Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training.

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.

Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip.

PURPOSE: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. MATERIALS AND METHODS: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1±0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0±19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. RESULTS: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). CONCLUSION: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.

Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report.

As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

Cross-cultural adaptation and validation of the Korean version of the Michigan hand questionnaire.

PURPOSE: The Michigan hand questionnaire (MHQ) is increasingly being used and has been adapted cross-culturally in some Western and Asian countries, but the validation process for an Asian translation of MHQ has not been well described. In this study, we translated and adapted the original MHQ cross-culturally to produce a Korean version, and then assessed the validity and reliability of the Korean version of the MHQ. METHODS: A total of 176 patients with common hand disorders completed the Korean version of the MHQ and the Disabilities of the Arm, Shoulder, and Hand questionnaire. We included the pain score assessed by a visual analog scale during activity, range of motion, measurement of grip strength, and subjective assessment of the functional state by use of Cooney's scale in the validation process. RESULTS: There were no major linguistic or cultural problems during forward and backward translations of the MHQ, except for a minor change owing to cultural discrepancies in eating, such as the dominant hand using a spoon and chopsticks instead of both hands using a knife and fork. All subscales of the MHQ showed satisfactory internal consistency. The reproducibility test showed no significant difference. The construct validity revealed a moderate to strong correlation between every subscale of the Korean MHQ against DASH disabilities and symptoms. The aesthetic and satisfaction domains, unique domains of the MHQ, had little correlation with the objective measure of the pain visual analog scale, grip strength, motion and subjective functional state. CONCLUSIONS: The Korean version of MHQ showed satisfactory internal consistency, test-retest reliability, and validity and demonstrated a significant correlation with the patient-based upper extremity questionnaire and clinical assessment. We found the application and evaluation of the instrument to be feasible and understandable among patients in Korea.

A case of pathologic fracture of femur whose primary tumor and occult metastases were ascertained by PET-CT.

We report a case of metastatic pathologic fracture of femoral shaft, whose primary cancer was ascertained by positron emission tomography-computed tomography (PET-CT). The abnormally increased biological activity of the space-occupying lesion of the lung was clearly demonstrated by PET-CT. Moreover, the occult bony metastatic lesions were confirmed with evidence of altered biologic activity. The PET-CT should be regarded as a valuable work-up tool for the orthopaedic management of metastatic pathologic fracture of a skeleton, all-the-more as a functional metabolic imaging tool.

A case of fracture of posterior margin of lateral tibial plateau by pivot shift mechanism in chronic ACL insufficiency.

We present a case of the fracture of the posterior margin of the lateral tibial plateau, probably by pivot shift mechanism in a chronic anterior cruciate ligament (ACL) insufficient knee. Multitudes of direct and indirect signs of ACL injury were evident on MRI, including anterior translation of the lateral tibial plateau, buckling of the posterior cruciate ligament, deep sulcus sign, and the fracture of the posterior aspect of lateral tibial plateau. With careful interpretation of the history and arthroscopic findings, the main insult of the current case was identified as the fracture of the posterior margin of the lateral tibial plateau with antecedent chronic ACL insufficiency, rather than as the acute or subacute ACL rupture. This type of injury is worth due attention as a late complication of chronic ACL insufficiency, and the clinicians should be careful in constructing the clinical scenario for the temporal relationship of injury. To the best of our knowledge, this type of injury as a late complication of chronic ACL insufficiency has never been reported in the literature.

Lateral epicondylar femoral avulsion fracture combined with tibial fracture: a counterpart to the arcuate sign.

