Epidemiology and Characteristics of Ankle and Foot Injuries in Electric Scooter-Related Accidents

Background

The use of electric scooters (e-scooters) continues to increase as a simple, inexpensive means of transport, resulting in a sharp increase in the incidence of scooter-related accidents. No study to date has closely examined the injury extent to the lower leg, joints, and extremities from e-scooter-related accidents. Here, we investigated the epidemiology and injury patterns of such accidents, focusing on injuries to the ankle and foot.

Methods

Based on data from a single tertiary hospital's database, the demographics of 563 patients with scooter-associated injuries were analyzed retrospectively. Among the patients, 229 patients who were injured by e-scooter riding were further investigated. Based on the data, the general demographics of whole scooter-associated injuries and the injury characteristics and fracture cases of the lower leg, ankle, and foot were analyzed.

Results

During the 4-year study period, the number of patients injured by e-scooters increased every year. Lower extremities were the most common injury site (67.2%) among riders, whereas injuries to the head and neck (64.3%) were more common in riders of non-electric scooters. Among the lower leg, ankle, and foot injuries of riders (52 cases), the ankle joint (53.8%) was the most commonly injured site, followed by the foot (40.4%) and lower leg (21.2%). The fracture group scored significantly higher on the Abbreviated Injury Scale than the non-fracture group (p < 0.001). Among the fracture group (20 cases), ankle fractures (9 cases) were most common, including pronation external rotation type 4 injuries (4 cases) and pilon fractures (2 cases). Five patients (25%) had open fractures, and 12 patients (60%) underwent surgical treatment.

Conclusions

The ankle and foot are the most common injury sites in e-scooter-related accidents. Given the high frequency and severity of e-scooter-related ankle and foot injuries, we suggest that more attention be paid to preventing these types of injuries with greater public awareness of the dangers of using e-scooters.

Fracture gap and working length are important actionable factors affecting bone union after minimally invasive plate osteosynthesis for the treatment of simple diaphyseal or distal metaphyseal tibia fractures

INTRODUCTION

Indirect reduction of minimally invasive plate osteosynthesis (MIPO) can often result in delayed union in tibia fractures. This study evaluated several factors in MIPO in relation to bone union.

HYPOTHESIS

We hypothesized that the fracture gap, plate - tibia distance, or working length would have a substantial effect on the tibia union rate.

MATERIALS AND METHODS

Forty-one patients with simple diaphyseal or distal metaphyseal tibia fractures who underwent internal fixation surgery using the MIPO technique were divided into two groups: patients with delayed union and patients without delayed union. Non-actionable factors involving AO/OTA classification, fibula fracture and actionable factors including postoperative fracture gap, plate - tibia distance, working length in relation to parameters of bone union were compared between the two groups. Also cumulative rates of bone union and risk factors of delayed union according to variables of interest were investigated.

RESULTS

AO/OTA classification, site of fibula fracture, postoperative fracture gap, working length, and bone union rate of the two groups significantly differed (p<0.05). The cumulative rate of bone union during 1-year follow-up according to 43A tibia fracture, distal fibula fracture, fracture gap, and working length significantly differed between the two groups (p<0.05). By univariate Cox proportional hazards model, 43A tibia fracture, distal fibula fracture, facture gap, and short working length were risk factors for delayed union (p<0.05).

DISCUSSION

Non-actionable factors involving AO/OTA classification, distal fibula fracture and actionable factors including postoperative fracture gap, working length were significant factors affecting bone union after MIPO. The present study indicated that small fracture gap and long working length during MIPO might facilitate bone healing in tibia fracture.

LEVEL OF EVIDENCE

IV; single-center retrospective cohort study.

Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy

PURPOSE

Changes in coronal and sagittal alignment of the knee joint after HTO have been reported in several previous studies. However, only few of them investigated the changes only on coronal alignment of the ankle joint. The purpose of this study was to investigate changes in both coronal and sagittal alignment of the ankle joint after HTO.

METHODS

46 patients (49 cases) who underwent HTO were retrospectively analyzed. Preoperative and postoperative lower extremity scanogram and EOS imaging system were investigated. The hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and knee tibia plafond angle (KTPA) were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), talar tilt (TT), tibial plafond inclination (TPI), and ankle joint axis point on the weight-bearing-line (AAWBL) ratio were measured by scanogram to investigate coronal alignment of the ankle. Knee lateral ankle surface angle (KLAS) and tibial lateral surface angle (TLS) were measured by EOS to evaluate sagittal alignment of the ankle.

