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Background: Olecranon fractures are common in motorcycle accidents, falls, or in direct elbow injury. In cases of transverse olecranon fracture, surgery is frequently required in adults. The aim of this study is to compare the biomechanical durability of suture anchor fixation in olecranon fractures to conventional tension band wiring technique in saw bones. Methods: 12 plastic saw bones were divided into 3 groups: tension band wiring fixation, modified Cha-Batman method, and a modified simple suture method using a suture anchor. After fixation, cyclic load tests were conducted for 1,000 cycles, at 5 Hz with a force of 10 N to 250 N. After cycling loading, the extent of displacement was measured using a non-contact coordinate measuring instrument, and statistical analysis performed. Results: The average displacement was significantly smaller in the modified Cha-Bateman method (1.4 mm) than in the tension band wiring method (3.8 mm, p = 0.007) and the modified simple suture method using suture anchor (3.3 mm, p = 0.012). There was no significant difference in displacement between tension band wiring fixation and the modified simple suture method (p = 0.564). Conclusions: This study provides a biomechanical basis for the hypothesis that the suture anchor technique in weak bone model could obtain results comparable to those of conventional tension band wiring. In particular, the modified Cha-Bateman method, showed stronger biomechanical properties than the tension band wiring method and modified simple suture method using a suture anchor. The current study could also provide pilot data that can be used in future experiments.

Background The flexor carpi ulnaris (FCU)-split approach and the over-the-top approach have been used frequently for the fixation of anteromedial facet (AMF) fractures of the coronoid process. Clinical studies have not compared functional recovery and complication rates associated with these approaches. This study aimed to compare the clinical effectiveness of the over-the-top and FCU-split approaches for the treatment of AMF fractures of the coronoid process. Methods Thirty-two patients who underwent surgery for AMF fractures between January 2013 and August 2019 were divided into the FCU-split and over-the-top groups. The FCU-split approach was used from January 2013 to March 2016, and the over-the-top approach was used from April 2016 to August 2019. Bony union, radiographic signs of osteoarthritis (Broberg and Morrey classification), and development of heterotopic ossification were evaluated. Postoperative pain score (visual analog scale at 2 days after the operation), surgical time (minutes), range of motion of the elbow, elbow function (Mayo Elbow Performance Score [MEPS]), and the presence of postoperative ulnar neuropathy were also compared between the 2 groups. Results The FCU-split and over-the-top approaches were performed in 15 and 17 patients, respectively. The mean age was 46 ± 13 years (range, 22-67 years), and the mean follow-up duration was 19± 6.7 months (range, 13-38 months). All coronoid fractures had a solid osseous union during the follow-up, and no subluxation or dislocation was observed in the 2 groups. The occurrence of heterotopic ossification and the grade of post-traumatic arthritis did not differ significantly between the groups (all P > .05). There were also no significant differences between the groups in terms of postoperative pain score, range of motion, and MEPS (all P > .05). However, the surgical time was shorter for the over-the-top approach than that for the FCU-split approach (79± 23 vs. 101 ± 14, P = .008), and the surgical time was significantly associated with the fracture classification and surgical approach (P = .001 and .003, respectively). In addition, postoperative ulnar neuropathy occurred less with the over-the-top approach than with the FCU-spilt approach (5.9% vs. 46%, P = .013). Conclusion Both the FCU-split and over-the-top approaches were appropriate for performing the buttress plate fixation for AMF fractures of the coronoid process and for restoring the elbow stability. The fixation of AMF fractures through the over-the-top approach was technically easier and had less incidence of postoperative ulnar neuropathy.

Background The primary aim of this study was to determine the mean values for three of the most common parameters measured to assess hindfoot alignment in asymptomatic subjects: hindfoot alignment angle (HAA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA). The secondary aim was to evaluate the mean value of each parameter according to age and sex. Methods We assessed 1128 asymptomatic subjects from January 2014 to June 2019. HAA, HAR and HMA were measured to evaluate the degree of hindfoot varus or valgus deviation on the hindfoot alignment view, described by Saltzman and el-Khoury. All subjects were divided into subgroups according to sex and age ( Results The overall mean HAA, HAR, and HMA were –4.07 ± 3.48°, 0.21 ± 0.15, and –6.12 ± 5.22 mm, respectively. Female subjects ≥45 years old had the largest valgus deviation (HAA, –7.08 ± 6.34°; HAR 0.09 ± 0.25; HMA, –10.58 ± 11.46 mm). Conclusions HAA, HAR, and HMA evaluation revealed that asymptomatic subjects had a hindfoot alignment with valgus deviation. Furthermore, the degree of valgus deviation was the largest in female subjects aged ≥45 years. We hope that the results of our study will be helpful to inform other researchers about the usefulness of these parameters as references.