We present a case of femoral avulsion of the lateral collateral ligament (LCL) with complete tear of the posterior cruciate ligament (PCL) and popliteus tendon accompanied by demonstrable posterolateral rotary instability (PLRI) of the knee. A 55-year-old man was involved in a road traffic accident. Radiographs revealed an avulsion fracture of the lateral epicondyle of the femur and a fracture of the tibial shaft. An MRI scan showed the lateral epicondyle was avulsed by the LCL and the popliteus tendon. The PCL signal was absent. The tibial shaft fracture was fixed with an intra medullary nail. Sagging of the tibia, with loss of prominence of tibial tuberosity and a positive posterior drawer test, demonstrated a complete tear of the PCL. The avulsion fracture of the lateral epicondyle was treated by an open reduction and internal fixation with two staples. A ligament can be avulsed at either end, and to our knowledge, this pattern of injury as a counterpart to arcuate sign has never been documented in the literature. It is important not to dismiss a small avulsion fracture around the knee joint as insignificant, as it could indicate the presence of a major ligamentous injury.

Meniscal ossicle: a case report.

Meniscal ossicle is a cortical or cancellous tissue with central viable marrow surrounded by meniscal cartilage. We present a case of medial meniscal ossicle at its posterior horn. A 21-year-old male military recruit visited our clinic due to left knee discomfort. He had not undergone any notable injury on the knee, but complained of intermittent catching or giving way without locking. Simple radiographs showed a small round bony fragment at posteromedial side of knee joint. The magnetic resonance imaging revealed an intra-substance lesion of meniscus, whose signal is identical to bone. On arthroscopy, the articular cartilage of medial femoral condyle and tibial plateau appeared degenerative with a groove-like scar. The medial meniscus seemed swollen at the posterior horn, but there was no discernible tear in the adjacent meniscus. After piecemeal removal of meniscal substance, a small osseous fragment was identified, which was evacuated via posteromedial portal. The resection of meniscus amounted to a subtotal meniscectomy. The activities of daily living were possible without any trouble even after 9 months of follow-up. This entity should be distinguished from intra-articular loose body, and included in the differential diagnosis of the incidental findings of small ossified density around knee joint.

Localized nodular synovitis of the knee presenting as anterior knee pain: a case report.

The localized nodular synovitis is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. We report a case of localized nodular synovitis at the infrapatellar fat pad of the knee which presented as a vague symptom of anterior knee pain. An arthroscopic excision of the lesion relieved the anterior knee pain and there has been no evidence of recurrence. Although the localized nodular synovitis shares some common histologic features with the pigmented villonodular synovitis without villous fronds, hemorrhage, or hemosiderin deposit, it is important to make a distinction between the two entities because their clinical presentations differ greatly, as do their responses to treatment. This rare tumorous lesion should be included in the differential diagnosis of common clinical symptom of anterior knee pain.

An en bloc avulsion fracture of tibial tuberosity and Gerdy's tubercle in an adolescent basketball player: a case report.

We report a case of en bloc avulsion fracture of tibial tuberosity and Gerdy's tubercle, which has never been reported. A 14-year-old boy suffered from an acute pain in his left knee during running just before a jump. Simple radiographs showed an avulsion of the tibial tuberosity. On CT scans, the fractured fragment was attached not only to patellar tendon but also to iliotibial band (ITB) via Gerdy's tubercle. MRI evaluation revealed no intra-articular associated pathology. Open reduction and internal fixation with three cannulated screws were performed under lateral parapatellar approach to expose both the tibial tuberosity with patellar tendon and Gerdy's tubercle with ITB. At postoperative 1 year, he could walk, run, squat, and complained of no difficulty in activities on daily living with full range-of-motion of the knee. Radiographs showed well-healed fracture in situ. Gradually, he returned to sports activity. We believe that the injury was caused by the dynamic pull of quadriceps muscle via patellar tendon onto tibial tuberosity and the mostly static pull of ITB onto Gerdy's tubercle, both of which took a part in the fracture of the anterolateral portion of the unfused epiphysis of proximal tibia. The pes anserinus attaching on the anteromedial metaphysis of proximal tibia might exert the opposing deforming force. Preoperative planning including the determination of the extent of fracture and recognition of concomitant injury is a prerequisite for appropriate treatment.