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medicaBackground:Ultrasound (US)-guided techniques reported for the treatment of calcific tendinitis have mostly demonstrated good results. This study investigates the effect of US-guided barbotage using a spinal needle in patients with calcific tendinitis of the shoulder.Methods: Thirty-six patients with calcific tendinitis of the shoulder treated by US-guided barbotage with a spinal needle and subacromial steroid injection were included in the study. We evaluated clinical outcomes based on American Shoulder and Elbow Surgeons (ASES) score, Constant score, and visual analog scale (VAS) for pain score. Radiological outcomes were assessed by X-ray imaging at each visit.Results: Our results showed that US-guided barbotage and subacromial steroid injection produced good clinical and radiological outcomes in patients with calcific tendinitis of the shoulder. Of the 36 patients, only one required surgical treatment, while the others showed improvement without any complications. Compared to values before the procedure, calcific deposit size and VAS, ASES, and Constant scores showed significant improvement 6 weeks after the procedure. No significant correlation was found between the initial calcific deposit size and clinical outcomes at each time point.Conclusions: In patients with calcific tendinitis of the shoulder, US-guided barbotage using a spinal needle and subacromial steroid injection can yield satisfactory clinical and radiological results.

Background Many researchers have questioned whether shoulder kinematics such as the glenohumeral position and scapular kinematics would be different in different age groups. However, studies comparing shoulder kinematics between different age groups have been rare. The aim of this study was to analyze and compare the three-dimensional (3D) glenohumeral position, scapular kinematics, and scapulohumeral rhythm (SHR) during scapular plane arm abduction between a normal young male group and a normal older male group. Methods Twenty normal men (10 young and 10 older) were enrolled in this controlled laboratory study. Fluoroscopic images were obtained using a single plane X-ray system. Bilateral computed tomography scans were taken to create a 3D model. A 3D-2D registration technique was used to determine the 3D position and orientation of the bones of the shoulder. Results During scapular plane arm abduction, there were significant differences in scapular kinematics between the groups. The older male group showed more upward rotation, posterior tilt, and external rotation than the young male group. On the other hand, the glenohumeral position such as superior inferior translation, anterior posterior translation, and external rotation of the humeral head did not show significant difference between the groups. The mean value of SHR for the overall arm elevation range from start to maximum elevation angle for the older group and young group was 2.298 ± 0.964 and 2.622 ± 0.931, respectively, showing a significant difference between the two groups (p = 0.035). Conclusions Scapular kinematics and SHR were significantly different between the older male group and the young male group. Our study could provide reference values of shoulder kinematics for older men aged 55-65 years.

Although many superior capsule reconstruction (SCR) techniques are currently practiced in clinical settings, there is a lack of guideline for choosing the appropriate graft material. Therefore, at most times the surgeon's personal preference becomes the deciding factor. This study compares two fairly recent SCR techniques, biceps tendon (BT) autograft and humeral dermal (HD) allograft, by evaluating the clinical and radiologic outcomes to aid the surgeon's decision in choosing the appropriate graft.Thirty-one patients underwent SCR using BT and 22 using HD. SCR BT was selected for patients with BT partial tear of less than 20%, no severe inflammation sign, and favorable anchor condition. SCR HD was done in patients when BT had a tear of more than 20%, a SLAP lesion, severe inflammation, or subluxation. Range of motion, strength and shoulder function scoring, plain radiography, and MRI were evaluated before and after surgery in regular intervals.In SCR BT group, forward flexion (FF) ROM increased from 121.94±43.24 to 148.71±17.46 after 2nd year of surgery, whereas in the SCR HD group the FF ROM improved from 129.09±27.76 to 148.64±17.81. In SCR BT group, internal rotation (IR) ROM increased from 5.29±2.56 to 5.55±1.82 after 2nd year of surgery, whereas in the SCR HD group the IR ROM improved from 4.77±2.52 to 6.36±1.09. Although ROM, strength, visual analog scale, American Shoulder and Elbow Surgeons score and Constant-Murley score all improved 2 years after surgery, no statistically significant difference was found. Six months after surgery, the graft thickness in the BT group was 3.58±0.384mm and 2.49±0.326mm for the HD group (P0.001). After 2 years, graft thickness in the BT and HD groups were 3.54±0.399mm and 2.49±0.306mm respectively (P0.001). SCR HD group showed a negative correlation of -0.475 between graft thickness and IR ROM (P = 0.026). In the SCR BT group, a negative correlation of -0.466 was found between graft thickness and IR ROM (P = 0.008). A positive correlation of 0.363 was found between ROM IR and AHD (Acromiohumeral distance) when results were compared before and 2 years after surgery (P = 0.045).SCR that used auto-BT and allo-HD tissue both showed favorable results, and no significant difference was noted between the two techniques. Given that the two techniques show equally favorable results, the surgeon's personal preference on choosing the SCR technique appears to be acceptable. Understanding the costs and patient's characteristics may aid the surgeon in deciding on the graft material.