Three-dimensional NAND flash memory featuring dozens of vertically stacked memory cells is the state-of-the-art technology for most storage platforms. To fabricate three-dimensional (3D) NAND memory, lateral etching of the Si₃N₄ layer over SiO₂ is an essential step that is conducted through a wet etching process using a phosphoric acid-based etchant. Silyl-phosphate or highly selective nitride serves as an etching solution additive to control the SiO₂ layer dissolution rate. However, silyl-phosphate is prepared with an expensive monomeric silica precursor and at high reaction temperatures and generates environmentally harmful byproduct gases, such as HCl, HF, and CH₃OH. This study demonstrates that silyl-phosphate can be prepared using low-cost polymeric silica under a mild reaction temperature by changing the characteristic acidity of phosphoric acid. The possibility of tuning the phosphoric acid acidity was first studied by molecular dynamics simulations, and phosphoric acids with stronger acidity were prepared by the evaporation of water from H₃PO₄ (85%). The concentrated phosphoric acid enabled a fast reaction of polymeric silica and phosphate at a low reaction temperature (80 °C). The obtained silyl-phosphate lowered the SiO₂ layer dissolution rate, thereby yielding a Si₃N₄/SiO₂ layer etching ratio of up to 940. The proposed method offers an environmentally friendly production process for special chemicals used in 3D NAND flash memory fabrication.

The purpose of this study was to compare the clinical, radiographic and arthroscopic outcomes after open wedge high tibial osteotomy (OWHTO) aiming either at the Fujisawa point (group F) or the lateral tibial spine (LTS, group L).Between January 2011 and May 2017, 89 cases underwent implant removal procedures with second-look arthroscopy at 19.8 months after OWHTO with first-look arthroscopy. Among them, 24 and 65 cases were enrolled in groups F and L, respectively. Outcomes included clinical (evaluated using the Western Ontario and McMaster Universities Osteoarthritis index and the International Knee Documentation Committee subjective score), radiographic (observation of the mechanical axis (MA) and tibial slope), and arthroscopic (including chondral lesions of the medial femoral condyle (MFC), trochlea, and patella scored according to the International Cartilage Repair Society grading) measures, investigated at index surgery and implant removal surgery. Outcomes were compared between two groups.Preoperative clinical characteristics and postoperative outcomes were similar between both groups. The mean postoperative MA was significantly lower in group F compared with group L (-3.9° vs. -1.6°, respectively; P 0.001). Similar MFC cartilage grading changes from index surgery to second look surgery were shown; however, further progression of patellofemoral grading was shown in group F.OWHTO aimed at the LTS has similar clinical outcomes to Fujisawa point. Surgery aimed at the LTS was slightly less corrected. Targeting the LTS could be an option after consideration of joint geometry and patellofemoral joint problems.