RESULTS

Varus alignment of the knee was corrected by significant change of the HKA angle (5.8 ± 3.1° vs. - 2.1 ± 2.8°, p < 0.001), MPTA (85.7 ± 2.9° vs. 91.7 ± 3.3°, p < 0.001), and KTPA (5.0 ± 3.5° vs. - 2.1 ± 4.2°, p < 0.001) after HTO. Regarding the ankle coronal alignment, there was significant change in TPI (3.9 ± 3.4° vs. - 0.9 ± 3.8°, p < 0.001) and AAWBL ratio (45.5 ± 14.7% vs. 61.6 ± 13.3%, p < 0.001). In sagittal alignment of the ankle, KLAS (4.5 ± 3.1° vs. 7.7 ± 3.7°, p < 0.001) significantly increased. Among the variables, the amount of correction in AAWBL ratio (R = 0.608, p < 0.01) showed strongest relationship with tibial correction angle.

CONCLUSION

Based on the present study, coronal and sagittal alignment of ankle joint was significantly affected by HTO. After HTO, AAWBL ratio increased due to lateralization of the ankle joint axis, and KLAS increased due to increased posterior tibial slope.

LEVEL OF EVIDENCE

III.

Intracapsular Chondroma Occurring in Metacarpophalangeal Joint of the Hand: A Rare Presentation

Extraskeletal chondroma comprises synovial chondromatosis, intracapsular chondroma and soft tissue chondroma, its presentation in the hand, however, is very rare. A 42-year-old woman presented with a mass around right fourth metacarpophalangeal (MCP) joint. She had no pain or discomfort in activities. The radiographs showed soft tissue swelling, but no calcification or ossifying lesions. The magnetic resonance imaging (MRI) showed a lobulated juxta-cortical encircling mass existing around the fourth MCP joint. We did not suspect any cartilage-forming tumour in MRI. The mass was easily removed because there was no adhesion with surrounding tissues and the specimen had the appearance of a cartilage. The histological diagnosis was chondroma. Based on the tumour location and histological results, we diagnosed it as intracapsular chondroma. Although intracapsular chondroma is very rare-ly seen in the hands, it is important to consider an intracapsular chondroma when differentiating a tumour in the hand because it is difficult to diagnose one in an imaging examination. Level of Evidence: Level V (Therapeutic).

Diagnostic Criteria and Treatment of Atypical Ulnar Fractures Associated With Prolonged Bisphosphonate Therapy: Multicenter Case Analysis

PURPOSE

Atypical ulnar fracture (AUF) related to prolonged bisphosphonate therapy is a rare complication. We propose diagnostic criteria of AUFs and present a treatment algorithm.

METHODS

Twelve AUFs in 10 patients were studied. The diagnosis of AUF was based on the case definition of atypical femoral fracture (AFF). We investigated clinical and radiographic characteristics of AUFs according to major and minor features of AFFs, and modified the case definition of an AFF to fit the characteristics of AUFs. All AUFs were treated surgically. The radiographic union of fractures was investigated, and delayed fracture healing was defined as a delay of 6 months or more.

RESULTS

The average point at which AUFs occurred was at a point 35.1% along the proximal diaphysis of the total ulnar length. All major features of AFFs were identified in the 12 AUFs. Among the minor features, generalized cortical thickening was observed in 6 AUFs, prodromal symptoms in 2 AUFs, bilateral involvement in 2 patients, and delayed fracture healing in 10 AUFs (5 delayed union, 5 nonunion). Initially, 11 of 12 AUFs were treated with plating, and 1 was treated with intramedullary nailing. Two nonunions were revised with sclerotic bone resections, bone grafts, and plate fixation. Finally, union was achieved in 9 AUFs.

CONCLUSIONS

The case definition of AFFs can be used for the diagnosis of AUFs, although some modifications must be included in the case definition. Plating is useful in managing AUFs, although sclerotic bone resections and bone grafts may be required. Atypical ulnar fractures occurred in patients who took bisphosphonates longer than AFFs or those whose bisphosphonates were discontinued a few years earlier. Therefore, physicians should be aware of AUFs in those patients and, if necessary, perform a screening test to look for atypical fractures in other bones.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic V.