Background: This study aimed to compare the clinical and radiologic outcomes between patients with irreparable cuff tears (ICTs) and those with cuff tear arthropathy (CTA) after reverse total shoulder arthroplasty (RTSA) with a humeral-lateralization prosthesis. Methods: A total of 127 patients with ICTs and CTA who underwent RTSA were enrolled and matched at a 1:2 ratio by propensity score. Preoperative shoulder function was assessed for all patients. Radiologic parameters including the acromion–deltoid tuberosity (ADT) distance, lateral humeral offset, and scapular notching were evaluated. Results: Thirty-four patients in the ICT group and 68 patients in the CTA group were matched for comparison. Preoperatively, mean active forward flexion in the ICT group (89.7° ± 29.4°) was significantly better than that in the CTA group (65.5° ± 24.0°, P < .001). In the CTA group, fatty infiltration of the supraspinatus was worse (3.7 ± 0.5) and the ADT distance was shorter (134.0 ± 12.0 mm) compared with the ICT group preoperatively (3.3 ± 0.8 [P = .008] and 140.7 ± 12.5 mm [P = .001], respectively). There was no significant difference in postoperative functional or radiologic outcomes between the 2 groups. However, gains in active forward flexion (37.9° in ICT group vs. 61.5° in CTA group, P < .01) and abduction (42.1° in ICT group vs. 60.6° in CTA group, P < .01) were significantly greater in the CTA group than in the ICT group. Conclusions: Shoulder function was significantly improved after RTSA regardless of the preoperative diagnosis. Postoperatively, radiologic findings were not significantly different between the 2 groups. Due to the fact that preoperative range of motion and rotator cuff status were better in patients with ICTs, improvements in active forward flexion and abduction were significantly greater in patients with CTA.

Many therapies have been developed for patients with mass rotator cuff tears. Partial repair is often performed in patients with partially repairable massive rotator cuff tears because it is simpler to perform than superior capsule reconstruction. It may, however, result in rotator cuff retears frequently. This article presents our modified technique of arthroscopic partial reconstruction of the superior capsule using the long head of the biceps tendon with a biceps interposition.

The aim of this study was to compare the scapular kinematics and scapulohumeral rhythm of healthy participants during arm elevation and lowering and to find the difference between active motion and passive motion of the shoulder.The study examined the shoulders of 10 healthy men (mean age, 23.5 years; age range, 22-28 years). The shoulders of participants were elevated and lowered while fluoroscopic images were taken, and 3-dimensional bone models were created from 2-dimensional to 3-dimensional images using model registration techniques. The Euler angle sequences of the models' scapular kinematics and scapulohumeral rhythm were compared during active and passive shoulder motion.There was a significant statistical difference of upward rotation during arm elevation between active and passive shoulder movements (P = .027). In particular, the upward rotation between 45° and 90° of elevation showed a statistically significant difference (P.001). When the scapula was tilted posteriorly by active motion, it resulted in a statistically significant difference as there was more tilting in the high-degree range of motions than when it was tilted by passive motion (P.001). There was no statistically significant difference between the 2 groups in scapular external rotation. However, during arm lowering, scapular kinematics did not show statistically significant difference between active and passive motion.The scapular kinematics showed statistically significant differences between active and passive motion of upward rotation and posterior tilting of the scapula during arm elevation, but there were none during lowering. In terms of upward rotation, active shoulders rotated more upward during arm elevation.

The purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database.Data from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models.Patient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601).Male gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.

Pelvic bone fractures are usually caused by high-energy trauma and are often accompanied by organ injuries. For hemodynamically unstable patients with pelvic bone fractures, knowing the anatomic type of fracture—whether it is a pelvic ring injury or an acetabular fracture—might be helpful in prioritizing treatment. A total of 302 patients with pelvic bone fractures who received treatment at the authors' level I trauma center between March 1, 2015, and February 28, 2017, were included in this study. Patients with pelvic bone fractures were enrolled in the Korea Trauma Data Bank and classified by anatomic type of pelvic bone fracture: pelvic ring injury, acetabular fracture, or combined fractures. The authors used t tests to analyze survival and death groups and multivariate regression to analyze mortality factors. Different types of pelvic bone fractures had significantly different mortality rates ( P P Orthopedics . 2021;44(6):e724–e728.]