The fifth metacarpal neck fracture is the most common metacarpal fracture. The palmar angulation from the fracture displacement is critical for determining treatment, yet there is no consensus regarding the angulation measurement method or the surgical cut-off value. This study aimed to identify a reliable measurement method for assessing palmar angulation. We evaluated inter-observer and intra-observer validation of measuring palmar angulation in oblique plain X-ray and computed tomography (CT) sagittal cuts.We identified surgically treated patients for acute isolated fifth metacarpal neck fracture between January 1, 2008, and December 31, 2020, and obtained preoperative, opposite hand, and final follow-up oblique X-rays and sagittal computed tomography (CT) radiograms. The oblique radiograph was taken with a 45° posteroanterior pronation. The metacarpal neck palmar angulation was measured in the radiograms using the metacarpal neck-shaft center (MNSC) angle and the shaft articular surface (SAS) angle methods by three orthopedic surgeons in two sessions. For the CT radiograms, each measurer selected the sagittal slot at their discretion to measure the angle. The final palmar angulation was the average of six measurements (two sessions, three measurers per session).The study included 51 patients; the average age was 32.5 (range 18-73) years, with 46 men and 5 women. The MNSC angle inter-observer reliability was better than the SAS angle. The MNSC angle inter-observer reliability was better than that of SAS angle. Intraclass coefficients (ICCs) for the MNSC angle demonstrated an excellent inter-observer agreement among the three measurers in the first (0.93) and second (0.88) session compared to ICCs for the SAS angle in the first (0.81) and second (0.87) session. The MNSC angle intra-observer reliability was also better than the SAS angle, with higher ICCs. Preoperative CT radiograms were available for 42 patients. Using CT scans for measurements, in the two sessions, the MNSC angle inter-observer reliability was higher than that of the SAS angle [MNSC: 0.83; SAS: 0.35], second [MSNC: 0.85; SAS: 0.81]. The intra-observer reliability was also better in the MNSC angle. When comparing average value among obtained radiograms, the physiologic angulation of the opposite hand oblique X-ray had the smallest average value, followed by preoperative CT and preoperative oblique radiography. Overall, the SAS angle measurement had a slightly larger angle than the MNSC method in the fractured and non-fractured hand measurements. Finally, a serial comparison of the oblique X-rays (pre-and postoperative, final follow-up, and the opposite hand with closed reduction and internal fixation) indicated that the angulation significantly decreased, and the post-operative values did not differ from the final follow-up X-ray for either method.The palmar angulation measurement in 45° pronated oblique X-ray using the MNSC angle method had good-to-excellent reliability, with superior results to sagittal CT radiograms. Although the angle is likely overestimated, the MNSC method is reliable for judging the fracture degree and reduction adequacy after surgery compared to the non-fractured hand physiologic angulation.

Background: The intracompartmental septum isolating the extensor pollicis brevis (EPB) has been reported to affect the patient’s response to nonsurgical treatment in de Quervain’s disease. A simple physical test called the modified staged Finkelstein test was developed to evaluate the septum; the result of this test was compared with those of the pre-existing physical test (EPB entrapment test) and ultrasonographic (US) examination of the septum. Methods: We retrospectively analyzed 52 patients who underwent two clinical tests, including the modified staged Finkelstein test and the EPB entrapment test, and US examination for de Quervain’s disease. The correlation between the clinical test results and US findings was evaluated; sensitivity, specificity, and positive and negative predictive values were calculated. Results: The proportion of wrists with a separate septum was 50% (26 patients) in the US examination. The sensitivity and specificity of the modified staged Finkelstein test were 88.5% and 73.1%, respectively; those of EPB entrapment test were 71.4% and 84.2%, respectively. The positive and negative predictive values of the modified staged Finkelstein test were 76.7% and 86.4%, respectively. Conclusions: The modified staged Finkelstein test showed acceptable diagnostic values for the diagnosis of septum compared with pre-existing physical tests. Knowledge about the existence of septum could be helpful in treating patients and expecting prognosis.

We aimed to compare trigger finger (TF) development between patients with carpal tunnel syndrome (CTS) treated with carpal tunnel release (CTR) and those treated conservatively, using the National Health Insurance Services data of Korea. We also aimed to investigate risk factors for post-CTR TF development.We selected CTS patients with or without CTR (3543 patients in each group) between 2002 and 2015. Sex, age, follow-up duration after CTS diagnosis, and comorbidities associated with TF-development were matched using propensity score. We compared the rates of TF diagnosis and subsequent TF operations between groups. Thereafter, we selected patients with CTS undergoing CTR, for whom minimum follow-up exceeded five years. We compared sex, age, height, weight, and comorbidities associated with TF risk factors between the TF-occurrence and non-TF-occurrence groups.On comparing CTR-treated patients with those treated conservatively for CTS, CTR-treated patients presented with significantly higher rates of TF diagnosis (12.2%) and TF operations (4.7%) than patients without CTR (6.2% and 1.2%, respectively). Among 433 TF-diagnosed patients and 166 TF-operated patients after CTR, most were identified 5 years after CTR, with 379 diagnosed (87.5%) and 147 operated (88.5%) patients. A total of 240 patients presented with newly developed TF over a five year period. Patients with subsequent TF exhibited a higher female sex rate and shorter height. None of the variables was significant risk factors for TF development in logistic regression analysis.We confirmed high incidences of post-CTR TF diagnosis and operations. TF develops most frequently in the first postoperative year.