Sagittal Parameters of Spine and Pelvis in Young Adults Using the EOS Imaging System: Prospective Study of 92 Asymptomatic Subjects

Study Design

This study adopted a prospective study design to evaluate the sagittal parameters of the spine and pelvis in young adults using the EOS imaging system.

Purpose

This study was designed to analyze spinopelvic sagittal alignment measurement values obtained using the EOS imaging system in asymptomatic young adults.

Overview of Literature

Sagittal alignment of the spine and pelvis is important in diagnosing and treating spinal diseases. We usually take sagittal images using whole-spine standing lateral radiography. Recently, the EOS imaging system, which uses a low-dose radiation in a weight-bearing state, was developed. So, we studied the sagittal parameters of the spine and pelvis in young adults by using the EOS imaging system.

Methods

We recruited young adults aged 20-30 years and explained the EOS imaging system. They voluntarily participated in the study. We took full-body standing orthogonal anteroposterior and lateral images using the EOS imaging system (EOS imaging, Paris, France). Then, we measured the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), T1/T12 kyphosis, and L1/S1 lordosis. We analyzed each parameter using Student t-test, paired t-test, and Pearson's correlation coefficient.

Results

Ninety-two patients were enrolled in the study. The average PI and SS were 47.18° and 36.03°, respectively. Moreover, PT and SVA were 11.17° and -10.15 mm, respectively. T1/T12 kyphosis was 37.37°, while L1/S1 lordosis was 46.64°. All parameters were enough for normal distribution. Pearson correlation coefficient analysis showed a meaningful correlation between PI and SS and PI and PT (R>0.6, p<0.05).

Conclusions

Measuring spinal and pelvic sagittal values is important. Sagittal parameters could help decide how to operate patients with spinal diseases. We attempted to obtain sagittal values using the EOS imaging system. These parameters could help preoperatively estimate the lumbar lordosis restoration and could also be used as guidelines for spinopelvic sagittal balance.

Computed Tomography-Based Morphologic Analysis of Osteoarthritis of the Distal Radioulnar Joint Associated with Extensor Tendon Ruptures

Backgroud

Although the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs.

Methods

Twelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister's tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared.

Results

Statistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister's tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister's tubercle to SN were statistically significant risk factors among the 8 parameters.

Conclusions

ETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister's tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.

Extensor Tendon Rupture Due to Advanced Kienböck's Disease: Two Case Reports and a Review of Literature

Extensor tendon rupture of the finger is a very rare complication of Kienböck's disease. However, advanced Kienböck's disease can cause an attritional rupture of extensor tendons due to displaced lunate fragment. An extensor tendon of the thumb is frequently damaged in the distal radial fracture, and an extensor tendon of the fifth finger is mainly ruptured in arthritis of distal radio-ulnar joint. On the other hand, the extensor tendons of the 2^nd, 3^rd and 4^th fingers are usually ruptured in advanced Kienböck's disease. We report two elderly patients diagnosed with advanced Kienböck's disease after non-traumatic rupture of extensor tendon of the fingers. Since the extensor tendon rupture in Kienböck's disease present as a loss of active extension of metacarpophalangeal joint in the central fingers, these patients should undergo imaging of the wrist joints to ascertain concomitant Kienböck's disease.

Reliability of the EOS Imaging System for Assessment of the Spinal and Pelvic Alignment in the Sagittal Plane

Background

The sagittal alignment of the spine and pelvis is not only closely related to the overall posture of the body but also to the evaluation and treatment of spine disease. In the last few years, the EOS imaging system, a new low-dose radiation X-ray device, became available for sagittal alignment assessment. However, there has been little research on the reliability of EOS. The purpose of this study was to evaluate the intrarater and interrater reliability of EOS for the sagittal alignment assessment of the spine and pelvis.

Methods

Records of 46 patients were selected from the EOS recording system between November 2016 and April 2017. The exclusion criteria were congenital spinal anomaly and deformity, and previous history of spine and pelvis operation. Sagittal parameters of the spine and pelvis were measured by three examiners three times each using both manual and EOS methods. Means comparison t-test, Pearson bivariate correlation analysis, and reliability analysis by intraclass correlation coefficients (ICCs) for intrarater and interrater reliability were performed using R package "irr."

Results

We found excellent intrarater and interrater reliability of EOS measurements. For intrarater reliability, the ICC ranged from 0.898 to 0.982. For interrater reliability, the ICC ranged from 0.794 to 0.837. We used a paired t-test to compare the values measured by manual and EOS methods: there was no statistically significant difference between the two methods. Correlation analysis also showed a statistically significant positive correlation.