Neuromuscular electrical stimulation (NMES) is a treatment modality that has been used to accelerate the rehabilitation of patients with neurological damage. However, it is unclear whether NMES of the deltoid can lead to the early restoration of shoulder function after reverse total shoulder arthroplasty (RSA).In this prospective and randomized study, 88 patients who underwent RSA with the same prosthesis design for cuff tear arthropathy or irreparable rotator cuff tear were assessed. The patients were divided into two groups (NMES group and non-NMES group, 44 patients each). For the NMES group, two pads of the NMES device were placed over the middle and posterior deltoid area, and NMES was maintained for 1 month after surgery. Shoulder functional outcomes and deltoid thickness were compared at 3, 6, and 12 months postoperatively. Shoulder functional outcomes were assessed based on the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Constant scores and the range of motion (ROM) and power of the affected shoulder. The thickness of the anterior, middle, and posterior deltoid was measured by ultrasonography.A total of 76 patients (NMES group, 33 patients; non-NMES group, 43 patients) were enrolled in the final analysis. The preoperative demographics and status of the remaining rotator cuff of both groups were not significantly different. At postoperative 3 months, the ROM and power of external rotation of the NMES group were significantly greater than those of the non-NMES group (ROM, 36° ± 14° vs. 29° ± 12°; P = .003; power, 4.8 kg ± 1.8 kg vs. 3.8 kg ± 1.0 kg; P.002). The ROM of external rotation of the NMES group at postoperative 6 months was also greater than that of the non-NMES group (41° ± 12° vs. 34° ± 11°; P = .013). However, there was no significant difference in the VAS, ASES, and Constant scores at all follow-up points despite gradual improvements until 1 year postoperatively. Serial measurements of the thickness of the anterior, middle, and posterior deltoid of both groups did not show significant differences.Postoperative NMES of the deltoid after RSA contributed to significantly faster ROM restoration and considerable improvement in the power of external rotation. Therefore, NMES following RSA could lead to the early restoration of external rotation and recovery of deltoid function.

The purpose of the present study was to estimate the risk of hip and spinal fracture after distal radius fracture. Data from the Korean National Health Insurance Service—National Sample Cohort were collected between 2002 and 2013. A total of 8013 distal radius fracture participants who were 50 years of age or older were selected. The distal radius fracture participants were matched for age, sex, income, region of residence, and past medical history in a 1:4 ratio with control participants. In the subgroup analysis, participants were stratified according to age group (50–59, 60–69, or ≥70 years) and sex (male or female). Distal radius fracture patients had a 1.51-fold and 1.40-fold higher incidence of hip fracture and spinal fracture in the adjusted models, respectively. Among males, patients of all ages had a significantly higher incidence of hip fracture, and those who were 50 to 69 years of age had a significantly higher incidence of spinal fracture. Among females, those older than 70 years had a significantly higher incidence of hip fracture, and patients of all ages had a significantly higher incidence of spinal fracture. Previous distal radius fracture has a significant impact on the risk of subsequent hip and spinal fractures.

This study aimed to compare the contact area, mean pressure, and peak pressure of the radiocapitellar joint (RCJ) in the upper limb after transradial amputation with those of the normal upper limb during elbow flexion and forearm rotation. Testing was performed using ten fresh-frozen upper limbs, and the transradial amputation was performed 5 cm proximal to the radial styloid process. The specimens were connected to a custom-designed apparatus for testing. A pressure sensor was inserted into the RCJ. The biomechanical indices of the RCJ were measured during elbow flexion and forearm rotation in all specimens. There was no significant difference in the contact area between the normal and transradial amputated upper limbs. However, in the upper limbs after transradial amputation, the mean pressure was higher than that in the normal upper limbs at all positions of elbow flexion and forearm rotation. The peak pressure was significantly higher in the upper limbs after transradial amputation than in the normal upper limbs, and was especially increased during pronation at 45° of elbow flexion. In conclusion, these results could cause cartilage erosion in the RCJ of transradial amputees. Thus, methods to reduce the pressure of the RCJ should be considered when a myoelectric prosthesis is developed.

We aimed to identify 3D motion differences in knee joint articular surface kinematics in healthy young and old participants during weight-bearing knee flexion. Twelve healthy male volunteers, six in their 60s and six in their 20s, without any musculoskeletal system disease involving the knees participated. 3D bone models of the femur and tibia were obtained using CT and matched into the fluoroscopic images captured during split squatting. Translation and rotation of the tibia to the femur during weight-bearing flexion were compared between the groups. Translation of the nearest medial-lateral articular surface location and rotational angle of medial-lateral connecting lines were also compared. As the tibial internal-external rotation angle and medial contact point anterior-posterior translation were significantly correlated between the groups, they could not represent the characteristics of age-related changes. Similar to lateral contact point translation and contact points line angles were significantly different during the initial 10° flexion period. At the 40°-45° knee flexion period, a significant difference was detected in the contact point line angle and in the tibial superior-inferior translation. 3D knee joint kinematic differences between participants in their 20s and 60s, especially during initial and 40°-45° periods, can predict kinematic effects on age-related disease.

Salivary gland hypofunction after irradiation is associated with a deficit of epithelial stem/progenitors in salivary glands. Although epidermal growth factor (EGF) is known to stimulate the proliferation of epithelial cells, the therapeutic effect of EGF on salivary epithelial stem/progenitors remains undetermined. In this study, we administered EGF to submandibular glands (SMGs) via a retrograde route through the SMG excretory duct before fractionated irradiation and examined whether EGF could protect salivary epithelial progenitor cells from radiation and alleviate radiation-induced salivary hypofunction. EGF-treated mice exhibited greater body and gland weights at 12 wk after irradiation than untreated mice. The retroductal delivery of EGF improved salivary secretory function and increased salivary amylase activity in a dose-dependent manner. Histological examinations highlighted the amelioration of the loss of keratine-14+ (KRT14+) basal ductal and/or MIST1+ acinar cells, as well as induction of fibrosis, following irradiation in EGF-treated mice. An additional in vitro experiment using a salivary gland organoid irradiation model indicated that the radioprotective effects of EGF promoted the growth and inhibited the apoptotic cell death of salivary epithelial cells. Our results suggest that retroductal delivery of EGF may be a promising therapeutic option for preventing radiation-induced salivary gland hypofunction.