Objectives: Sarcopenia is a skeletal muscle loss disease with adverse outcomes, including falls, mortality, and cardiovascular disease (CVD) in older patients. Distal radius fractures (DRF), common in older people, are strongly related to falls. We aimed to investigate the correlation between DRF and low skeletal muscle mass, which strongly correlated to sarcopenia. Methods: We performed a retrospective review of data from patients diagnosed with or without DRF in our institute between 2015 and 2020. Finally, after propensity score matching, data from 115 patients with and 115 patients without DRF were used for analyses. Multivariate logistic regression analysis was performed for sex, body mass index (BMI), the presence of low skeletal muscle mass, bone quality measured by dual-energy X-ray absorptiometry (DXA), and comorbidities (diabetes mellitus, CVD). Results: We found that female sex (odds ratio = 3.435, p = 0.015), CVD (odds ratio = 5.431, p < 0.001) and low skeletal muscle mass (odds ratio = 8.062, p = 0.001) were significant predictors for DRF. BMI and osteoporosis were not statistically significantly related to DRF. Conclusions: Women with low skeletal muscle mass and CVD may be more responsible for DRF than osteoporosis.

Patellar fractures account for approximately 1% of all human body fractures. This study aimed to compare the surgical outcomes of open reduction and closed reduction for patellar fractures. This retrospective study included 62 patients (63 cases) who underwent surgical treatment of patellar fractures from 2008 to 2013. Of the 63 cases, open and closed reductions were performed in 42 and 21 cases, respectively. Plain radiography was used to assess fracture healing. Comminuted patellar fracture was the most common fracture type in both groups. Tension band wiring and cannulated screw fixation were mainly used in the open and closed reduction groups, respectively. There was no significant difference in the modified hospital for special surgery score, visual analog scale score for pain, and range of motion between the two groups. The mean union time was 3.2 and 3.0 months in open and closed reductions, respectively. Postoperative knee stiffness was noted in five cases of open reduction and in three cases of closed reduction. One patient in the open reduction group had a refracture. There were no notable differences in treatment outcomes between open and closed reductions. Thus, closed reduction may not be inferior to open reduction as a surgical treatment for patellar fractures.

Malunion after distal radius fracture is common in older patients; however, whether patient-perceived outcomes are influenced by radiologic outcome is controversial. This study evaluated patient-perceived outcomes according to radiologic parameters in older patients who underwent nonoperative treatment. The records of 167 patients older than 55 years who had a distal radius fracture were reviewed. All fractures were treated nonoperatively, and average length of follow-up was 7 years. Outcomes were evaluated using numeric rating scales for pain and satisfaction, as well as Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Radiographs were evaluated for dorsal tilt, radial inclination, and ulnar variance. Fifty-one patients (30%) developed malunion. The pain numeric rating scale score was 0.8 for patients with malunion and 0.4 for patients with acceptable alignment; this difference was not statistically significant. The QuickDASH score was higher for patients with malunion (14.9 vs 11.1 for patients with acceptable alignment); however, this difference was not clinically meaningful. Satisfaction scores were lower for patients with malunion than for patients with acceptable alignment (80.8 vs 92.3). Patients with malunion stated they would choose surgery rather than a cast (13.3% vs 7.2%) if they developed another fracture; this difference was not statistically significant. The subanalysis according to radiologic parameters showed dorsal tilt and ulnar variance affected patient satisfaction but not other outcomes. This study indicated nonoperative treatment in older adults obtained acceptable patient-perceived outcomes despite residual deformity. However, patients whose radiologic parameter exceeded the tolerable range were less satisfied. [ Orthopedics . 2021;44(2):e190–e196.]

A meta-analysis was performed to compare trapeziectomy with ligament reconstruction and tendon interposition (LRTI) vs prosthetic replacement for first carpometacarpal joint osteoarthritis. Seven prospective and retrospective comparison trials were retrieved. A total of 459 patients receiving trapeziectomy with LRTI and 374 patients receiving prosthesis replacement with a follow-up of 12 to 69 months were identified. There were no differences in visual analog scale scores or complications. However, the mean Disabilities of the Arm, Shoulder and Hand score was 3.73 points lower and the mean pinch power was 1.16 points higher in the prosthesis replacement group, and this was significant. Prosthetic replacement led to a superior clinical outcome compared with trapeziectomy with LRTI, with no difference in complications. [ Orthopedics . 2021;44(2):e151–e157.]

