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Acute traumatic posterior glenohumeral dislocation in association with a massive rotator cuff tear is rare. Moreover, only few cases with interposition of the long biceps head of the tendon has been described to prevent reduction in posterior dislocation of the shoulder. In addition, combined scapula fracture with posterior shoulder dislocation also extremely rare. We present a case of Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon. For the treatment arthroscopic in situ superior capsule reconstruction was performed using the long head of the biceps tendon with rotator cuff repair.

Fracture of the ossification center of the humerus lateral epicondyle during adolescence is a rare injury. Generally, nondisplaced fractures of the humerus lateral epicondyle heal after conservative treatment, such as short-term immobilization using either a cast or a sling. However, complications such as stiffness, instability, pseudarthrosis, and incarceration of the fracture fragment within the elbow joint are associated with relatively displaced fractures of the humerus lateral epicondyle during adolescence. Recently, it has become possible to arthroscopically repair the lateral collateral ligament complex using advanced arthroscopic techniques. We present a case of all-arthroscopic treatment of avulsion fracture of the humerus lateral epicondyle in an adolescent using a single working portal, two all-suture anchors, and the double-pulley repair technique.

We describe the case of an 11-year-old female patient who was diagnosed as having rhabdomyolysis. Furthermore, rhabdomyolysis in a localized area has not yet been well studied. The diagnosis was made on the basis of the findings from several imaging studies and laboratory data. In addition, interdepartmental consultation was performed to rule out other possible diagnoses. After the diagnosis, the patient was treated with vigorous intravenous hydration and immobilization of the affected area. Regular laboratory follow-ups were performed, and the patient could be discharged with no complication. The patient remained clinically stable at the time of discharge and returned to daily life and sporting activities without any further symptoms at the 1 month after discharge.

The conventional AO hook locking compression plate (LCP) (Synthes, Solothurn, Switzerland) has only three holes for lateral fragments; therefore it is not suitable for use during the fixation of small-comminuted fragments in some cases. Recently, a novel hybrid hook LCP (TDM, Seoul, Korea) was developed to overcome this limitation. Here, we evaluated the clinical and radiologic outcomes of a novel hybrid hook LCP for Neer type V distal clavicle fractures compared to the outcomes of a conventional AO hook plate.Seventy-eight consecutive patients who underwent hook LCP fixation for Neer type V distal clavicle fractures were included. The subjects were divided into 2 groups: the conventional AO hook LCP group and the novel hybrid hook LCP group. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score, Korean shoulder score (KSS), and Constant score were recorded. The percentage modified coracoclavicular distance (MCCD %) was used for the evaluation of fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, postoperative acromioclavicular joint arthrosis, non-union, or delayed union, were also analyzed.There were no differences in the clinical outcomes (ASES, KSS, and Constant scores) between the two groups. Bone union was achieved in a significantly shorter period in the hybrid hook LCP group (13.6±2.0weeks) than in the AO hook LCP group (17.5±4.8weeks, p0.001). Consequently, the time to implant removal was also significantly shorter in the hybrid hook LCP group (4.0±0.5months) than in the AO hook LCP group (5.4±1.1months, p0.001). The MCCD% showed no significant differences between the treatment groups. There was no statistically significant difference in the complication rate between the two groups; however, the hybrid hook LCP fixation resulted in a lower prevalence of hook-related complications.The hybrid hook LCP fixation showed satisfactory clinical and radiologic outcomes in comparison with the AO hook LCP fixation. The hybrid hook LCP is useful for multiple screw fixation of inferior comminuted fragments in Neer type V distal clavicle fractures. The bone union was significantly shorter; thus, the time to implant removal was also significantly shorter.Level III, Retrospective study.

The pathogenesis of degenerative subscapularis (SC) tear is not clear, several mechanisms are involved: intrinsic tendon degeneration or subcoracoid impingement. The aim of this study was to propose new radiographic markers, the coraco-lesser tuberosity angle (CLA), lesser tuberosity angle (LTA) and lesser tuberosity height (LTH). The hypothesis was that higher values of CLA, LTA, and LTH would be associated with a higher likelihood in detecting a SC tear.A total of 114 patients who classified as SC tears through arthroscopic evaluation were retrospectively enrolled in the study from 2016 to 2018. Fifty-seven patients with impingement syndrome were also enrolled as the control group for normal-population comparison. The CLA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation, the LTA and LTH were measured on magnetic resonance imaging. Multivariable analyses were used to clarify the potential risks for SC tears. All measurements were calculated by two shoulder surgeons independently measured at 2 different times, 1 month apart.The intra- and inter-observer reliabilities for radiologic measurements and the interobserver reliability of SC tear classification were almost perfect. The mean CLA value of SC tear group (41.4±4.2°) was significantly larger than that of the control group (38.7±4.0°, p0.001). The mean LTA value of SC tear group (33.4±4.3°) was significantly larger than that of the control group (31.0±3.9°, p=0.001). Mean LTH value was 9.5±1.9mm in patients and 8.9±1.5mm for controls, there was no statistically significant difference (p=0.054). Multivariable analysis showed that larger CLAs significantly increased the risk of SC tears, with odds ratios of 1.17 per degree. Moreover, larger LTAs also significantly increased the risk of SC tears, with odds ratios of 1.14 per degree.Our findings confirmed associations between new predictors (CLA and LTA) and SC tears. CLA and LTA values were greater in patients with SC tears than in controls, suggesting that they may be independent risk factors for SC tear onset.IV, retrospective study.

