Evaluation of Inferior Capsular Laxity in Patients with Atraumatic Multidirectional Shoulder Instability with Magnetic Resonance Arthrography

OBJECTIVE: To compare inferior capsular redundancy by using magnetic resonance arthrography (MRA) images in patients with multidirectional instability (MDI) of the shoulder and control subjects without instability and thereby develop a screening method to identify the presence of shoulder MDI. MATERIALS AND METHODS: The MRA images of patients with MDI of the shoulder (n = 65, 57 men, 8 women; mean age, 24.5 years; age range, 18–42 years) treated over an eight-year period were retrospectively reviewed; a control group (n = 65, 57 men, 8 women; mean age, 27.4 years; age range, 18–45 years) without instability was also selected. The inferior capsular redundancy was measured using a new method we named the glenocapsular (GC) ratio method. MRA images of both groups were randomly mixed together, and two orthopedic surgeon reviewers measured the cross-sectional areas (CSAs) and sagittal capsule-head ratios on oblique sagittal images, as well as the axial capsule-head ratios on axial images and GC ratios on oblique coronal images. RESULTS: The CSAs and GC ratios were significantly higher in patients than in controls (both, p 1.42 was found to be most suggestive of MDI of the shoulder, owing to its high sensitivity (92.3%) and specificity (89.2%). CONCLUSION: GC ratio can be easily measured and used to accurately screen for MDI of the shoulder.

Prognostic Factors after Arthroscopic Treatment of Infectious Knee Arthritis / 대한정형외과학회잡지

PURPOSE: This study examined the effects of gender, age, underlying disease, duration after onset of symptoms, preoperative invasive procedures, bacterial culture of joint fluid, and stage of infection by the Gächter classification on the prognosis of patients with infectious knee arthritis who underwent arthroscopic surgery. MATERIALS AND METHODS: From June 2014 to December 2016, 51 patients who underwent arthroscopic surgery for infective knee arthritis were enrolled in this study. The average follow-up period was 14.2±2.1 months (range, 12–20 months). The subjects were 27 men (52.9%) and 24 women (47.1%), with an average age of 55.1±17.6 years (range, 13–84 years). A preoperative evaluation of the joint aspiration with a count of more than 50,000 leukocytes and a polymorphonuclear leukocyte count of 95% or more was performed. All patients underwent arthroscopic surgery and postoperative continuous joint irrigation. RESULTS: The initial mean value of the C-reactive protein decreased from 9.55±6.76 mg/dl (range, 1.51–31.06 mg/dl) to a final mean of 0.74±1.26 mg/dl (range, 0.08–6.77 mg/dl); the mean duration of C-reactive protein normalization was 27.6±18.9 days (range, 8–93 days). Among the 51 patients who received arthroscopic surgery and antibiotics, 44 patients (86.3%) with infectious knee arthritis completed treatment with improved clinical symptoms, such as fever, pain, and edema, and the C-reactive protein decreased to less than 0.5 mg/dl. Finally, 5 cases were treated with two or more arthroscopic operations, and 2 cases were converted to arthroplasty after prosthesis of antibiotic-loaded acrylic cement. CONCLUSION: The duration of surgery after the onset of symptoms and the stage according to the Gächter classification are important prognostic factors for predicting the successful treatment of infectious knee arthritis. On the other hand, the other factors were not statistically significant. Nevertheless, patients with bacteria cultured from the joint fluids appear to reflect the treatment period because the period of normalization of the C-reactive protein is shorter than that of the control group.

Clinical and Radiologic Results Comparing the Periarticular Proximal Humerus Locking Plate and Polarus Nail for Displaced Proximal Humerus Fractures

BACKGROUND: This study compared the clinical and radiological outcomes of the single calcar screw plate and Polarus nail techniques for the treatment of the proximal humerus fractures. METHODS: Seventy-two patients diagnosed with displaced proximal humerus fracture were enrolled for the study. Of these, 50 patients underwent the locking plate surgery with a single calcar screw (plate group), whereas 22 patients underwent the Polarus nail surgery (nail group). The plate group was further divided into plate 1 group (with medial support), and plate 2 group (without medial support). The radiological and functional results of both groups were compared to the nail group. RESULTS: The α angle 1 year after surgery was significantly different between plate 1 and plate 2, and plate 2 and nail groups (p=0.041, p=0.043, respectively). The ratio that does not satisfy the reference value of γ angle was 2.8% in plate 1, 7.1% in plate 2 and 22.7% in nail group (p=0.007); there was a significant difference between plate 1 and nail group, and plate 2 and nail group (p=0.014, p=0.033, respectively). CONCLUSIONS: No significant differences were observed in the clinical results between locking plate and Polarus nail. However, in the plate 2 group and nail group, the rate of failure to maintain reduction during the 1-year period after surgery was statistically and significantly higher than the plate 1 group (level of evidence: level IV, case series, treatment study).

