Operative treatment of chronic ulnar collateral ligament humeral origin avulsion fracture in young baseball players.

Chronic ulnar collateral ligament humeral origin avulsion fracture in young baseball players is a rare condition and a difficult problem to treat. Eight high school or college student baseball players with onset of symptoms in their adolescent ages were collected in this series. Their mean age at surgical intervention was 17.8 ± 1.99 years. The fracture was operated on with muscle splitting, ulnar nerve-sparing technique. Suture anchors were employed to fix the avulsed fragment. Visual analog scale, Mayo elbow performance score, and Conway scale were used for objective patient evaluation. The patients were followed up for 30.8 ± 10.2 months. Six patients have achieved solid bony union, and 2 had partial union. All patients showed no medial space widening on followed-up stress films. Visual Analogue Scale score improved from 9 to 0. The Mayo elbow performance score improved from 60 ± 10 to 85 ± 15 points pre- and post-operatively. The Conway scale had 3 excellent, 3 good, and 2 fair results. The average return to pitching occurred 7 months post-operatively at a rate of 75%. The present results indicate that open reduction and fixation with suture anchors is an effective treatment method for chronic ulnar collateral ligament humeral origin avulsion fracture in young baseball players.

Primary Synovial Osteochondromatosis of the Hip Joint Treated with Arthroscopic-assisted Mini-open Surgery-Two Case Reports.

INTRODUCTION: Primary synovial osteochondromatosis of the hip joint is a rare condition. It is characterized by the presence of multiple intra-articular loose bodies and can result in mechanical symptoms, even causing degenerative change. Surgical treatment is indicated for synovial osteochondromatosis of the hip joint. However, the optimal approaches for successful surgical management are still controversial. CASE REPORT: We report two cases with primary synovial osteochondromatosis of the hip joint where arthroscopic-assisted mini-open surgical treatmentwas performed. The posterior approach was used, and a minimal arthrotomy was performed with preservation of bloody supplement of thefemoral head. With the assistance of an arthroscope, synovectomy, debridement, and loose body removal were completed without dislocating the femoral head. The follow-up duration was 5years and 2.5 years, respectively. There were no perioperative or post-operative complications. At the latest follow-up, the patients remain symptom free with no radiographic evidence of recurrence. CONCLUSIONS: Our arthroscopic-assisted mini-open method could achieve the goals of extensive synovectomy, debridement, and loose body removal, thus reducing the recurrence rate. This method avoids dislocation of the femoral head, thus reducing the occurrence of surgical complications.

Clinical Outcome of Minimally Invasive Decompression Without Discectomy in Contained Foraminal Disc Herniation: A Single-Center Study.

BACKGROUND: Foraminal disc herniation is rare. When conservative treatment fails, it is often treated with discectomy via a paraspinal or Wiltse approach. In contained foraminal disc herniation, more symptoms arise from the foraminal compression of the exiting nerve root, including the dorsal root ganglion, than from the herniation itself. We aimed to evaluate the benefits of stand-alone decompression without discectomy for patients with contained foraminal disc herniation. METHODS: This study included 17 patients with unilateral single-level foraminal disc herniation (14 women and 3 men; mean age, 62.8 ± 14.6 years, range, 37-86 years). Disc herniation was confirmed as contained by preoperative magnetic resonance imaging and/or computed tomography and by intraoperative exploration. All patients underwent thorough decompression without discectomy, via a paraspinal approach. Pain was evaluated preoperatively and at 3 and 12 months postoperatively using a visual analog scale (VAS). The Oswestry Disability Index (ODI) and Macnab criteria were used to evaluate final outcomes. RESULTS: The most commonly affected level was L5-S1. All 17 patients showed significant improvements in VAS and ODI scores at 3 and 12 months postoperatively. According to the Macnab criteria, outcome results were excellent in 13 patients and good in 4. The mean duration of follow-up was 18.4 ± 2.4 months, with no recurrences or lumbar instability at the final follow-up. CONCLUSIONS: Stand-alone decompression without discectomy is an effective method for relieving symptoms and preserving the disc in contained foraminal disc herniation. A minimally invasive approach with thorough decompression techniques yields good results.

High Prevalence of Methicillin-Resistant Staphylococcus aureus among Patients with Septic Arthritis Caused by Staphylococcus aureus.