Cystic echinococcosis (CE) is a representative neglected tropical disease (NTD) with increased morbidity and mortality but is ignored and overlooked in developed countries. Serological and radiographic findings are helpful in distinguishing these parasites; however, conflicting results of these can make it difficult to diagnose if medical knowledge of hepatic parasitic disease, including the etiology, features of imaging, and immunodiagnostic test, is not acquired. We report the case of a male patient with dyspepsia and right epigastric pain who had positive results for cysticercosis antibodies on immunodiagnostic examination. Abdominal ultrasonography revealed two huge communicating cystic lesions measuring 8–11 cm. Further evaluations for cysticercosis of the brain (neurocysticercosis) and eyes (intraocular cysticercosis) were unremarkable throughout the brain imaging test and fundus examination. A laparoscopic right hemi-hepatectomy was performed for diagnosis and treatment. On histopathological examination, diverse stages of Echinococcus granulosus were identified. Albendazole was administered postoperatively, and the patient was also followed up. We should be aware of the etiologies that have been prevalent in parasite infection thought to be the cause of hepatic cysts. Moreover, we make an effort to ascertain the patient’s nationality, past travel experiences, and immediate environment, including any animals and pets. We present the case of a patient who was worried about the possibility of liver invasion of cysticercus due to the positivity of the cysticercosis antibody and was ultimately diagnosed with CE.

BACKGROUND: It remains unclear whether the deep layer of the rotator cuff is an articular layer of the supraspinatus (SS) or infraspinatus (IS), rotator cable, or superior capsule. Therefore, this study aimed to analyse the relationship between occupation ratios and delamination patterns of rotator cuff tears (RCTs). We hypothesised that the deep layers are related to the occupation ratios of the deep SS and IS sections. MATERIALS AND METHODS: A total of 265 patients with RCTs were retrospectively enrolled between 2013 and 2017 and divided into four groups: A, non-delaminated tear; B, delaminated tear with the deep layer equally retracted to the superficial layer; C, delaminated tear with the deep layer more retracted; D, delaminated tear with the superficial layer more retracted. Muscle volume was evaluated by measurement of each occupation ratio of the SS and IS, and the IS muscle was additionally divided into two areas, deep and superficial. RESULTS: The SS occupation ratio was significantly lower in group C than in the other groups (p = 0.009). Conversely, comparison of the IS occupation ratios revealed no significant intergroup differences. The occupation ratio of the superficial IS was significantly lower in group D than in the other groups (p = 0.003). In group C, the occupation ratios of the deep IS section were significantly decreased according to RCT size (p = 0.034). CONCLUSION: Our findings demonstrate that the superficial layers are related to the IS superficial section and the deep layers to the SS and IS deep sections. LEVEL OF STUDY: IV.

Yoo, Jae Sung;Nam, Soon Sik

Reverse Hill-Sachs lesions are occasional complication of posterior shoulder dislocation. However, Isolated fractures of the lesser tuberosity humerus are rare, occurring in only 0.46 persons per 100,000. A lesser tuberosity fracture with a reverse Hill-Sachs lesion on the humeral head is an extremely rare case presentation. We present a case of a greater tuberosity fracture of the humeral head by posterior dislocation in addition to a lesser tuberosity fracture with a reverse Hill-Sachs lesion. To our knowledge, this is the first case report of a reverse Hill-Sachs lesion with a greater and lesser tuberosity fracture of the humeral head due to posterior shoulder dislocation.

We present the case of a professional golf player who gradually developed a boutonniere deformity of the thumb due to chronic repetitive injury to the thumb and was treated with reconstruction of its insertion onto the proximal phalangeal base. The athlete showed an insertion variation of the extensor pollicis brevis, where some slips attached onto the extensor hood and the other slips ran along with the extensor pollicis longus to the distal phalanx, providing no slip to the proximal phalanx. The slips inserting to the distal phalanx were transferred to the base of the proximal phalanx and sagittal band reconstruction. As a result, the boutonniere deformity of the thumb fully recovered with satisfactory outcomes.Level of Evidence: Level V.

Anterior cable reconstruction (ACR) using the long head of the biceps tendon (LHBT) was developed to place at the native superior capsule attachment site for large to massive rotator cuff tears (LMRCTs) with anterior cable disruption. In this study, we investigated whether ACR for reinforcement before ARCR prevented retear after arthroscopic rotator cuff repair (ARCR), especially in cases of LMRCTs with anterior cable disruption. A total of 125 patients who underwent arthroscopic rotator cuff repair (ARCR) for LMRCTs were retrospectively enrolled. To assess the benefit of ACR with LHBT, all data were compared with those after ARCR alone. As a result, ACR with LHBT showed satisfactory clinical and radiologic outcomes in comparison with conventional ARCR only technique. ACR with LHBT prevented retear after ARCR and improved the AHD, although There was no difference of clinical outcomes between two groups.

