Anatomic fit of precontoured extra-articular distal humeral locking plates: a cadaveric study

Background@#Extra-articular distal humerus locking plates (EADHPs) are precontoured anatomical plates widely used to repair distal humeral extra-articular diaphyseal fractures. However, EADHPs frequently cause distal protrusion and resulting skin discomfort. The purpose of this study was to predict the occurrence of anatomic fit mismatch. We hypothesized that the smaller the humerus size, the greater the anatomic fit mismatch with EADHP. @*Methods@#Twenty humeri were analyzed in this study. Humeral length and distal humeral width were used as parameters of humeral size. Plate protrusion was measured between the EADHP distal tip and the distal humerus. We set the level of unacceptable EADHP anatomic fit mismatch as ≥10 mm plate protrusion. @*Results@#A significant negative linear correlation was also confirmed between humeral size and plate protrusion, with a coefficient of determination of 0.477 for humeral length and 0.814 for distal humeral width. The cutoff value of humeral length to avoid ≥10 mm plate protrusion was 293.6 mm (sensitivity, 88.9%; specificity, 81.8%) and for distal humeral width was 60.5 mm (sensitivity, 100%; specificity, 81.8%). @*Conclusions@#Anatomic fit mismatch in distal humeral fractures after EADHP fixation has a negative linear correlation with humeral length and distal humeral width. For patients with a distal humeral width <60.5 mm, ≥10 mm plate protrusion will occur when an EADHP is used, and an alternative implant or approach should be considered.

Body donation trends in Yonsei University: a statistical analysis of donor records / 대한해부학회지

Body donation trends in Korea have changed significantly over the last 3 decades. Establishing a body donation system will promote donations to universities for academic purposes. Yonsei University College of Medicine started its own body donation system in 1992, including documenting donors’ records. However, there has been no reported attempt to analyze the trend of these records, which could provide noteworthy information that can be interpreted for medical advances. This study performed a statistical analysis of the donors’ records between 1992 and 2019 to analyze the sociological and anthropological changes. Donor personal information such as sex, age, religion, and place and cause of death were extracted from the Yonsei University College of Medicine database. Our statistical analysis revealed significant correlations between donors’ records and the changes in the number of geriatric hospitals, religious beliefs, number of donations, and donor age.

Anatomic fit of precontoured extra-articular distal humeral locking plates: a cadaveric study

Background@#Extra-articular distal humerus locking plates (EADHPs) are precontoured anatomical plates widely used to repair distal humeral extra-articular diaphyseal fractures. However, EADHPs frequently cause distal protrusion and resulting skin discomfort. The purpose of this study was to predict the occurrence of anatomic fit mismatch. We hypothesized that the smaller the humerus size, the greater the anatomic fit mismatch with EADHP. @*Methods@#Twenty humeri were analyzed in this study. Humeral length and distal humeral width were used as parameters of humeral size. Plate protrusion was measured between the EADHP distal tip and the distal humerus. We set the level of unacceptable EADHP anatomic fit mismatch as ≥10 mm plate protrusion. @*Results@#A significant negative linear correlation was also confirmed between humeral size and plate protrusion, with a coefficient of determination of 0.477 for humeral length and 0.814 for distal humeral width. The cutoff value of humeral length to avoid ≥10 mm plate protrusion was 293.6 mm (sensitivity, 88.9%; specificity, 81.8%) and for distal humeral width was 60.5 mm (sensitivity, 100%; specificity, 81.8%). @*Conclusions@#Anatomic fit mismatch in distal humeral fractures after EADHP fixation has a negative linear correlation with humeral length and distal humeral width. For patients with a distal humeral width <60.5 mm, ≥10 mm plate protrusion will occur when an EADHP is used, and an alternative implant or approach should be considered.

Body donation trends in Yonsei University: a statistical analysis of donor records / 대한해부학회지

Body donation trends in Korea have changed significantly over the last 3 decades. Establishing a body donation system will promote donations to universities for academic purposes. Yonsei University College of Medicine started its own body donation system in 1992, including documenting donors’ records. However, there has been no reported attempt to analyze the trend of these records, which could provide noteworthy information that can be interpreted for medical advances. This study performed a statistical analysis of the donors’ records between 1992 and 2019 to analyze the sociological and anthropological changes. Donor personal information such as sex, age, religion, and place and cause of death were extracted from the Yonsei University College of Medicine database. Our statistical analysis revealed significant correlations between donors’ records and the changes in the number of geriatric hospitals, religious beliefs, number of donations, and donor age.

Treatment of acute high-grade acromioclavicular joint dislocation

Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.