Conclusions

EOS showed excellent reliability for assessment of the sagittal alignment of the spine and pelvis.

The Treatment of Distal Radius Fractures with Ipsilateral Elbow Injury

Background: The purpose of this study was to assess the functional outcomes of simultaneous distal radius fractures (DRFs) and ipsilateral elbow injuries (IEI) and to evaluate whether the DRFs and IEI affect each other’s outcomes.

Methods: From February 2008 to March 2015, 29 of 846 patients treated for DRFs were found to be associated with IEI and 26 patients with follow-up over 12 months were enrolled. There were 12 men and 14 women with a mean age of 55 years (range, 17–86 years). Associated IEI was divided into fracture group (10 patients) and dislocation group (16 patients). Clinical outcomes of DRFs and IEI were evaluated using the Gartland and Werley score and Mayo Elbow Performance Score, respectively. A correlation between the wrist scoring and the elbow scoring was analyzed. In addition, the wrist scoring between fracture group and dislocation group of the elbow was compared.

Results: The DRFs was rated as excellent in 14 patients, good in seven patients, and fair in five patients. The IEI was rated as excellent in 12 patients, good in 11 patients, fair in two patients, and poor in one patient. Acceptable outcome rate of both DRFs and concomitant IEI was 73%, although that of DRFs and IEI was 81% and 88%, respectively. A correlation between the wrist outcome and the elbow outcome showed a negative linear relationship (Spearman rho = −0.435, p = 0.026). In addition, there was no difference in the outcome of DRFs between ipsilateral elbow fractures group and dislocation group.

Conclusions: As a correlation of DRFs and ipsilateral IEI have a linear relationship, the functional outcomes of both injuries are related to each other. Therefore, we recommend that combined injuries should be managed appropriately at the same time for contended recovery of the wrist and elbow.

Radiologic Changes by Early Motion in Neck Fractures of the Fifth Metacarpal Treated with Antegrade Intramedullary Fixation

BACKGROUND

As intramedullary (IM) fixation is one of the fixation methods used in neck fractures of the fifth metacarpal, an early motion of injured finger can be allowed. The purpose of this study is to evaluate whether immediate active motion affects the stability of antegrade IM fixation in surgical treatment of neck fractures of the fifth metacarpal bone and to assess related factors.

METHODS

Thirty one patients treated by closed reduction and antegrade IM fixation were consecutively enrolled. All patients started active motion of the little finger since 7 postoperative days and only daily activities including writing, typing or washing were allowed until the union of fracture. All fractures were healed within four to eight weeks. The changes of angulation, fifth metacarpal length and tip to head distance of K-wire were compared between immediate postoperative radiographs and radiographs at eight weeks. In addition, the effects by age, gender, initial angulation and comminution of the metacarpal neck were assessed.

RESULTS

The average change of angulation was 0.12°, 5th metacarpal length was 1.49mm and tip to head distance of K-wire was 1.31mm. There was no significant difference in the change of angulation (p = 0.137). But, there were significant differences in the change of 5th metacarpal length and tip to head distance of K-wire ([Formula: see text]). The change of angulation was related to a comminution of the metacarpal neck and that of 5th metacarpal length was related to age and sex.

CONCLUSIONS

The change of 5th metacarpal length and tip to head distance of K-wire can occur by an early mobilization in the antegrade IM fixation for neck fractures of the fifth metacarpal. However, we thought that an early active motion after surgery is important to increase the patients' satisfaction, even though careful selection of candidates is necessary.

Atypical Fracture of the Proximal Shaft of the Ulna Associated with Prolonged Bisphosphonate Therapy

Atypical fractures have been reported as a complication of long-standing bisphosphonate therapy and occur commonly in the subtrochanteric region or shaft of the femur showing typical radiographic features. We encountered a case of atypical fracture of the proximal one-third of the shaft of the ulna. Radiographic findings of this case differed from previously reported cases of ulnar fracture in terms of showing a transverse fracture line with cortical thickening and an oblique fracture line with anterior cortical spike. On the other hand, these findings were similar to radiographic features of atypical femoral fractures. The present case was managed surgically and union of fracture was achieved after 6 months. As there are possibilities of occurrence of atypical fractures in sites other than the femur, the physicians should cautiously examine the patients' history and radiographic findings.