BackgroundLocking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.MethodsForty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).ResultsNo significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%,p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.ConclusionsWhen implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

Background: The coracoclavicular fixation with suture anchors adds stability to type IIb distal clavicle fractures fixed with a plate and screws when loaded to failure. The purpose of this study was to compare the clinical and radiological outcomes between the use of a locking compression plate (LCP) with all-suture anchor fixation and hook LCP fixation of Neer IIb distal clavicle fractures. Methods: A total of 82 consecutive patients who underwent plate fixation for Neer IIb distal clavicle fractures were included. The subjects were divided into two groups: an LCP with all-suture anchor fixation group and hook LCP fixation group. For clinical assessments, the American Shoulder and Elbow Surgeons score, Korean shoulder score (KSS), and Constant score were recorded. A percentage of the coracoclavicular distance (CCD%) was used to evaluate fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, stiffness, peri-anchor osteolysis, postoperative acromioclavicular joint arthrosis, nonunion, or delayed union, were also analyzed. Results: There were no differences in the clinical and radiological outcomes at the final follow-up between the two groups. The period for bone union and CCD% showed no significant differences between groups. Stiffness at 3 months after surgery of LCP with all-suture anchor fixation ( n = 3, 10.7%) was less than that of hook LCP fixation ( n = 17, 31.5%). The complication rate also showed no significant differences between groups. However, LCP with all-suture anchor fixation had anchor-related complications, although it can reduce hook-related complications. Conclusion: LCP with all-suture anchor fixation showed satisfactory outcomes in comparison with hook LCP fixation. In Neer IIb distal clavicle fractures, LCP with all-suture anchor fixation is a useful method for the maintenance of reduction, avoiding implant removal, and hook-related complications. However, anchor fixation should be carefully used, especially in osteoporotic patients or patients with underlying diseases. Level of Evidence: Level III, retrospective study.

Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.Level of evidence: Level III-2, Retrospective study

BACKGROUND The purpose of this study was to evaluate the influence of anterolateral ligament (ALL) injuries on stability and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction. METHODS One-hundred and nineteen consecutive patients underwent a second-look arthroscopic surgery after ACL reconstruction and magnetic resonance imaging (MRI) examination of the ALL. The patients were divided into an ALL intact group (n = 39) and ALL injured group (n = 80). The ALL injuries were divided according to the three anatomical parts of the ALL (femoral, meniscal, and tibial) using MRI evaluation. Stability and clinical results were evaluated using the Lachman test, pivot-shift test, KT-2000 arthrometer, and Lysholm score. On second-look arthroscopy, graft tension and synovial coverage were evaluated. RESULTS The clinical evaluation revealed no significant differences in ALL injury. Although the synovial coverages showed no significant difference (P = 0.113), the second-look arthroscopic findings indicated that tension was statistically significantly dependent on the ALL injury (P

Arthroscopic Bankart repair is generally accepted as the choice of treatment for labrum and glenoid rim restoration. Recently, the antegrade suture passer has been one of the widely used devices in arthroscopic surgery. This device saves time by combining tissue grasping, suture passage, and suture retrieval into one convenient step. In addition, a knotless anchor is also used for a Bankart repair to prevent knot-induced articular cartilage injuries. Arthroscopic Bankart repair usually uses two anterior portals (anterosuperior accessory portal and anteroinferior working portal) with one posterior viewing portal. The purpose of this technical note was to present a simple and easy technique for Bankart repair using a single anterior working portal with an antegrade suture passer and knotless anchors.

Background: Hook plates are widely used for repair of acromioclavicular joint (ACJ) dislocations. However, it is unclear whether repair of torn coracoclavicular (CC) ligament is necessary. The purpose of this study was to evaluate the outcomes of the hook plate fixation with direct CC ligament repair for acute ACJ dislocation in comparison with the hook plate fixation without direct CC ligament repair. Methods: The study included 120 patients with acute ACJ dislocations who underwent surgery. The patients were divided into 73 patient groups with Arbeitsgemeinschaft für Osteosynthesefragen (AO) hook plate fixation and direct CC ligament repair and 47 patient groups without direct CC ligament repair. For clinical assessments, the American Shoulder and Elbow Surgeons score, constant score, and time for implant removal were recorded. The corcoclavicular distance (CCD) and the CCD ratio were used for the evaluation of reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, and postoperative ACJ arthrosis, were also analyzed. Results: There were no differences in the clinical outcomes between the two groups. There was no difference in the timing of implant removal between the two groups. The last follow-up CCD was not statistically significant between group with direct CC ligament repair and without repair (9.1 ± 3.3 vs. 9.0 ± 2.8, respectively, p > 0.05). The last follow-up CCD ratio showed significant differences between the two groups (12.6 ± 25.5% vs. 26.3 ± 39.7, respectively, p < 0.05). There was no statistically significant difference in the complication rate between the two groups. Conclusion: The hook plate fixation with direct CC ligament repair group was better for maintenance of reduction than that of the hook plate fixation without direct CC ligament repair group. Although, there were no differences of clinical outcomes and complications between two groups. Level of Evidence: Level III, Retrospective Study.