Current evidence shows no significant difference in clinical outcomes between patients treated with versus without additional physiotherapeutic intervention, and high-quality studies are lacking. Patient education and exercise (so-called home exercise program) seems sufficient after distal radius fracture based on current evidence, suggesting that there is no need to prescribe a routine supervised physiotherapy session for all patients. The subgroup who would obtain significant benefit from supervised physiotherapy session has not yet been identified. Future studies should aim to identify for whom this costly intervention is needed. Earlier rehabilitation after surgery leads to early recovery and return to work at short-term follow-up.

Introduction Lateral epicondylitis is a common tendinopathy of the elbow. An adequately validated questionnaire is essential to compare the various treatment options, because there is still controversy regarding the best treatment for lateral epicondylitis. Purpose of the study The patient-rated tennis elbow evaluation (PRTEE) was introduced to measure the degree of symptoms and the limitation of function in these patients. This English questionnaire was previously translated into several languages and validated; however, it has not been translated into Korean. The aim of this study was to translate and cross-culturally adapt the PRTEE questionnaire into Korean, and to assess the reliability and validity of the translated questionnaire. Methods Eighty-three patients were asked to complete the Korean version of the PRTEE and other questionnaires related to the upper extremity or to the general health condition (the Disabilities of Arm, Shoulder, and Hand questionnaire, Short Form-12, and EQ-5D). The PRTEE responses were recorded twice to evaluate test-retest reliability. Internal consistency, test-retest reliability, concurrent validity, and ceiling and flooring effects were evaluated. Results The Korean version of the PRTEE showed high internal consistency (Cronbach's alpha = 0.968). The overall test-retest reliability was good (intra-class correlation score = 0.94). High correlation efficiencies between the PRTEE and other questionnaires were observed, supporting high concurrent validity (Spearman's correlation = 0.83 for the Disabilities of Arm, Shoulder, and Hand questionnaire; -0.73 for Short Form-12; and -0.57 for EQ-5D). Ceiling and floor effects were not observed on this test. Conclusion We successfully translated the PRTEE into the Korean language; this version of the PRTEE showed good reliability and construct validity in Korean-speaking patients with lateral epicondylitis.

PURPOSE Local steroid injection is an effective treatment modality for carpal tunnel syndrome. This study aimed to investigate the success rate of ultrasonography-guided local steroid injection and determine the prognostic value of the cross-sectional area (CSA) of the median nerve for steroid injection. METHODS We retrospectively evaluated 40 patients with carpal tunnel syndrome whose median nerve CSA was >15 mm2 (large-CSA group; n = 16) or ≤15 mm2 (small-CSA group; n = 24). The CSA was measured using ultrasonography, and all the patients were treated with ultrasonography-guided corticosteroid injection. Demographic characteristics, symptoms, initial QuickDASH score, Boston Carpal Tunnel Questionnaires, and results of the nerve conduction study were assessed at baseline. Treatment success was defined in this study as the absence of symptom recurrence within the entire follow-up period. RESULTS The treatment success rate was 45% (n = 18) after an average follow-up of 16 months. Overall, 11 patients (28%) underwent carpal tunnel release on an average of 11 months after steroid injection. The large-CSA group showed a significantly worse grade of electrodiagnostic testing at baseline than did the small-CSA group; however, there was no significant difference in final Boston Carpal Tunnel Questionnaires symptom score (1.7 vs 1.8, respectively) and the rate of continued treatment success at the last follow-up (42% vs 50%, respectively). The proportions of patients who required carpal tunnel decompression were 29% and 25% in the small-CSA and large-CSA groups, respectively. CONCLUSIONS Local steroid injection for carpal tunnel syndrome has an overall success rate of 45% after a mean follow-up of 16 months. Preinjection CSA was not associated with whether the steroid injection was considered successful. This indicates that increased median nerve CSA does not preclude the possibility of symptomatic relief after a local steroid injection. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