The objective of this study was to investigate the clinical and radiologic outcomes after superior capsule reconstruction (SCR) with biceps tendon (BT) for irreparable rotator cuff tears.The retrospective study period was May 2015 through February 2018. The average follow-up was 32 months (24-48 months) after surgery. Study inclusion criteria included an arthroscopic SCR performed using only our technique and minimum 2-year clinical follow-up by office visit and survey. Exclusion criteria included irreparable subscapularis tear and those patients lost to follow-up. This method enabled SCR by using the extraarticular portion and the intraarticular portion and making it 2 to 3 bundles by moving back and forth in the intraarticular area. Physical examination and functional scoring procedures were performed before surgery and at 3, 6, 12, and 24 months after surgery. Radiography and magnetic resonance imaging (MRI) were performed before surgery, after surgery (only radiography), and at 6 and 24 months after surgery.Fifty-three shoulders involving 45 consecutive patients underwent BT technique for irreparable massive rotator cuff tears. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant score (CS) showed statistically significant improvement (VAS, 4.1-1.0; ASES, 60.9-82.7; and CS, 64.9-80.0; P.0001). The shoulder active range of motion improved significantly by 23 for forward elevation (125.3-148.4; P.0001) and by 12 for external rotation (38.0-50.9, P.0001). The acromiohumeral distance (AHD) was significantly increased by 2.7 mm (4.4 ± 1.4 mm -7.1 ± 1.3 mm). No graft tear was detected in 39 patients (86.7%) during follow-up (24-48 months).SCR via our technique improved clinical and radiologic outcomes. Thirty-five (77.7%) patients achieved 17-point improvement (the minimally clinically important difference) in the last follow-up of ASES score. Clinical scores and AHD had significantly increased, and good healed rate (86.7%) was observed in MRI.Level IV, retrospective case series.

Background The occurrence and related predictors of acromial fracture following reverse total shoulder arthroplasty (RTSA) have not been fully elucidated. The aim of this study was to determine the incidence and risk factors of acromial fractures after RTSA. Methods We conducted a multicenter, retrospective case-control study of 787 cases (29 in acromial fracture group and 758 in control group) that underwent RTSA performed by 6 surgeons. The mean duration of follow-up after RTSA was 31.6 ± 21.8 months (range, 12-136 months). Demographic variables (age, sex, arm dominance, body mass index, working status, bone mineral density [BMD]), clinical variables (preoperative diagnosis, previous operation, implant design, preoperative clinical scores, screw size in glenoid fixation, postoperative rehabilitation), and radiographic variables (acromial thickness, critical shoulder angle, deltoid length, humeral offset to lateral acromion) were investigated. To determine risk correlation, univariate analysis and multivariate logistic regression analysis with calculated odds ratios (ORs) were performed. Results Postoperative acromial fractures occurred in 29 of the 787 shoulders with RTSA (3.7%). Acromial fractures were detected at a mean of 10.0 months (range, 1-66 months) postoperatively. Univariate analysis revealed that the occurrence of an acromial fracture was significantly associated with a previous operation (38% [11 of 29] vs. 21% [156 of 758], P = .025) and BMD (–2.33 vs. –1.74, P = .013). Multivariate logistic regression analysis found that the occurrence of a postoperative acromial fracture was significantly associated with a previous operation (P = .034; OR, 2.91; 95% confidence interval, 1.08-7.84) and deltoid length (P = .004; OR, 1.04; 95% confidence interval, 1.01-1.07). Conclusion Acromial fracture following RTSA is not an uncommon complication, with an overall incidence of 3.7%. A previous operation, increased deltoid length, and low BMD were risk factors of acromial fracture following RTSA.

Background The purpose of this study was to compare clinical and radiologic results between treatment with locking plate fixation and fibular allograft augmentation (FA) and treatment with locking plate fixation and additional inferomedial screws (IMSs) in 3- or 4-part proximal humeral fractures with medial comminution in geriatric patients. Methods We enrolled 164 patients with 3- or 4-part proximal humeral fractures with medial comminution who were treated with locking plates. The patients were divided into 2 groups according to additional augmented fixation procedures. The IMS group was composed of patients treated with additional IMSs (80 patients), whereas the FA group was treated with an additional fibular allograft (84 patients). On the basis of fracture classification, the IMS group was subdivided into those with 3-part fractures (52 patients) and those with 4-part fractures (28 patients) and the FA group was subdivided into those with 3-part fractures (55 patients) and those with 4-part fractures (29 patients). Clinical and radiographic results were compared and analyzed. Results In patients with 3-part fractures, no differences in clinical outcomes were found regardless of additional procedures. However, the FA group showed superior clinical outcomes in patients with 4-part fractures (P = .038 for Constant score and P = .045 for visual analog scale score). The postoperative neck-shaft angle was maintained in the FA group compared with the IMS group with both fracture types at the last follow-up (P = .048 for IMS vs FA with 3-part fractures and P = .023 for IMS vs FA with 4-part fractures). The number of complications was significantly higher in the IMS group (5.5%) than in the FA group (1.2%) (P = .001). Conclusion An FA technique is considered a primary additional procedure for medial support in patients with 4-part proximal humeral fractures involving medial metaphyseal comminution when treated with locking plate fixation.