Background: The pathoanatomy and biomechanics of elbow instability have been previously reported; however, few researchers have dealt with the operative management and clinical consequence of recurrent elbow instability. Recent studies on arthroscopic lateral collateral ligament (LCL) complex repair have reported successful outcomes similar to those achieved by open repair. We aimed to determine the validity of arthroscopic repair of the LCL complex in elbows with unstable dislocation with or without intra-articular fracture. Methods: Eighteen consecutive patients who had undergone arthroscopic repair of the LCL complex for unstable dislocation of the elbow with or without intra-articular fracture and who were followed for at least 12 months were included in the study. Ligament injury combined with coronoid and/or radial head fractures were treated with arthroscopic technique. Pain, range of motion, clinical outcomes based on the Mayo Elbow Performance Score (MEPS), and surgical complications were evaluated. Results: At 12 months follow-up, all 18 patients demonstrated complete settlement of the instability and mean (and standard deviation) extension of 1.7 ± 3.8°, flexion of 138.3 ± 3.8°, supination of 88.6 ± 5.3°, and pronation of 88.2 ± 5.6°. The average MEPS was 97.7 ± 3.9 points and according to this validated outcome score. However, slight widening (2 mm) of the radiocapitellar joint space was accompanied in one patient, although the varus stress test and pivot shift test were not observed. One patient showed delayed union of the anteromedial facet fracture, and two patients showed pin site irritation, which was a complication of arthroscopic coronoid fracture fixation and was fully resolved after pin removal. Conclusion: In patients with unstable elbow dislocation, with or without an intra-articular fracture, arthroscopic repair of the LCL complex is an effective and alternative treatment option that can restore elbow stability and have satisfactory clinical and radiographic results.

Treatment of Hill-Sachs lesions is still controversial despite the frequent incidence in patients with recurrent shoulder dislocation. We report the use of arthroscopic microfracture for the treatment of recurrent shoulder dislocation with a linear, isolated, narrow, engaging Hill-Sachs lesion. Arthroscopic microfracture can be an alternative treatment option to obtain healing of defects and avoid external rotation limitation in young, active patients with recurrent dislocation with linear, isolated, narrow, engaging lesions.

We sought to evaluate proper elbow arthroscopy portal placement in pediatric and adolescent patients. Overall, 109 pediatric and adolescent patients who underwent elbow arthrography were included. Condylar width was measured and the proximal anterior joint capsule location was determined using the ulna-capsular distance. Condylar width and Bone mass index(BMI) also had a high positive correlation coefficient with the proximal joint capsule location. Proximal ulnar border is recommended new bony landmark in pediatric and adolescent patients who undergo elbow arthroscopy. In particular, condylar width and BMI were found to have a high positive correlation with the proximal joint capsule location.

In this paper, we propose a formula for modeling dielectric properties for evaluating the electromagnetic transmission of foamed concrete (FC) widely used as building materials. This includes the effective permittivity and loss tangent according to the foam content of FC mixes containing blast furnace slag (BFS), as well as the content of the BFS, by modifying the dielectric modeling formula for porous foam materials. The difference between the permittivity calculated using the proposed modeling formula and the actual measured permittivity ranges from 0.2% to 2.6%. The calculated result and the measured value are approximately the same. The transmission properties of FC were calculated using the calculated dielectric property values. FC samples containing BFS were fabricated using different foam and BFS content, and their transmission properties were measured, the results of which coincided well with the simulation results. Therefore, the accuracy of the proposed dielectric property modeling of FC containing BFS was verified.

Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL allows axial motion and promotes uniform callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique. Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA). Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups. Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

Despite the high failure rates of techniques used to maintain the reduction of single-tunnel coracoclavicular (CC) fixation, analyses of the etiology of loss of reduction related to surgical techniques are limited. Therefore, it was hypothesized that the initial coracoclavicular tunnel angle was related to loss of reduction in the single-tunnel technique for AC joint dislocation. This study aimed to evaluate the clinical and radiological outcomes of arthroscopic single-tunnel CC suture button fixation according to the initial coracoclavicular tunnel angle. Thirty-two consecutive patients who underwent arthroscopic single-tunnel CC suture button fixation for AC joint dislocation from 2014 to 2018 were enrolled. The tunneling-first technique was used in the first 11 patients, while the reduction-first technique was used in the remaining 22 consecutive patients. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score and Korean Shoulder Score (KSS) were recorded. For radiological evaluation, coracoclavicular distance ratio, coracoclavicular tunnel angle, coracoid, and clavicular tunnel widths were measured. The ASES score did not differ significantly between the two groups (n.s.). However, the KSS was significantly better in the reduction-first group (p = 0.031). No significant intergroup differences were observed in the pre- and postoperative coracoclavicular distance ratio. However, at the last follow-up, loss of coracoclavicular distance ratio was significantly smaller in the reduction-first group (p