New Technique for Removal of the Ulnar Intramedullary Nail Failed to Remove: Broken Assembly Piece in the Nail

Methods about removal of intramedullary nail in complicated cases were reported in some literatures but there are no reports about nail removal in the ulna. The authors would like to report such a case and the technique. We removed bone of the inlet site and created another bony window using an osteotome to expose the interlocking screw holes. Only a bony window the size of 2 inter-interlocking holes at the most proximal part of the nail can be used to remove the nail with minimal damage of the triceps brachii tendon and soft tissue.

Posterior Deltoid-to-Triceps Tendon Transfer for Elbow Extension in a Tetraplegia Patient: A Case Report

In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case—a 36-year-old man—with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29.

Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing

Background

Plate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient's condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs.

Methods

Fifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results

In groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent.

Conclusions

The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.

Unstable Simple Elbow Dislocation Treated with the Repair of Lateral Collateral Ligament Complex

Background

Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED.

Methods

We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images.

Results

All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS.

Conclusions

USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.

Changes in bone mineral density of both proximal femurs after total knee arthroplasty

Background

This study investigated the effects of total knee arthroplasty (TKA) on bone mineral density (BMD) of the proximal femur in patients who underwent the procedure.

Methods

Forty-eight patients scheduled to undergo unilateral TKA because of primary knee osteoarthritis were included in this study, which was conducted at a medical center between October 2006 and October 2009. In these 48 patients, 96 hips were evaluated. Measurement of BMD was performed preoperatively and one month, three months, six months, and one year after unilateral TKA. Repeated measured analysis of variance and paired t-tests for comparison of two repeated samples were used to compare differences between time points (preoperation, one, three, six, and 12 months) and between the operative and nonoperative sides.

Results

Preoperatively, BMD of the femoral neck, trochanter, and total hip on the operative side were lower than on the nonoperative side; however, there was no statistical difference. BMD of both femoral neck areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both trochanter areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both total hips was significantly lower than preoperative BMD at three months after TKA. However, no statistical differences of changes in BMD were observed between the operative and nonoperative sides at each measurement time.

Conclusions

According to our results, TKA was found to affect both proximal femurs during the acute period. However, TKA did not affect a change in BMD of the proximal femur during one year postoperative.

Evaluation of associated carpal bone fractures in distal radial fractures

Background

The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs).

Methods

Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed.

Results

CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury between patients with DRFs and CBFs and those without CBFs.

Conclusions

Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.

Evaluation of the sigmoid notch involvement in the intra-articular distal radius fractures: the efficacy of computed tomography compared with plain X-ray

Background

The purpose of this study is to evaluate the efficacy of computed tomography (CT) scans compared with plain radiographs on detecting the involvement of the sigmoid notch.

Methods

This study involved 121 cases diagnosed as the intra-articular distal radius fracture and performed post-reduction CT scans. We determined the presence of the sigmoid notch involvement with both plain radiographs and CT scans and compared findings of plain radiographs with CT scans about the incidence and the pattern of injuries. And the differences of results between arbeitsgemeinschaft für osteosyntheses (AO) type C2 and C3 were compared.

Results

The incidences of sigmoid notch involvement detected in plain radiographs were 81 cases (66.9%), whereas CT scans were 99 cases (81.9%). The sensitivity of plain radiographs compared with CT scans was 74.7%, the specificity was 68.2%, the positive predictive value was 91.4%, the negative predictive value was 37.5%, the false negative value was 25.3%, and the false positive value was 31.8%. In comparison between AO type C2 and C3, the incidence of sigmoid notch involvement was not a significant difference, but the displacement of fracture fragment showed a significant difference.

Conclusions

The intra-articular distal radius fracture usually accompanies the sigmoid notch involvement. Considering that the evaluation of sigmoid notch involvement by plain radiography often results in misinterpretation or underestimation, performing CT scan in intra-articular distal radius fracture is thought to be beneficial.

Ultrasound-guided supraclavicular brachial plexus block in pediatric patients -A report of four cases-

Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery.

A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation

Background

A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery.

Methods

One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery.

Results

There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction.

Conclusions

Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

A clinical comparison of vertical infraclavicular brachial plexus block using 0.75% or 0.5% ropivacaine for upper limb surgery

BACKGROUND

We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery.

METHODS

We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed.

RESULTS

There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine.

CONCLUSIONS

Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.