Peri-anchor cyst formation after arthroscopic bankart repair: comparison between biocomposite suture anchor and all-suture anchor

Background@#The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials. @*Methods@#This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized. @*Results@#At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference. @*Conclusions@#Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.

Peri-anchor cyst formation after arthroscopic bankart repair: comparison between biocomposite suture anchor and all-suture anchor

Background@#The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials. @*Methods@#This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized. @*Results@#At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference. @*Conclusions@#Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.

Follistatin Mitigates Myofibroblast Differentiation and Collagen Synthesis of Fibroblasts from Scar Tissue around Injured Flexor Tendons

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

BACKGROUND: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. METHODS: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in 20° external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in 20° external rotation view. RESULTS: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was 138° ± 4°, and at one-year follow-up, the neck shaft angle was 137° ± 5°. There was no significant difference between the preoperative and postoperative values (p=0.105). CONCLUSIONS: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

BACKGROUND: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. METHODS: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in 20° external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in 20° external rotation view. RESULTS: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was 138°± 4°, and at one-year follow-up, the neck shaft angle was 137°± 5°. There was no significant difference between the preoperative and postoperative values (p=0.105). CONCLUSIONS: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

Treatment of Acute Acromioclavicular Joint Dislocation: Kirschner's Wire Trans-acromial Fixation versus AO Locking Hook Plate Fixation

BACKGROUND: The purpose of this study is to compare clinical and radiological outcomes between trans-acromial fixation with Kirschner's wire (K-wire) and AO locking hook plate fixation for acute acromioclavicular (AC) joint dislocation. METHODS: This study included 61 patients who underwent either closed reduction and trans-acromial fixation with K-wire (group A, 23 patients) or open reduction and internal fixation with AO locking hook plate (group B, 38 patients). Pain on a visual analogue scale (VAS) score, the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM) were used in the functional evaluation. For radiological evaluation, coracoclavicular distance (CCD) was measured on both clavicular anteroposterior view and compared between groups. RESULTS: At one-year follow-up, no significant differences in VAS pain score, UCLA shoulder score, ASES score, and active ROM were observed between groups, despite five cases (22.7%, 5/23) of complication in group A. The side-to-side difference between normal and affected CCD was 2.4 ± 2.2 mm in group A and 0.2 ± 0.7 mm in group B. This difference showed a statistical significance between groups (p<0.001). CONCLUSIONS: For the treatment of acute AC joint dislocation, the K-wire trans-acromial fixation group showed a significantly greater CCD than the AO locking hook plate group. In addition, during the follow-up period, much higher incidence of complication related to implant was observed in the trans-acromial fixation group. Although clinical outcomes between groups were not significantly different, these results should be interpreted carefully.

Treatment of Acute Acromioclavicular Joint Dislocation: Kirschner's Wire Trans-acromial Fixation versus AO Locking Hook Plate Fixation

BACKGROUND: The purpose of this study is to compare clinical and radiological outcomes between trans-acromial fixation with Kirschner's wire (K-wire) and AO locking hook plate fixation for acute acromioclavicular (AC) joint dislocation. METHODS: This study included 61 patients who underwent either closed reduction and trans-acromial fixation with K-wire (group A, 23 patients) or open reduction and internal fixation with AO locking hook plate (group B, 38 patients). Pain on a visual analogue scale (VAS) score, the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM) were used in the functional evaluation. For radiological evaluation, coracoclavicular distance (CCD) was measured on both clavicular anteroposterior view and compared between groups. RESULTS: At one-year follow-up, no significant differences in VAS pain score, UCLA shoulder score, ASES score, and active ROM were observed between groups, despite five cases (22.7%, 5/23) of complication in group A. The side-to-side difference between normal and affected CCD was 2.4 ± 2.2 mm in group A and 0.2 ± 0.7 mm in group B. This difference showed a statistical significance between groups (p<0.001). CONCLUSIONS: For the treatment of acute AC joint dislocation, the K-wire trans-acromial fixation group showed a significantly greater CCD than the AO locking hook plate group. In addition, during the follow-up period, much higher incidence of complication related to implant was observed in the trans-acromial fixation group. Although clinical outcomes between groups were not significantly different, these results should be interpreted carefully.