Background: Recently, several in vitro biomechanical studies that used dual small locking plate fixation for humeral shaft fractures have investigated. However, in vivo studies about dual plate fixation for humeral shaft fractures are limited. The purpose of our study was to report the outcomes of dual small plating for humeral shaft fractures in comparison with those of single large fragment plating. Methods: Sixty consecutive patients who underwent an open reduction internal fixation for humeral shaft fractures at our institution from September 2014 to December 2017 were included. Single 4.5-mm locking compression plate (LCP) fixation was used in the first 40 cases, and dual 3.5-mm LCP fixation was used in the final 20 consecutive cases. Data were collected to define patient characteristics, injury mechanism, clinical outcomes, time to surgery, operative time, estimated blood loss, and complications. Using simple radiography during the follow-up period (6, 12, 24, and 52 weeks after surgery), the shoulder and elbow joint ranges of motion (ROM) were also evaluated. Results: Demographic data, time to surgery, surgical time, and estimated blood loss had no significant differences between the two groups. No significant differences were observed in nonunion rate and union rate 3 months after surgery. However, two patients (5%) in the single 4.5-mm LCP fixation group showed metal failure and breakage. No significant differences were found in postoperative shoulder and elbow ROM. Three patients (7.5%) in the single plating group and one patient (5%) in the dual plating group developed radial nerve palsy after surgery. No vascular injury and deep infection were observed in either group. Conclusion: For diaphyseal humeral fractures, dual 3.5-mm LCP fixation to the humerus is a possible treatment choice. This method showed satisfactory union rate, ROM, and complication rate, without increasing surgical time, in comparison with the conventional single 4.5-mm LCP fixation. Level of evidence: III

In all-inside anterior cruciate ligament (ACL) reconstruction, it is usually difficult to obtain sufficient autologous semitendinosus tendon length for quadruple stranded graft in Asians, females, and those with short stature. The purpose of this study was to compare biomechanical properties of three different types of suture preparations for tripled graft and determine which method could achieve sufficient strength for ACL through in vitro study. The hypothesis of this study was that suturing with a rip-stop (RS) stitch for tripled-strand graft would lead to stronger mechanical properties than suturing with buried-knot four sutures.Twenty-four bovine digital extensor tendons harvested from forelimbs were prepared for tripled-strand graft in three different ways: (1) buried-knot four sutures, (2) two RS sutures, and (3) four RS sutures. These grafts were directly connected to cylindrical metal rods of a tensile testing machine. All specimens underwent cyclic loading followed by a load-to-failure test. Preparation time, elongation, stiffness, and ultimate failure load were compared.For biomechanical comparison, the group with buried-knot four sutures was excluded because six (75%) specimens failed during the cycle load test. The group with four RS sutures showed lower total elongation (two RS sutures: 8.42±5.28mm; four RS sutures: 3.86±0.83mm, p=0.030), higher stiffness (two RS sutures: 247.28±53.39N/mm; four RS sutures: 329.27±55.56N/mm, p0.001), and higher ultimate failure load (two RS sutures: 567.74±60.50N; four RS sutures: 736.46±32.50N, p=0.009). The most common failure mechanism of triple stranded graft was tendon split across sutures.The method with four RS sutures showed sufficient strength for triple stranded graft for all-inside ACL reconstruction without increasing preparation time.III, controlled laboratory study.

Current studies suggest that radiographic markers such as the critical shoulder angle (CSA) and the greater tuberosity angle (GTA) are associated with rotator cuff tears (RCTs). However, because the analysis of CSAs and GTAs according to the partial thickness rotator cuff tear patterns is limited, the purpose of the present study was to evaluate the relationship of CSAs and GTAs with partial thickness rotator cuff tear (PTRCT) patterns.This retrospective study included 1,069 patients from 2013 to 2017. The subjects were divided into 4 groups: Group A, control group; Group B, articular-sided PTRCTs; Group C, bursal-sided PTRCTs; and Group D, full thickness rotator cuff tears (FTRCTs). RCTs were diagnosed with magnetic resonance imaging and the CSA and GTA were measured on simple radiographs. Multivariable analyses were used to clarify the potential risks for these pathologies.The mean CSAs of articular-sided PTRCTs (34.2°±4.7°) and FTRCTs (34.7°±4.4°) were significantly larger than those of the control group (32.3°±4.3°) and the bursal-sided PTRCTs (31.5°±4.6°), (P0.001). Multivariable analysis also showed that larger CSAs had a significantly increased risk of both articular-sided PTRCTs and FTRCTs, with odds ratios of 1.12 and 1.17 per degree, respectively. The mean GTAs of bursal-sided PTRCTs (73.2°±4.8°) and FTRCTs (72.3°±5.4°) were significantly larger than that of the control group (70.5°±5.1°) (P0.001), although the mean GTA of articular-sided PTRCTs (71.5°±6.9°) did not show a significant difference when compared with the other groups. Multivariable analysis also showed that larger GTAs had a significantly increased risk of both bursal-sided PTRCTs and FTRCTs, with odds ratios of 1.13 and 1.07 per degree, respectively.A large critical shoulder angle was associated more with articular-sided PTRCTs than bursal-sided PTRCTs. A large greater tuberosity angle was associated more with bursal-sided PTRCTs than with articular-sided PTRCTs. Both critical shoulder angle and greater tuberosity angle were positively associated with the occurrence of full thickness rotator cuff tears.IV, Retrospective study.