This study used in vivo three-dimensional to two-dimensional image registration techniques to compare the glenohumeral kinematics of shoulders with massive rotator cuff tears that were successfully treated conservatively and those of normal shoulders.Ten patients (age, 67.4 ± 3.63 years) with massive rotator cuff tears on one side and without contralateral tears were enrolled. We performed computed tomography and fluoroscopy on both shoulder joints and created three-dimensional bone models of the humerus and scapula using image registration techniques. We measured the humeral superoinferior translation, angle of humeral external rotation, scapular upward rotation, scapular anteroposterior tilt, and scapular external rotation of the torn shoulders with good range of motion after effective conservative treatment and compared these measurements to those of the contralateral normal shoulders.There was a significant difference in the initial position of the humeral head relative to the glenoid in the tear group; it was 2.0 mm higher than that in the normal group (p .05). This difference disappeared in the range from 40° to full elevation. The scapular motion of the tear group was significantly more upwardly rotated than that of the normal group: by 9.9° at rest (p .05) and by 11.6° at terminal elevation (p .05). No significant differences were detected for humeral head external rotation, scapular anteroposterior tilt, and scapular external rotation between the two groups.Kinematics of shoulders with massive cuff tears could not be recovered completely even though the patients had no significant symptoms after successful conservative treatment.

Acromioclavicular-coracoclavicular ligament injury occurs frequently, and the clavicle hook plate technique is an easy-to-use treatment method. However, complications such as subacromial impingement syndrome, synovitis, erosion, osteolysis, post-operative pain, and post-operative limitations in range of motion have been reported. We aimed to evaluate the use of the clavicle hook plate in the shoulder joints and to compare in vivo three-dimensional (3D) scapular kinematics and scapulohumeral rhythm between the shoulders with a clavicle hook plate and contralateral normal shoulder joints. Ten male patients (aged 40.5 ± 14.4 years) who underwent clavicle hook plate fixation for an acromioclavicular-coracoclavicular ligament injury were selected. Computed tomography and fluoroscopy were conducted on both the shoulder joints, and 3D models were created. Using a 3D-2D model-image registration technique, we determined the 3D coordinates of the scapula, and we measured the scapular kinematics and scapulohumeral rhythm. The values for upward rotation, posterior tilt, and external rotation in the two groups increased in proportion with humeral elevation, showing significant differences between the two groups (p

Background The purpose of this study was to evaluate the biomechanical properties of two different fixation constructs in varus collapse proximal humerus fracture, locking plate with medial support screw and locking plate with intramedullary fibular graft. Methods We used 8 pairs of undamaged fresh-frozen humen cadaveric humeri and fibula from patients ranging in age from 62 to 81 years. We simulated a proximal humerus fracture with medial comminution using wedge shaped osteotomy. One group was fixed with locking plate with medial support screws, the other group with locking plate with intramedullary fibular graft. Biomechanical test was carried out using servohydraulic material testing system. We measured displacement of specimens under cyclic load test, maximum failure load, initial stiffness, and mode of failure under increasing load test. Findings Under cyclic loading, the displacement of the specimen was significantly less in the locking plate with fibular strut graft group than in the locking plate with medial support screws group. (p = 0.012) Under increasing load test, the Locking plate with fibular strut graft group showed higher values in both maximum failure load and initial stiffness than the Locking plate with medial support screws group, and this was statistically significant. (p = 0.012, p = 0.001). Interpretation In biomechanical study, the locking plate with fibular strut graft showed significantly better results in all of the maximum failure load, initial stiffness, and gap depletion compared to the locking plate with medial support screws. Level of evidence Level IV.

Shoulder kinematics is important, as it is associated with shoulder arthropathy and pain mechanisms. Various static and dynamic analysis methods are prevalent for shoulder kinematics. These include 2-dimensional plane x-ray, computed tomography, and magnetic resonance imaging, cadaver study, electromagnetic motion analysis, transcortical bone pins technique, and in vivo 3-dimensional motion analysis. Although these methods provide the value of the shoulder kinematics angle, they are unable to explain why such changes occur. Since each method has its pros and cons, it is important to understand all factors accurately, and to choose a method that best meets the purpose of the researcher.

