0.54, and BMI of 25.67 ± 3.12. The degree of varus of group 2 was statistically significantly higher than group 1 (p = 0.002). Comparison between the BMI of two groups showed no statistical significance (p = 0.053).ConclusionThrough a comparative study of sole horizontal tear and root ligament tear of the PHMM, the authors have found that sole root ligament tear of the PHMM is more relative to the genu varum than sole horizontal tear of the PHMM. However, body weight was statistically irrelevant to the incidence of the two lesions.

Simple Excision vs the Kidner Procedure for Type 2 Accessory Navicular Associated With Flatfoot in Pediatric Population

Background: Recently, many studies have argued against the Kidner procedure and its several modifications, with the accessory navicular considered an irritant rather than a hindrance to foot function, and simple excision has been advocated. We designed this prospective, comparative study of simple excision and the Kidner procedure in children and adolescents with flatfoot and evaluated functional and radiographic outcomes. Methods: From February 2004 to March 2009, we followed 50 consecutive feet of symptomatic type 2 accessory navicular. Simple excision and the Kidner procedure were performed in 25 feet each, respectively. The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, the visual analogue scale (VAS), and the talo–first metatarsal, talocalcaneal, and calcaneal pitch angles were evaluated preoperatively and postoperatively for a minimum of 3 years. Patient satisfaction was assessed. Results: The preoperative AOFAS midfoot scale and VAS of each group were improved at final follow-up. The talo–first metatarsal and talocalcaneal angles were not significantly different pre- and postoperatively. However, the calcaneal pitch angle of both groups was improved at the final follow-up. At the final follow-up, we observed no significant differences between the 2 groups in the AOFAS midfoot scale, the VAS, and the talo–first metatarsal, talocalcaneal, and calcaneal pitch angles. The satisfaction frequencies were 86% and 82% in groups 1 and 2, respectively. Conclusions: We found that in children and adolescents with accessory navicular and flatfoot, simple excision and the Kidner procedure both gave satisfactory results and both minimally restored the medial longitudinal arch similarly. Level of Evidence: Level II, prospective therapeutic study.

Positive or Negative Ulnar Variance after Ulnar Shortening for Ulnar Impaction Syndrome: A Retrospective Study

Background The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. Methods Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. Results A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. Conclusions After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.

Clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in scapholunate advanced collapse at 5 and 10 years.

SummaryThis retrospective study examined clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in patients with a scapholunate advanced collapse (SLAC) at 5 and 10 years. PurposePartial wrist arthrodesis is commonly performed to treat wrist arthritis because it provides pain relief without sacrificing complete wrist motion. The purposes of this retrospective study were to evaluate clinical and radiological outcomes after scaphoidectomy and 4-corner fusion after more than 10 years of follow-up and to compare the midterm and long-term results. MethodsForty-two patients were enrolled. The following were evaluated annually: pain (visual analog scale); Disabilities of the Arm, Shoulder, and Hand score; range of motion; grip strength; and Modified Mayo Wrist score. Bony union and arthritic changes in the radiolunate joint were also evaluated radiologically. Midterm and long-term results were compared. ResultsThe mean (SD) follow-up period was 12.2 (1.43) years. Two patients were excluded from the study because of complications, so the final postoperative evaluation included 40 patients. Visual analog scale and Disabilities of the Arm, Shoulder, and Hand scores improved to a satisfactory level by 5 years after surgery and did not differ significantly between 5 and 10 years. Flexion, extension, and radial deviation were reduced after 5 years compared with preoperative measures, and no difference was found between 5 and 10 years. Ulnar deviation, pronation, and supination did not change significantly after surgery. Grip strength was significantly recovered from 29.7 (4.9) kg at 5 years after surgery to 32.1 (8.5) kg at 10 years. The Modified Mayo Wrist score improved significantly to 83.2 (4.1) at 5 years after surgery but did not differ significantly between 5 and 10 years. All cases showed radiological solid fusion, and the mean (SD) period of union was 9.34 (3.7) weeks. Further radiolunate arthritic change was verified in 2 patients, but Modified Mayo Wrist scores were fair. One patient experienced inexplicable pain; therefore, total wrist fusion was performed at 6 years after surgery. ConclusionsThis retrospective cohort study of patients followed up for more than 10 years showed that the midterm and long-term results of 4-corner fusion for stage III SLAC were satisfactory, and arthritic changes in the radiolunate joint were minimal.