Background The conventional AO hook Locking Compression Plate (LCP) (Synthes, Solothurn, Switzerland) has only three holes for lateral fragments; therefore, it is not suitable for use during the fixation of small comminuted fragments in some cases. Recently, a novel hybrid hook LCP (TDM, Seoul, Korea) was developed to overcome this limitation. Here, we evaluated the clinical and radiologic outcomes of a novel hybrid hook LCP for Neer type V distal clavicle fractures compared to the outcomes of a conventional AO hook plate. Methods Seventy-eight consecutive patients who underwent hook LCP fixation for Neer type V distal clavicle fractures were included. The subjects were divided into 2 groups: the conventional AO hook LCP group and the novel hybrid hook LCP group. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and Constant score were recorded. The percentage Modified Coracoclavicular Distance (MCCD%) was used for the evaluation of fracture reduction. Typical reported complications, such as secondary dislocation, implant failure or loosening, peri-implant fracture, acromion osteolysis, postoperative acromioclavicular joint arthrosis, non-union, or delayed union, were also analyzed. Results There were no differences in the clinical outcomes (ASES, KSS, and Constant scores) between the two groups. Bone union was achieved in a significantly shorter period in the hybrid hook LCP group (13.6 ± 2.0 weeks) than in the AO hook LCP group (17.5 ± 4.8 weeks, p Conclusion The hybrid hook LCP fixation showed satisfactory clinical and radiologic outcomes in comparison with the AO hook LCP fixation. The hybrid hook LCP is useful for multiple screw fixation of inferior comminuted fragments in Neer type V distal clavicle fractures. The bone union was significantly shorter; thus, the time to implant removal was also significantly shorter. Level of evidence Level III, retrospective study.

Background The pathogenesis of degenerative subscapularis (SC) tear is not clear, several mechanisms are involved: intrinsic tendon degeneration or subcoracoid impingement. The aim of this study was to propose new radiographic markers, the coraco-lesser tuberosity angle (CLA), lesser tuberosity angle (LTA) and lesser tuberosity height (LTH). The hypothesis was that higher values of CLA, LTA, and LTH would be associated with a higher likelihood in detecting a SC tear. Method A total of 114 patients who classified as SC tears through arthroscopic evaluation were retrospectively enrolled in the study from 2016 to 2018. Fifty-seven patients with impingement syndrome were also enrolled as the control group for normal-population comparison. The CLA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation, the LTA and LTH were measured on magnetic resonance imaging. Multivariable analyses were used to clarify the potential risks for SC tears. All measurements were calculated by two shoulder surgeons independently measured at 2 different times, 1 month apart. Results The intra- and inter-observer reliabilities for radiologic measurements and the interobserver reliability of SC tear classification were almost perfect. The mean CLA value of SC tear group (41.4 ± 4.2°) was significantly larger than that of the control group (38.7 ± 4.0°, p Conclusion Our findings confirmed associations between new predictors (CLA and LTA) and SC tears. CLA and LTA values were greater in patients with SC tears than in controls, suggesting that they may be independent risk factors for SC tear onset. Level of evidence Level IV, retrospective study.

The purpose of this study was to analyze the relationship between the occupation ratio and partial-thickness rotator cuff tears. The study included and retrospectively investigated 683 patients with partial-thickness rotator cuff tears between 2013 and 2017. Fifty patients with impingement syndrome were also enrolled as the control group for normal-population comparison. The participants were divided into five groups: Group A, control group; Group B

We have prepared three pigments and six soluble dyes with thermal stability derived from diketo-pyrrolo-pyrrole (DPP) pigment by N-alkylation and dimerization. Synthesized dyes and pigments were measured by an absorption maximum (λmax) and thermal stability using a UV-VIS spectrophotometer and thermogravimetric analysis (TGA) respectively, comparing with C.I. Pigment Red 254. These dyes exhibited superior solubility to the organic solvents by introducing the linking group (n-octyl). DPP pigments have inferior thermal and solvent stability, which has so far inhibited their commercial adoption in color filter fabrication. The thermal stability of the N-alkylated dyes can be highly contributed by both the carbon number and their shapes of N-alkyl group in DPP ring.

Four thermally stable and solvent soluble dyes were prepared from diketopyrrolopyrrole pigment via an N-alkylation reaction. To improve the thermal stability of the dyes, a hydroxyl functional group that could react with blocked polyisocyanates was introduced into the dyes. The prepared dyes had absorption maxima near 500 nm, and the chromaticity diagrams of all synthesised dyes exhibited smaller x and y values than those of CI Pigment Red 254, indicating that the colour of the synthesised dyes was close to an orange shade. The dyes reacting with blocked polyisocyanates showed extremely high thermal stability compared with analogous dyes not reacting with polyisocyanates.