Many options have been developed to treat irreparable massive cuff tears. Superior capsular reconstruction has been reported as one of the treatment options for relatively young patients with irreparable massive cuff tear. However, this original technique has a disadvantage of requiring a tensor facia lata autograft. It requires another incision at the lateral thigh and can be a cause of thigh pain. This article describes our modified technique for arthroscopic superior capsule reconstruction using the biceps autograft to preserve the long head of the biceps tendon anchors to the glenoid labrum (the snake technique).

ObjectiveThis paper aims to describe the medical service of two polyclinics of the PyeongChang Winter Olympic Games and to analyse the injury and illness of athletes who visited the polyclinics during the oilympic period in order to provide some insight with respect to the future construction and operation of polyclinics in mass gathering events such as the Olympic Games.MethodsThe PyeongChang Olympic Village was located near the Olympic Stadium for snow sports athletes and the Gangneung Olympic Village was located near the ice venues for ice sports athletes. During the Olympic Games, polyclinics were consisted of emergency service and outpatient clinics. We retrospectively analysed the electronic medical record data of athletes who visiting polyclinics between 9 February 2018 and 25 February 2018.ResultsDuring the Olympics, there were 1639 athlete encounters in both polyclinics. Among those, injuries of athletes were 237 (14% of all athlete encounters) in total, and the most common injured site was knee joint. Upper respiratory infection was the most frequent case in diseases of athlete encounters. Total 223 cases of image study were done, MRI was 44 cases.ConclusionThe PyeongChang Winter Olympic Games had the highest number of participants in the history of Winter Olympic Games. Overall 48% of athletes encountered polyclinics due to disease during the Games period. Upper respiratory infection and other seasonal diseases were more frequent this Olympic Games than before. Polyclinics were managed healthcare of athletes as well as injury and illness of athletes. In winter sports, a polyclinic and similar medical facilities should be prepare for diseases considering geography, weather as well as injuries and endemic diseases when planning future mass gathering events.

ObjectiveTo describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.MethodsWe recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.ResultsIn total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1 day and >7 days of absence from sport, respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.ConclusionOverall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.

Patients with pelvic bone fractures with gastrointestinal perforations are reported in 4.4% of the cases and in very rare cases jejunum (0.15) is involved. However, intestinal perforations are often undiagnosed on the first examination before peritonitis is evident. We are presenting a report where a patient with anteroposterior compression injury, who was expected to undergo an internal fixation procedure, did not show any jejunum perforations on abdominal CT or other physical exams but was found on abdominal CT 1 week after right before surgery, therefore excision and anastomosis surgery, pelvic open reduction and internal fixation was simultaneously done with favorable results. In our case, we present a 61 year old male patient with liver trauma, adhesion at the abdominal cavity, with a past history of gallbladder excision, but without abdominal pain, fever, or infection symptoms. Therefore, this was a case that was difficult to initially diagnose the patient with jejunum perforation and peritonitis. The diagnosis was further supported during laparotomy when peritonitis around the area of intestinal perforation was observed. Generally, it is understood that pelvic bone fracture surgery is not immediately done on patients with peritonitis. However, this kind of patient who had peritonitis with intestinal adhesion and other complications could undergo surgery immediately as infection or other related symptoms did not coexist and the patient was rather stable, and as a result the treatment was successful. [ J Trauma Inj 2016; 29: 56-59 ]

We encountered a rare condition of rice body in subacromial and subdeltoid spaces in a patient with unremarkable medical history. Although it is uncommon, there have been continued reports on its formation in certain type of infective and inflammatory arthritis. However, except for a traumatic event, evaluation yielded no known and conceivable cause for his chronic inflammatory bursitis. Relatively typical findings for rice body on magnetic resonance imaging have been described, and in our case the imaging prompted us to schedule early removal, which is generally accepted as the management of choice to prevent further progression of symptoms. The symptoms of the shoulder showed significant improvement, and a close follow-up schedule has been recommended for observation of recurrence and development of any foreseeable underlying cause.

Background: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. Methods: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg+lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. Results: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of 2.4 ± 2.1 points, which was lower, with statistical significance, than the VAS score of group 2, which was 4.4 ± 3.1 points (p Conclusions: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.

Numerous surgical options have been introduced for the treatment of chronic refractory lateral epicondylitis of the elbow, but it remains unclear which option is superior. The clinical outcomes of an open surgery group and an arthroscopic surgery group were evaluated, and the results of the 2 procedures were compared. From among patients with lateral epicondylitis refractory to 6 months of conservative treatment, 68 patients satisfying study criteria were recruited. Open surgery was performed in 34 cases (group 1), and arthroscopic surgery was performed in 34 cases (group 2). Compared with preoperatively, the 2 groups had significantly improved values for grip strength, range of motion, and Disabilities of the Arm, Shoulder and Hand score at 12 months postoperatively. Group 1 had significantly greater improvements in grip strength and visual analog scale pain score compared with group 2 ( P =.048 vs P =.006). Group 2 had significantly greater ( P =.045) improvement in pronation compared with group 1. Group 2 returned to work sooner than group 1. On the questionnaire regarding satisfaction with surgery 24 months postoperatively, 4 patients (12%) in group 2 reported dissatisfaction compared with no patients in group 1. Open surgery and arthroscopic surgery both yielded good clinical results. Nonetheless, for patients requiring muscle strength or having severe pain at work, open surgery would be more effective. [ Orthopedics . 2018; 41(4):237–247.]