Ulnar Shortening for Adolescent Ulnar Impaction Syndrome: Radiological and Clinical Outcomes

PURPOSE To determine the amount of shortening needed in an ulna to achieve final neutral ulnar variance in adolescents with ulnar impaction syndrome. Radiological and clinical outcomes were evaluated after ulnar shortening and after growth had stopped. METHODS From February 2006 to February 2009, we prospectively followed 16 consecutive patients treated with a shortening osteotomy for positive ulnar variance. The study group included 10 boys and 6 girls with an average age of 16.1 years. The closed medial half-side of the physis of the distal radius was used to measure the variance as a reference for the ulna. Based on the radius without any growth potential, the amount of shortening was determined for the ulna with potential for further growth. The preoperative, postoperative, and final ulnar variances were evaluated. The clinical results were compared before surgery and at the time of growth termination. RESULTS Preoperative ulnar variance was 3.4 mm ± 0.6 mm and the amount to be shortened was 6.1 mm ± 1 mm. The final ulnar variance was 0.2 mm ± 0.3 mm. The mean visual analog scale pain score improved from 6.6 ± 1.0 before surgery to 2.2 ± 0.5 after surgery. The mean range of forearm rotation increased from 132° ± 11° before surgery to 170° ± 16° at final follow-up. In addition, grip strength was 15.3 kg ± 7.6 kg (71% of grip strength on the unaffected side) before surgery and 19.8 kg ± 4.9 kg (90% of grip strength on the unaffected side) at final follow-up. The modified Mayo Wrist Score was 85 ± 8 at the final follow-up. No cases of complications or treatment failure occurred. CONCLUSIONS Ulnar shortening was considered a useful procedure for adolescents with ulnar impaction syndrome, particularly if the measurement for the shortening amount was determined using the physis of the distal radius and ulna.

Plating after tibial lengthening: unilateral monoaxial external fixator and locking plate.

Several studies recently reported the usefulness of plating methods following limb lengthening with external fixators. This study describes modification at the time of plate insertion, selection of a locking plate, and the direction of plating. From April 2006 to July 2009, 12 consecutive patients, mean age 17.8 years, were enrolled in the study. The mean follow-up period was 36.5 months. All lengthening procedures were performed at the tibia. After proximal tibial osteotomy, a monoaxial external fixator was maintained on the lateral side of the tibia. At the end of distraction, a manually bent locking plate was inserted on the anteromedial side of the tibia, and the external fixator was removed. The mean final lengthening amount was 4.23 cm (range, 3.6–5.0 cm). The mean duration of the external fixator was 54.9 days (range, 47–67 days) and the mean external fixator index was 13.0 days/cm (range, 12.3–14.4 days/cm). The mean time to bony consolidation was 195.7 days (range, 150–264 days) and the mean healing index was 46.1 days/cm (range, 38.4–55 days). There were only minor complications in four patients. This case series showed that, especially with tibia lengthening, our method allows for successful early removal of the external fixator as compared with other methods (plating after lengthening), is associated with fewer complications, and is an effective alternative. Level of Evidence: Therapeutic Level IV.

Treatment of Unstable Distal Ulna Fractures Associated With Distal Radius Fractures in Patients 65 Years and Older

PURPOSE To prospectively compare the clinical and radiological outcomes of 2 treatment methods for unstable distal ulna fractures associated with distal radius fractures in patients 65 years of age and older. METHODS From February 2008 to March 2010, the first 29 ulnas were treated surgically (group 1) and the next 32 ulnas were treated nonoperatively (group 2). The mean final follow-up period was 34 months (range, 24-56 mo). All radiuses were fixed internally, in both groups. Clinical outcomes were compared between groups using a visual analog scale for postoperative pain; Disabilities of the Arm, Shoulder, and Hand scores; active range of motion; grip strength; and the modified system of Gartland and Werley. Radiological outcomes, including ulnar variance, were evaluated. Arthrosis was evaluated at the radiocarpal joint or distal radioulnar joint (DRUJ) according to the system of Knirk and Jupiter. RESULTS There were no significant differences between the groups in any of the clinical outcomes. No significant differences were observed for radiological outcomes including ulnar variance, distal radius, and union rate. There were no patients in either group with symptomatic arthritic changes in the radiocarpal joint or DRUJ at the final follow-up. In group 2, 1 patient had malunion (angulated, 14°) on the anteroposterior view without evidence of arthrosis in the DRUJ, and functional outcomes were good. CONCLUSIONS In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures.

Psoas Abscess Caused by Spontaneous Rupture of Colon Cancer

Spontaneous rupture of colon cancer, combined with psoas abscess formation, is rare. A 44-year-old male visited for back pain and left buttock mass. Abdominal computed tomography and magnetic resonance image revealed a large abscess in the left psoas muscle and in the left lower quadrant area. Ten days after incision and drainage, a skin defect around the left anterior superior iliac spine remained. A local flap was performed using a superficial skin graft. Ten days after the stitches had been removed, fecal discharge was observed around the anterior superior iliac spine at the flap site. An operation was performed by a general surgeon who had diagnosed this as a case of enterocutaneous fistula. Operative findings included a ruptured tumor mass in the descending colon, which was connected to a retroperitoneal abscess. Pathologic report findings determined adenocarcinoma of the resected colon. Herein, we report a case of psoas abscess resulting from perforating colon cancer.