Multifocal Osteonecrosis in a Patient with Gout: Case Report and Review of the Literature

Osteonecrosis (ON) is a common comorbidity in gout; however, avascular ON of multiple sites is unusual. Multifocal ON is defined as osteonecrotic lesions affecting three or more separate anatomic sites. We report a case of a 31-year-old woman diagnosed with gout, who had multifocal ON. Initially, she was treated with benzbromarone, colchicine, and meloxicam. Two years later, she developed severe tophi and was diagnosed with chronic renal failure. Magnetic resonance imaging (MRI) of both legs revealed bilateral ON of the femoral head. She underwent bilateral hip replacement surgeries. After two years, she had pain and limited movements in the left shoulder, with tophi identified via dual-energy computed tomography. Despite management with non-steroidal anti-inflammatory drugs, colchicine, and prednisolone, she had persistent shoulder pain. MRI of the left shoulder revealed ON. She therefore underwent left shoulder replacement surgery. Following the case report, we review the literature on multifocal ON with gout.

Clinical and Radiologic Results Comparing the Periarticular Proximal Humerus Locking Plate and Polarus Nail for Displaced Proximal Humerus Fractures

BACKGROUND: This study compared the clinical and radiological outcomes of the single calcar screw plate and Polarus nail techniques for the treatment of the proximal humerus fractures. METHODS: Seventy-two patients diagnosed with displaced proximal humerus fracture were enrolled for the study. Of these, 50 patients underwent the locking plate surgery with a single calcar screw (plate group), whereas 22 patients underwent the Polarus nail surgery (nail group). The plate group was further divided into plate 1 group (with medial support), and plate 2 group (without medial support). The radiological and functional results of both groups were compared to the nail group. RESULTS: The α angle 1 year after surgery was significantly different between plate 1 and plate 2, and plate 2 and nail groups (p=0.041, p=0.043, respectively). The ratio that does not satisfy the reference value of γ angle was 2.8% in plate 1, 7.1% in plate 2 and 22.7% in nail group (p=0.007); there was a significant difference between plate 1 and nail group, and plate 2 and nail group (p=0.014, p=0.033, respectively). CONCLUSIONS: No significant differences were observed in the clinical results between locking plate and Polarus nail. However, in the plate 2 group and nail group, the rate of failure to maintain reduction during the 1-year period after surgery was statistically and significantly higher than the plate 1 group (level of evidence: level IV, case series, treatment study).

Heart Failure Secondary to Pazopanib for Treatment of Metastatic Renal Cell Carcinoma / 대한내과학회지

A 78-year-old man was diagnosed with renal cell carcinoma, and left nephrectomy was performed. He started pazopanib. One month later, he visited our hospital because of general weakness and dyspnea. His oxygen saturation was low. A chest X-ray showed pulmonary edema and bilateral pleural effusion. An echocardiogram showed a larger left ventricle and lower ejection fraction than observed at the previous examination. The patient discontinued pazopanib and started diuretics and digoxin. His symptoms improved and a follow-up X-ray showed improvement in the pulmonary edema with bilateral pleural effusion.

Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to investigate the functional and radiologic results of treatment of the old with intertrochanteric fractures by implementation of the proximal femoral nail antirotation (PFNA) with Valgus reduction. MATERIALS AND METHODS: A retrospective review of patients (over 65 years old) with intertrochanteric fractures undergoing PFNA, during the period March 2008 to August 2012 at Chungbuk National University Hospital, with follow-up for at least 12 months, was conducted. Fifty-one patients were identified. The mean observation period was 15.6 months and the mean age of patients was 78.6 years old. In this study, AO foundation and Orthopaedic Trauma Association (AO/OTA) classification of initial fractures, post operative neck shaft angle, location of the blade tip (Cleveland index), tip-apex distance (TAD), incidence of complication, Wayne-County reduction, and Koval walking ability were analyzed. RESULTS: Satisfactory reduced status was achieved by significant (p<0.05) valgus reduction in 49 out of 51 cases and the mean period for radiologic bony union was 15.3 weeks. The mean blade sliding distance was 3.5 mm and the mean TAD was 18.7 mm; however, the blade location did not affect the results. No complications, including surgical site infection, delayed union, nonunion, rotational angulation, and cutting out of the blade tip were found. Thirty-one patients out of 42 who maintained their pre-fracture ambulatory ability, 11 patients (out of 42) remained ambulatory but became more dependent on assistive devices. CONCLUSION: It is expected that the Wayne-County reduction followed by internal fixation with PFNA is a useful treatment option for intertrochanteric fractures in elderly patients because it shows few complications with good functional and radiologic results.