Background The purpose of this study is to describe and analyze the shoulder injuries in elite athletes during the 2018 Winter Olympics in Pyeongchang. Methods To collect the data of all Olympic athletes who visited venue medical centers, polyclinics, and Olympic-designated hospitals for shoulder injuries during the Olympic Games (February 9 through 25, 2018), we reviewed Olympic electronic medical records and patient information obtained from Olympic medical service teams about athletes who complained of shoulder pain. Results During the Olympics, a total of 14 athletes visited clinics for shoulder-related symptoms. Five athletes were injured in games and nine were injured in training. The injury was due to overuse in four patients. Ten patients had trauma-related symptoms: one after being hit by an opponent and the other nine after a collision with the ground or an object. There were no patients who complained of symptoms related to pre-existing shoulder conditions. The most common cause of shoulder pain was snow-boarding (one big air and three slopestyle). The most common diagnosis was contusion (n = 6), followed by rotator cuff injuries (n = 3), superior labrum from anterior to posterior lesion (n = 1), sprain (n = 1), acromioclavicular-coracoclavicular injury (n = 1), dislocation (n = 1), and fracture (n = 1). Conclusions To the best of our knowledge, this study is the first epidemiologic study of shoulder injury conducted during a huge sports event involving a variety of competitions for elite athletes. If the risk factors of shoulder injury can be established by continuing research in the future, it will be helpful to prevent injury and to prepare safety measures for athletes.

Background We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. Methods We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. Results The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. Conclusions The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

In this study, we investigated the pennation angles of ankle muscles as they relate to muscle contraction intensity (MCI). Eight male subjects with no history of musculoskeletal injuries participated. In each patient, the ankle joint was fixed at 15° dorsiflexion and 0°, 15° and 30° plantarflexion. Ultrasound images (SonoAce Pico, Samsung Medison, Korea) were taken to measure the pennation angle of tibialis anterior (TA), gastrocnemius medial (GCM), gastrocnemius lateral (GCL), and soleus (SOL). The torque dynamometer (Biodex system 3, Biodex Medical System, USA) was used to measure the ankle contraction intensity corresponding to 0, 30, 70 and 100% of maximum voluntary contraction (MVC) respectively. Pennation angles in ankle muscles on sub-maximal muscle contraction were determined. In the present study, the significant differences was found at between 0% of MVC and sub-maximal MVCs, between 0° and 15° of dorsiflexion, and between 15° of plantarflexion and 15° of dorsiflexion. This study may be beneficial in implementing a more realistic muscle model of muscle force.

Backgrounds After shoulder dislocation, kinematic changes in shoulder, including translation of the humeral head, ensue. There have been many attempts to measure these changes using motion measurement techniques, but in vivo three-dimensional (3D) glenohumeral changes have not been appreciated until now. The purpose of this study was to measure and analyze changes in glenohumeral translation in patients with shoulder dislocation and compare these changes with healthy shoulder. Methods We included 20 subjects who had suffered shoulder dislocation for first time, and 3D models of their humerus and scapula were obtained using computed tomography and fluoroscopic images during scapular plane abduction and external rotation of shoulder with elbow flexed at 90° and arm abducted at 90°. We measured the superior/inferior (SI) and anterior/posterior (AP) translations for both shoulders. Results No statistically significant difference between healthy and dislocated shoulders was detected in SI translation for scapular plane abduction with increasing elevation angles. In AP translation, the humeral head was located 2.29 mm more anteriorly in the dislocated shoulder than in the healthy shoulder. However, no statistically significant difference was seen. For internal to external rotation, the angle of the rotated arm had an effect on AP translation. However, no statistically significant difference was detected. In the apprehension test, there was no significant difference in the mean value of AP translation. Conclusion Compared with the contralateral healthy shoulder, changes in glenohumeral translation during in vivo movement after shoulder dislocation were found to be non-significant.

The purpose of this study was to investigate whether healed tuberosities yield better rotational range of motion (ROM) and functional outcomes compared with unhealed tuberosities after reverse shoulder arthroplasty in elderly patients with comminuted proximal humerus fractures.This study included 38 patients who underwent reverse arthroplasty because of 4-part proximal humerus fractures; 14 patients had healed tuberosities (group A) and 24 patients had unhealed tuberosities (group B). Functional assessments included visual analog scale pain score, American Shoulder and Elbow Surgeons score, Constant score, and active ROM.There were no significant differences in the patients' demographics between the 2 groups. At final follow-up, no significant differences were found between groups in visual analog scale score (group A, 1.4; group B, 1.6; P = .647), American Shoulder and Elbow Surgeons score (74.3 and 70.7; P = .231), and Constant score (67.9 and 63.9; P = .228) and ROM with forward flexion and internal rotation. However, in external rotation, there was a significant difference between groups (29° and 10° in external rotation with the elbow at the side [P .001]; 25° and 7° in external rotation with shoulder abduction [P .001]).After reverse shoulder arthroplasty for 4-part proximal humerus fracture, tuberosities were healed in an anatomic position in 37% of patients. However, there were no significant differences in functional outcomes and ROM between the 2 groups, with the exception of external rotation, which was better in the healed tuberosity group. Therefore, tuberosity healing is not a prerequisite for satisfactory outcomes after reverse shoulder arthroplasty for 4-part proximal humerus fractures in elderly patients.

