Yeung-Jen Chen

Degeneration of the accessory navicular synchondrosis presenting as rupture of the posterior tibial tendon

Degeneration of the accessory navicular synchondrosis may be associated with decreased function of the posterior tibial tendon in patients who are middle-aged or older. We investigated the role of ultrasonography in differentiating between degeneration of the accessory navicular synchondrosis with separation of the accessory navicular from the navicular, which has not been previously reported to our knowledge, and a rupture of the posterior tibial tendon. We studied fourteen patients (mean age, fifty-five years; range, forty-one to seventy-two years) who had an operatively confirmed injury of the accessory navicular synchondrosis. The mean duration of follow-up was thirty-nine months (range, twenty-seven to fifty-four months). Preoperative radiographs demonstrated a type-II accessory navicular (an accessory navicular with a synchondrosis) in all fourteen patients. Ultrasonography, which was performed for twelve patients, demonstrated a defect in the synchondrosis in eleven patients and a normal posterior tibial tendon in all twelve. The operative findings included incomplete separation of the synchondrosis in four of the fourteen patients, complete separation of the synchondrosis and the periosteum in eight, and avulsion of the accessory navicular in two. On the basis of our findings, we concluded that post-traumatic degeneration of an accessory navicular synchondrosis may present clinically as a variant type of avulsion or rupture of the posterior tibial tendon in this age-group. Ultrasonography is useful for distinguishing between complete or partial separation through the synchondrosis and rupture or attenuation of the posterior tibial tendon.

Surgical indications in low lumbar burst fractures: Experiences with anterior locking plate system and the reduction-fixation system

A study of 14 surgically treated patients with low lumbar burst fractures (L3 to L5) is reported. Initially, 13 patients presented with incomplete neurologic deficits below the level of injury. The follow-up period ranged from 24 to 40 months, with an average of 30 months. In group 1, seven patients underwent one-stage anterior decompression, fusion, and Anterior Locking Plate System (ALPS) fixation. In Group 2, seven patients had posterior surgery with decompression, portero-lateral fusion, and a short segment fixation, one above and one below the injuried level, with the reduction-fixation transpediculate system. Indications for one-stage anterior surgery consisted of patients with incomplete neurologic deficits, segmental kyphotic deformity caused by loss of anterior vertebral height (< 50%), or canal encroachment < 50%. When there is significant radiologic evidence of lamina fractures, displaced or greenstick type, or injuries that occurred at the L5 level, the posterior approach was undertaken initially. This may be followed by anterior surgery if satisfactory vertebral height restoration or canal clearance was not achieved. Five dura tears (36%) were noted during surgery: two tears in group 1 and three tears in group 2. There were two patients in group 2 (29%) who had screws broken; however, none in group 1 demonstrated implant failure. In the low lumbar region, the step-off ALPS plate is preferable to the straight plate because of the increasing size of the vertebral body toward the caudal area. A low profile and easy application were its advantages. However, the ALPS could not be distracted or compressed anteriorly.

Intraosseous Tophaceous Pseudotumor in the Trigonal Process of the Talus

Primary gout with destructive tophaceous pseudotumor development rarely occurs in juvenile patients with asymptomatic hyperuricemia. An expansile, intraosseous tophaceous pseudotumor on the posterior process of the talus was verified in a 14-year-old boy with posterior ankle impingement and asymptomatic hyperuricemia. A review of the literature found no similar cases had been reported. The pathogenesis of this intraosseous tophaceous pseudotumor on the trigonal process probably was caused by the penetration of urate crystals from the periosteum into the posterior process of the talus. However, the time that this intraosseous tophaceous pseudotumor developed probably was close to the time that the second ossification center of the talus fused to the talus. Thus, it cannot be ruled out that the intraosseous tophaceous pseudotumor had formed during the fusion process of the second ossification center as a possible pathogenic mechanism in this unusual case.

Treatment of Segmental Femoral Shaft Fractures

In a prospective study, 35 segmental femoral shaft fractures were treated either with closed intramedullary nails (most were Grosse-Kempf interlocking nails) or an open method technique (most were open Küntscher nails with supplementary wires). The follow-up period was at least one year. There was an 82.9% (29/35) union rate and a union period of 6.1 +/- 1.9 months. Knee range of motion was on average 125 degrees. Although there was no statistical difference, the closed intramedullary nailing group showed superiority to the open method group. Complications were not particularly different from those in other type fractures, but could be managed better. Closed nailing technique can be improved with training and experience. Whenever possible, with adequate indications, closed intramedullary nailing is better than open treatment for segmental femoral shaft fractures.

Posterior tibial tendon tear combined with a fracture of the accessory navicular: A new subclassification?

A 58-year-old woman with a diagnosis of a tear of the posterior tibial tendon associated with the os accessory navicular fracture was treated surgically. We believe that the dysfunction of the posterior tibial tendon was associated with an os accessory navicular fracture. This case is proposed as a new subclassification that was separate from the traditional classification of the tear of the posterior tibial tendon.

Shoulder ultrasonography performed by orthopedic surgeons increases efficiency in diagnosis of rotator cuff tears

BackgroundRotator cuff tears are very common and their incidence increases with age. Shoulder ultrasonography has recently gained popularity in detecting rotator cuff tears because of its efficiency, cost-effectiveness, time-saving, and real-time nature of the procedure. Well-trained orthopedic surgeons may utilize shoulder ultrasonography to diagnose rotator cuff tears. The wait time of patients planned to have shoulder MRI (magnetic resonance imaging) to rule in rotator cuff tears may decrease after orthopedic surgeon start doing shoulder ultrasonography as a screening tool for that. Patients with rotator cuff tears may be detected earlier by ultrasonography and have expedited surgical repair. The efficacy in determination of rotator cuff tears will also increase.MethodsPatients were retrospectively reviewed from January 2007 to December 2012. They were divided into 2 groups: Ultrasound (-) group and the Ultrasound (+) group. Age, gender, wait time from outpatient department (OPD) visit to MRI exam, MRI exam to operation (OP), and OPD visit to OP, patient number for MRI exam, and number of patients who finally had rotator cuff repair within two groups were compared.ResultsThe wait time of OPD visit to OP and MRI to OP in patients who received shoulder ultrasonography was significantly less than that in patients did not receive shoulder ultrasonography screening. Only 23.8% of the patients with a suspected rotator cuff injury undergone arthroscopic rotator cuff repair before ultrasonography was applied as a screening tool. The percentage increased to 53.6% after orthopedic surgeon started using ultrasonography as a screening tool for rotator cuff tears.ConclusionsOffice-based shoulder ultrasound examination can reduce the wait time for a shoulder MRI. The efficacy of determination of rotator cuff tears will also increase after the introduction of shoulder ultrasonography.