A giant cell tumor of the tendon sheath (GCTTS) is a localized form of giant cell tumor and is a benign lesion of uncertain etiology that involves trauma, inflammation, allergy, toxin, clonal chromosomal abnormalities, and aneuploidy [1, 2]. GCTTS is clinically a slow growing soft tissue mass that develops over a period of several months to a year [3]. Approximately 85 % of GCTTS occurs in the fingers, while 12 % of tumors are located in the knee, elbow, hip, and ankle [4]. The tumor affects individuals between the age of 30 and 50 years and is found more often in women than in men [5]. GCTTS in the knee is extremely rare, particularly in children [4]. The average tumor size of GCTTS is about 2 cm [6], although the tumor in this case, measuring 3.0×2.4×2.2 cm, was much larger than average. Moreover, almost all cases of GCTTS of the patella tendon are located in the infrapatella fat pad [7]; however, in this case, the mass is located anterior to the patella tendon. We present a case of a large-sized GCTTS that is located anterior to the patella tendon in a 7-year-old girl.

The purpose of this study was to evaluate sonoelastography (SE) in the assessment of the long head of biceps tendon (LHBT) in patients with symptoms of biceps tendinitis or tendinosis and in patients without biceps lesion. The findings were compared with those obtained at clinical examination, using ultrasonography (US).36 shoulders of 34 consecutively registered patients with clinical symptoms and US findings of biceps tendinitis or tendinosis, and 114 shoulders of 98 patients without biceps lesions were assessed with SE. Transverse and longitudinal images of LHBT were obtained using SE. SE images were evaluated by reviewers using an experimentally proven color grading system.The transverse images of SE showed a mean sensitivity of 69.4 %, a mean specificity of 95.6 % and a mean accuracy of 89.3 %. Good correlation of conventional ultrasound findings was found (p 0.001, r = 0.763). The longitudinal images of SE showed a mean sensitivity of 94.4 %, a mean specificity of 92.1 % and a mean accuracy of 92.7 %. Good correlation of conventional ultrasound findings was found (p 0.001, r = 0.585). Inter-observer reliability of SE was in "almost perfect agreement" with a weighted kappa coefficient of 0.84.SE has potential to be clinically useful in the detection of the intratendinous and peritendinous alterations of LHBT and has excellent accuracy and excellent correlation with conventional ultrasound findings.Lo scopo di questo studio è stato quello di valutare l’efficacia della elastosonografia (SE) nello studio del tendine del capo lungo del bicipite (LHBT) in pazienti con sintomi quali tendiniti o tendinosi del muscolo bicipite ed in pazienti asintomatici. I risultati ottenuti sono stati messi a confronto con i dati derivanti dall’esame clinico del paziente e dall’ultrasonografia (US).Mediante SE sono state studiate 36 spalle di 34 pazienti sintomatici con evidenza all’ecografia di segni di tendinite o tendinosi del muscolo bicipite e 114 spalle di 98 pazienti che non presentavano lesioni del muscolo bicipite. Alla SE, sono state ottenute immagini con scansioni trasversali ed assiali del tendine del capo lungo del muscolo bicipite. Le immagini ottenute mediante SE sono state valutate da alcuni revisori che utilizzano un sistema comprovato di gradazione del colore.Le immagini SE ottenute secondo una scansione trasversale hanno mostrato sensibilità media del 69.4 %, una specificità media del 95.6 % ed una accuratezza media del 89.3 %. E’ stata riscontrata una buona correlazione con i dati ottenuti mediante US (E’ stato dimostrato come la SE mostri utilità clinica per lo studio delle lesioni intratendinee e peritendinee del LHBT con una grande correlazione ed accuratezza con i reperti evidenziati all’ US convenzionale.

Background Current studies suggest that radiographic markers such as the critical shoulder angle (CSA) and the greater tuberosity angle (GTA), are associated with rotator cuff tears (RCTs). However, because the analysis of CSAs and GTAs according to the partial thickness rotator cuff tear patterns is limited, the purpose of the present study was to evaluate the relationship of CSAs and GTAs with partial thickness rotator cuff tear (PTRCT) patterns. Method This retrospective study included 1069 patients from 2013 to 2017. The subjects were divided into 4 groups: Group A, control group; Group B, articular-sided PTRCTs; Group C, bursal-sided PTRCTs; and Group D, full thickness rotator cuff tears (FTRCTs). RCTs were diagnosed with magnetic resonance imaging and the CSA and GTA were measured on simple radiographs. Multivariable analyses were used to clarify the potential risks for these pathologies. Results The mean CSAs of articular-sided PTRCTs (34.2° ± 4.7°) and FTRCTs (34.7° ± 4.4°) were significantly larger than those of the control group (32.3° ± 4.3°) and the bursal-sided PTRCTs (31.5° ± 4.6°), (p Conclusion A large critical shoulder angle was associated more with articular-sided PTRCTs than bursal-sided PTRCTs. A large greater tuberosity angle was associated more with bursal-sided PTRCTs than with articular-sided PTRCTs. Both critical shoulder angle and greater tuberosity angle were positively associated with the occurrence of full thickness rotator cuff tears. Level of evidence IV, Retrospective study.