In spite of many excellent outcomes with arthroscopic anterior cruciate ligament (ACL) reconstruction, problems remain with this procedure; rotation instability and physical disabilities are not always completely resolved.1,2) Rotation stability has been achieved by tunneling the femur at the 10-o'clock position or by double bundle ACL reconstruction.3-8) However, there has been a great deal of debate as to the ability of the double bundle technique with respect to the selection of grafts, fixation methods, and techniques for tightening each bundle.4,5,8,9) Complications of this technique have included failure of graft fixation and excessive tunnel dilation due to an increase in tunnel numbers and adversity when an operation has required revision. Endobutton (Smith & Nephew, Andover, MA, USA) was introduced and commonly used as a femoral fixation method to overcome limitations in length and thickness of the autograft.5) However, Endobutton has had some problems in the graft healing in the bony tunnel due to shortening of grafted tendons, as well as excessive dilation of tunnels for the receipt of Endobuttons.10) For this reason, we minimized graft motion by fixating the graft with a bio-absorbable transfemoral pin, Rigidfix pin (Mitek, Johnson and Johnson, Raynham, MA, USA). In order to restore the native tibial insertion of ACL, the Retroscrew (Arthrex, Naples, FL, USA) was designed and introduced. It was proven to facilitate optimum joint line fixation at the level of the intercondylar floor for soft tissue autografts and allografts to maximize graft stiffness, fixation strength, abrasion resistance, and anatomical placement.11) To prove its advantages in the clinical setting and in clinical outcomes, we used the Retroscrew as a tibial fixation to the articular outlet of the tibial tunnel for anteromedial (AM) bundle. In addition, for further fixation to the distal portion, the gracillis and semi-tendinosus tendons, without detachment of the tibial insertion, were used for the posterolateral (PL) bundle, and a bio-absorbable interference screw, Intrafix (Mitek, Johnson and Johnson), was also applied to the articular outlet of the PL femoral tunnel in order to minimize graft motion. Thus, we designed a clinical study to investigate the clinical outcomes of this technique.

Purpose: The purpose of this study is to investigate the accompanying lesions of humerus greater tuberosity fracture with anterior shoulder dislocation and to analyze its clinical results. Materials and Methods: From May 2005 to November 2008, arthroscopy was performed on a total of 30 selected patients who were diagnosed with humerus greater tuberosity fracture with anterior shoulder dislocation and who were also under the age of 40. The preoperative and postoperative Constant and Rowe scores were compared. Results: There was a total of 21 cases of anteroinferior labral lesions: 2 Bankart lesions, 4 bony Bankart lesions, 4 Perthes lesions, 2 free ALPSA lesions, 3 GLAD lesions and 6 capsular tears. For other lesions, 5 rotator cuff partial tears, 3 SLAP lesions and 1 biceps tendon rupture were found. The constant scores were increased from 56.3 to 94.43 points (p

Scapular fractures account for approximately 1% of all fractures, and 8% to 10% are acromion fractures. We compared the results of early and delayed treatment for non-displaced and type III acromion fractures, respectively, to investigate an early treatment method for nondisplaced acromion fractures. Patients treated between March 1999 and March 2006 with 2-year follow-up were selected for the study. The early fixation group comprised 16 patients, and the delayed reconstruction group comprised 18 patients. Moreover, the delayed reconstruction group was further divided into 2 additional groups: delayed group B and delayed group N. Delayed group B comprised 7 cases receiving bone graft, and delayed group N comprised 11 cases not receiving bone graft. Mean Constant scores were significantly greater for the early fixation group (92±6.6; range, 64–98) than for both delayed groups N (86±7.8; range, 54–96) and B (81±9.4; range, 58–92) ( P =.042 and .024, respectively). Mean pain score was 14±4.8 (range, 5–15) in the early fixation group, 12±7.4 (range, 5–15) in delayed group N, and 9±8.8 (range, 5-15) in delayed group B ( P =.052 and .018, respectively). Mean daily activity score was also significantly greater in the early fixation group (19±6.4; range, 16–20) than in both delayed group N (14±6.2; range, 10–18) and delayed group B (10±4.4; range, 8–18) ( P =.048 and .021, respectively). The P values for Constant, pain, and daily activity scores between delayed groups N and B were .048, .038, and .052, respectively. In cases of young patients with type IC acromion fractures at the time of injury, a high activity level, and the early need for crutches or a walker, early surgical treatment should be considered.

Purpose The purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. Meterials and Methods The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. Results There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. Conclusion Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.