This was a systematic review with a meta-analysis.Despite rising trends toward surgical treatment of distal radius fractures (DRF) with volar locking plate (VLP) fixation, there is a lack of consensus on when to start vigorous wrist range of motion (ROM) exercises after surgery.We performed a meta-analysis to compare early and late mobilization after VLP fixation in patients with DRF.Four prospective randomized controlled trials with a minimum of 6 months of follow-up were retrieved through MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library, and the KoreaMed databases in March 2021. We divided patients into an early group (patients who started ROM exercises of the wrist within 2 weeks after surgery), and a late group (patients who started ROM exercises 5 or 6 weeks after surgery). The primary outcome was treatment efficacy which was measured through improvement in pain score, function score, ROM, and grip power. The secondary outcome was the incidence of postoperative complications.This meta-analysis included 127 patients in the early group and 131 patients in the late group. The outcomes were compared at 6 weeks, 3 months, and 6 months postoperatively. There was no significant difference in pain score, though the early group had a lower average visual analog scale score. The early group had a lower arm, shoulder, and hand disability score than the late group (95 % CI, -16.25 to -8.35 points; P.001) at 6 weeks postoperatively, suggesting significantly superior outcomes. A similar trend persisted at 3 (n = 74 in the early group and n = 77 in the late group; 95% CI, -5.45 to -0.30; P = .029) and 6 months (n = 102 in the early group and n = 100 in the late group; 95% CI, -4.81 to 0.21; P = .073), but the differences were smaller. The early group had a higher grip power at all follow-up periods, but the difference was only significant at 6 months postoperatively (n = 88 in the early group and n = 83 in the late group; 95% CI, 0.50 to 6.99; P = 0.024). The early group also had more favorable ROM in all directions at 6 weeks, but only in supination at 6 months. The complication rate was not significantly different between the 2 groups. There were no differences in the rates of secondary operation and reduction loss.Early ROM exercise after VLP in DRF resulted in superior functional scores and grip power until 6 months postoperatively. The dominance of the joint ROM, which was seen at 6 weeks after surgery in the early exercise group, decreased with time and ultimately showed little difference at 6 months. Early exercise is safe and did not increase complication rates.

Through the analysis of blood and hair samples, this study evaluated the effects of grazing in alpine areas on welfare indices and indicators of stress in dairy cows. Twenty-one Holstein dairy cows (body weight: 637 ± 21.5 kg; days in milk: 133 ± 17.7, and second parity) were randomly assigned to 3 groups: control (nongrazing), 12 h of alpine grazing (12 hG), and 24 h of alpine grazing (24 hG). Blood samples for plasma collection were taken for 3 consecutive days at the end of the experiment. Hair samples were collected at the beginning and end of the experiment. Hormone measurements included cortisol, serotonin, and dehydroepiandrosterone (DHEA) in both plasma and hair samples. Plasma cortisol and DHEA levels did not differ among the 3 groups, whereas the plasma serotonin level was higher in the 24 hG group than that in the other groups. The plasma cortisol to DHEA ratio was lower in the 24 hG group than that in the control and 12 hG group. The hair samples taken at the end of the experiment showed that the cortisol level was significantly higher in the control group than that in both of the grazing groups and also higher in the 12 hG than that in the 24 hG group. Hair DHEA and serotonin levels were highest in the 24 hG group. The hair cortisol to DHEA ratio was significantly higher in the control group than that in the 12 hG and 24 hG groups and in the 12 hG group than that in the 24 hG group. Our study showed that grazing dairy cows in alpine areas for 24 h improved their welfare, as indicated by increased serotonin levels in hair and plasma, increased hair DHEA level, and decreased stress indicators, including the hair cortisol level and cortisol to DHEA ratio. Farm facilities should allocate optimal grazing time for optimal welfare of dairy cows.

Purpose To identify the structural integrity of the healing site after medial open wedge high tibial osteotomy (MOWHTO) in patients with a posterior root tear of the medial meniscus (PRTMM) and chondral lesion by second-look arthroscopy and to determine the clinical and radiological findings. Materials and methods From August 2010 to June 2016, 52 consecutive patients underwent MOWHTO and arthroscopic examination without a chondral resurfacing procedure and meniscal treatment for PRTMM. Twenty-four patients were available for second-look arthroscopic evaluation. The mean follow-up period was 19.5 months (range, 5 to 46 months). Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. Results There were 5 lax healing, 6 scar tissue, 13 failed healing of PRTMM. Definite change of chondral lesion was not observed. The Kellgren-Lawrence grade did not improve according to the follow-up plain radiograph. The mean Lysholm score improved from 34.7 preoperatively to 77.1 at the last follow-up, and the mean HSS score significantly increased from 36.5 to 82.4. Conclusions This study revealed a low rate of healing potency of PRTMM and chondral lesion after MOWHTO without any attempt for meniscal treatment or chondral resurfacing. The cartilage and healing status of PRTMM was not associated with improved clinical outcomes and radiological findings.