Background In all-inside anterior cruciate ligament (ACL) reconstruction, it is usually difficult to obtain sufficient autologous semitendinosus tendon length for quadruple stranded graft in Asians, females, and those with short stature. The purpose of this study was to compare biomechanical properties of three different types of suture preparations for tripled graft and determine which method could achieve sufficient strength for ACL through in vitro study. Hypothesis The hypothesis of this study was that suturing with a rip-stop (RS) stitch for tripled-strand graft would lead to stronger mechanical properties than suturing with buried-knot four sutures. Methods Twenty-four bovine digital extensor tendons harvested from forelimbs were prepared for tripled-strand graft in three different ways: 1) buried-knot four sutures, 2) two RS sutures, and 3) four RS sutures. These grafts were directly connected to cylindrical metal rods of a tensile testing machine. All specimens underwent cyclic loading followed by a load-to-failure test. Preparation time, elongation, stiffness, and ultimate failure load were compared. Results For biomechanical comparison, the group with buried-knot four sutures was excluded because six (75%) specimens failed during the cycle load test. The group with four RS sutures showed lower total elongation (two RS sutures: 8.42 ± 5.28 mm; four RS sutures: 3.86 ± 0.83 mm, p = 0.030), higher stiffness (two RS sutures: 247.28 ± 53.39 N/mm; four RS sutures: 329.27 ± 55.56 N/mm, p Conclusion The method with four RS sutures showed sufficient strength for triple stranded graft for all-inside ACL reconstruction without increasing preparation time. Level of evidence III, controlled laboratory study.

BACKGROUND: Sonoelastography (SE) is a new technique that can assess differences in tissue stiffness, the purpose of this study was to evaluate the ability of SE to assess the long head of biceps tendon alteration.METHODS: Forty shoulders of 36 consecutively registered patients with clinical symptoms and conventional ultrasonography findings of biceps tendinitis or tendinosis, and 40 asymptomatic shoulders of 20 healthy volunteers were assessed with SE. Transverse and longitudinal images of long head of biceps tendon were obtained using SE. SE images were performed by one orthopedic surgeon and evaluated by two orthopedic surgeons using an experimentally proven color grading system.RESULTS: The transverse images of SE showed a sensitivity of 87.5%, a specificity of 95.0% and a accuracy of 91.3%, the longitudinal images of SE showed a sensitivity of 92.5%, a specificity of 90.0% and a accuracy of 91.3%. Inter-observer reliability of SE was in 'almost perfect agreement' with a weighted kappa coefficient of 0.83.CONCLUSIONS: SE is valuable in the detection of the intratendinous and peritendinous alterations of biceps tendon, and has excellent accuracy and excellent correlation with conventional ultrasound findings.

Magnetic coupling delivering wireless power in capsular endoscope(CE) is described in this paper. The characteristic of the magnetic flux linkage coil which generates the induced electromotive force(emf) under the magnetic field was analyzed. With the analyzed results, a magnetic flux linkage coil system was developed and tested. It was confirmed that the magnetic flux linkage coil system could supply more than 50 ㎽ power at 125 ㎑ without changing the structure of conventional CE.

Recently, the number of systems which utilize wireless power transmission to a receiving module in a short distance is increasing. For efficient use of receiving space, coils are wound around the ferrite core to produce electromotive force(emf) in suppling power by wireless transmission. This paper analyzed the magnetic flux density distribution in the ferrite core in magnetic field environment which is uniformly oriented along to a single axis at 125kHz. For numerical analysis, Ansoft Maxwell which is applying the FEM(Finite Element Method) method was used. We studied the variations of the gathered magnetic fluxes to the changes of the relative permeabilities of the ferrite cores. Also we calculated the magnetic flux variation by shaving the ferrite core off for the groove of coil winding. Results showed that using a small ferrite core in magnetic field at 100kHz band can increase the amount of magnetic flux than without the core. The magnetic flux decreased 23% by shaving the core 0.5 mm on the periphery of 4.75 mm radius core with the relative permeability 800.

Background The concept of utilizing nonabsorbable suture tape fixed directly to bone to augment Brostrom repairs of the anterior talofibular ligament (ATFL) has been proposed. However, no clinical data are currently available regarding the arthroscopic modified Brostrom operation with an internal brace. Materials and methods This study involved 85 consecutive patients (22 in the with internal brace group; 63 in the without internal brace group) who could be followed up for >6 months after undergoing an arthroscopic modified Brostrom operation. The American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status. At preoperation and at 24 weeks after surgery, the anterior drawer test was examined clinically. Results Improvement of mean AOFAS score in the internal brace group from before surgery to two weeks after surgery was statistically significant (p