BACKGROUND: This study investigated the clinical characteristics of patients with septic arthritis caused by Staphylococcus aureus and tried to identify the risk factors for methicillin-resistant S. aureus (MRSA) arthritis. METHODS: Between January 2008 and December 2011, patients with septic arthritis caused by S. aureus were identified from the computerized databases of a regional hospital and a medical center in southern Taiwan. The medical records of these patients were retrospectively reviewed. RESULTS: A total of 93 patients with S. aureus arthritis were identified, and MRSA arthritis was found in 38 (40.9%) cases. The mean age of the patients was 58 years, and 86 (92.5%) episodes were classified as community-acquired infections. Diabetes mellitus (n = 41, 44.1%) was the most common underlying disease, followed by chronic kidney disease and liver cirrhosis. Patients with MRSA arthritis were more frequently elderly and found in the setting of healthcare-associated infection than patients with methicillin-susceptible S. aureus (MSSA) infections. No other significant differences in clinical manifestations and outcomes were noted between these two groups of patients. Overall, the in-hospital mortality rate was 5.4%, and diabetes mellitus was the only risk factor for mortality. CONCLUSIONS: MRSA is emerging in the setting of community-acquired septic arthritis. MRSA septic arthritis is more likely to develop in the elderly and in healthcare-associated infections than MSSA septic arthritis.

Right iliac aortic aneurysmal hemorrhage as a complication of lumbar discectomy.

BACKGROUND: Vascular injury is rarely reported but can be a life-threatening complication after lumbar disc surgery. CASE DESCRIPTION: We report a case of the rupture of a pseudoaneurysm of the right common iliac artery after spinal surgery for herniation of an intervertebral disc. It was successfully treated by prompt surgical repair. CONCLUSION: This case reminds us of this rare but possible complication, and emphasizes the importance of early diagnosis and urgent intervention.

Distraction arthroplasty of the trapeziometacarpal joint without trapeziectomy.

BACKGROUND: Thumb carpometacarpal joint (CMC) arthrosis leads to pain and joint instability. Therefore, pain relief and functional restoration of the CMC joint are primary goals of surgical treatment, after failure of conservative treatment. Several options for surgical treatment were listed, ranging from simple debridement of the joint, reconstruction with tendon graft, arthroplasty, to arthrodesis. Distraction arthroplasty is a good choice for mild to moderate CMC arthrosis or instability. METHODS: Ten patients with persistent basal joint pain who failed conservative treatment and having basal joint instability with significant poterolateral translation were included. They were treated by distraction arthroplasty without trapeziectomy. The functional outcome was evaluated by Patient-Rated Wrist Evaluation (PRWE) questionnaire. The Wilcoxon signed-rank test was used for analysis. RESULTS: The mean follow up period is 37 months (minimum 15 months). All patients achieved total or near total pain relief. Significant improvement of functional outcome was gained. The PRWE functional score showed an average improvement of 41.5 (p = 0.005). No loss of reduction or CMC joint instability was noted. CONCLUSION: Our technique (distraction arthroplasty without trapeziectomy) preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.

Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management.

BACKGROUND: Avulsion fractures of the posterior cruciate ligament have long been regarded as rare injuries. In the past, it was common practice to use cast immobilization as an external adjunct after open reduction and internal fixation of fractures. METHODS: Sixteen patients with displaced avulsion fractures of the posterior cruciate ligament were treated with open reduction and internal fixation between August 1989 and July 1993. Malleolar screws were chosen as fixation devices in 14 patients. In the other two, pull-through sutures were used because the size of the fractured fragments was too small to obtain purchase of screws. The postoperative management protocol evolved from an initial regimen of 6 weeks' immobilization in a cast with the knee flexed to 40 degrees for the first five patients (group I), to 4 weeks' immobilization in a cast for the next six patients (group II), to the present protocol of immediate postoperative range of motion (40-70 degrees) with muscle-strengthening exercises in a functional brace for the last five patients (group III). The average follow-up period was 36 months (range, 24-58 months). Hughston's criteria were used to assess the clinical results. RESULTS: Overall, there were 12 (75%) good and 4 fair (25%) results. There was no poor result. CONCLUSION: Avulsion fractures of the posterior cruciate ligament should be treated with open reduction and stable internal fixation if any displacement is seen on initial radiographs at presentation. With the use of functional brace and aggressive postoperative rehabilitation program (i.e., immediate range of motion of 40-70 degrees with muscle-strengthening exercises), satisfactory results can be expected and achieved.