Effect of the Starting Point of Half-Pin Insertion on the Insertional Torque of the Pin at the Tibia

PURPOSE: The authors have observed a failure to achieve secure fixation in elderly patients when inserting a half-pin at the anteromedial surface of the tibia. The purpose of this study was to compare two methods for inserting a half-pin at tibia diaphysis in elderly patients. MATERIALS AND METHODS: Twenty cadaveric tibias were divided into Group C or V. A half-pin was inserted into the tibias of Group C via the conventional method, from the anteromedial surface to the interosseous border of the tibia diaphysis, and into the tibias of Group V via the vertical method, from the anterior border to the posterior surface at the same level. The maximum insertion torque was measured during the bicortical insertion with a torque driver. The thickness of the cortex was measured by micro-computed tomography. The relationship between the thickness of the cortex engaged and the insertion torque was investigated. RESULTS: The maximum insertion torque and the thickness of the cortex were significantly higher in Group V than Group C. Both groups exhibited a statistically significant linear correlation between torque and thickness by Spearman's rank correlation analysis. CONCLUSION: Half-pins inserted by the vertical method achieved purchase of more cortex than those inserted by the conventional method. Considering that cortical thickness and insertion torque in Group V were significantly greater than those in Group C, we suggest that the vertical method of half-pin insertion may be an alternative to the conventional method in elderly patients.

Characteristics of Magnetic Resonance Arthrography Findings in Traumatic Posterosuperior Rotator Cuff Tears

BACKGROUND: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. METHODS: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. RESULTS: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. CONCLUSIONS: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.

Characteristics of Magnetic Resonance Arthrography Findings in Traumatic Posterosuperior Rotator Cuff Tears

BACKGROUND: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. METHODS: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. RESULTS: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. CONCLUSIONS: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.

Dual-Energy Computed Tomography Arthrography of the Shoulder Joint Using Virtual Monochromatic Spectral Imaging: Optimal Dose of Contrast Agent and Monochromatic Energy Level

OBJECTIVE: To optimize the dose of contrast agent and the level of energy for dual-energy computed tomography (DECT) arthrography of the shoulder joint and to evaluate the benefits of the optimized imaging protocol. MATERIALS AND METHODS: Dual-energy scans with monochromatic spectral imaging mode and conventional single energy scans were performed on a shoulder phantom with 10 concentrations from 0 to 210 mg/mL of iodinated contrast medium at intervals of 15 or 30 mg/mL. Image noise, tissue contrast, and beam hardening artifacts were assessed to determine the optimum dose of contrast agent and the level of monochromatic energy for DECT shoulder arthrography in terms of the lowest image noise and the least beam hardening artifacts while good tissue contrast was maintained. Material decomposition (MD) imaging for bone-iodine differentiation was qualitatively assessed. The optimized protocol was applied and evaluated in 23 patients. RESULTS: The optimal contrast dose and energy level were determined by the phantom study at 60 mg/mL and 72 keV, respectively. This optimized protocol for human study reduced the image noise and the beam-hardening artifacts by 35.9% and 44.5%, respectively. Bone-iodine differentiation by MD imaging was not affected by the iodine concentration or level of energy. CONCLUSION: Dual-energy scan with monochromatic spectral imaging mode results in reduced image noise and beam hardening artifacts.

Femoral Graft-Tunnel Angles in Posterior Cruciate Ligament Reconstruction: Analysis with 3-Dimensional Models and Cadaveric Experiments

PURPOSE: The purpose of this study was to compare four graft-tunnel angles (GTA), the femoral GTA formed by three different femoral tunneling techniques (the outside-in, a modified inside-out technique in the posterior sag position with knee hyperflexion, and the conventional inside-out technique) and the tibia GTA in 3-dimensional (3D) knee flexion models, as well as to examine the influence of femoral tunneling techniques on the contact pressure between the intra-articular aperture of the femoral tunnel and the graft. MATERIALS AND METHODS: Twelve cadaveric knees were tested. Computed tomography scans were performed at different knee flexion angles (0degrees, 45degrees, 90degrees, and 120degrees). Femoral and tibial GTAs were measured at different knee flexion angles on the 3D knee models. Using pressure sensitive films, stress on the graft of the angulation of the femoral tunnel aperture was measured in posterior cruciate ligament reconstructed cadaveric knees. RESULTS: Between 45degrees and 120degrees of knee flexion, there were no significant differences between the outside-in and modified inside-out techniques. However, the femoral GTA for the conventional inside-out technique was significantly less than that for the other two techniques (p<0.001). In cadaveric experiments using pressure-sensitive film, the maximum contact pressure for the modified inside-out and outside-in technique was significantly lower than that for the conventional inside-out technique (p=0.024 and p=0.017). CONCLUSION: The conventional inside-out technique results in a significantly lesser GTA and higher stress at the intra-articular aperture of the femoral tunnel than the outside-in technique. However, the results for the modified inside-out technique are similar to those for the outside-in technique.