The aim is to report the long-term clinical results after pisiform excision in patients with refractory flexor carpi ulnaris (FCU) tendinopathy. We performed pisiform excision in 14 patients with recalcitrant FCU tendinopathy, who had failed conservative treatment. Nine patients were followed-up for more than 2 years. Pre-operative pain visual analog scale (VAS) was extracted from the electronic medical records. Post-operative symptoms and function were assessed with pain VAS, quick disabilities of arm, shoulder and hand (DASH) score, patient rated wrist evaluation (PRWE) score, and satisfaction VAS for surgery at the final follow-up. After the mean follow-up period of 6 years, all patients showed improvement in pain VAS (from 5.9 to 1.2). The post-operative scores of quick DASH and PRWE were 3.5 and 13.1, respectively. Satisfaction VAS score was 8.8 and all patients returned to their work. Excision of the pisiform bone improved symptoms in patients with refractory FCU tendinopathy.

The purpose of this study was to test the hypothesis that an improved outcome can be achieved by employing simultaneous steroid injection after percutaneous A1 pulley release. One hundred and twelve digits were randomized to either percutaneous A1 pulley release alone or release of the A1 pulley with a steroid injection. The visual analogue scale score for pain, modified patient global impression of improvement and modified Quinnell grade were assessed at 3 weeks and 3 months after surgery. At 3 weeks, subjective improvement in the group with simultaneous steroid injection was significantly superior. At 3 months, pain score in the patients without a steroid injection was significantly better. No significant differences were found in the modified Quinnell grade. We conclude from this study that the simultaneous steroid injection at the time of surgical release decreases pain and improves subjective outcomes during the early postoperative period after percutaneous trigger finger release. Level of evidence: I

The sand-cone method is commonly used to measure the in situ density of compacted soils. While determining field density with this method, differences in the sand-filling process between the test hole and the calibration container can cause errors. The differences can result from various in situ conditions such as the shape and size of the test hole and the moisture conditions of the filling sand and test ground. Temporary rainfall can increase the moisture content of both in situ soils and filling sand. This study examined the effect of wetting conditions on the accuracy of the sand-cone method in a laboratory. Compacted soils with different water contents (2–16%) were prepared in a small circular container in the laboratory, and the sand-filling process was simulated for cylindrical, conical, and roof-shaped test holes with depths of 10 and 15 cm. As the water content of the compacted soils increased, the sand-cone method underestimated the volume of sand accumulated in the test holes by up to 20%, resulting in the calculated density being overestimated by an identical amount. Slightly moist sand was poured into artificial test holes. When the water content of the filling sand was below 1%, no significant error was observed in the calculated volume.

Backgroud This review aimed to evaluate the effects of corticosteroid injections on Morton's neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework. Methods Several electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton's neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). guidelines, and clinical outcomes were evaluated using various outcome measures. Results With 3-12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain. Conclusions Corticosteroid injections showed a satisfactory clinical outcome in patients with Morton's interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.

Three-dimensional flows of Mach number 3 around a double-compression ramp with finite span have been investigated numerically. Shadowgraph visualisation images obtained in a supersonic wind tunnel are used for comparison. A three-dimensional Reynolds-averaged Navier–Stokes solver was used to obtain steady numerical solutions. Two-dimensional numerical results are also compared. Four different cases were studied: two different second ramp angles of $${30}^{\circ }$$ and $${45}^{\circ }$$ in configurations with and without sidewalls, respectively. Results showed that there is a leakage of mass and momentum fluxes heading outwards in the spanwise direction for three-dimensional cases without sidewalls. The leakage changed the flow characteristics of the shock-induced boundary layer and resulted in the discrepancy between the experimental data and two-dimensional numerical results. It is found that suppressing the flow leakage by attaching the sidewalls enhances the two-dimensionality of the experimental data for the double-compression ramp flow.

Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying(one medial-row tie among 4 medial-row sutures) on the medial-row in double–row suture-bridge configuration (2×2 anchor with 4×4 suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2×2 anchor double-row configuration. The mean age was 61.3 years (range, 31–81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.

Background Thickened synovial plicae in the radiocapitellar joint have been reported as a cause of lateral elbow pain. However, few reports regarding diagnosis based on detailed physical examination and magnetic resonance imaging (MRI) findings are available. The aims of this study were to characterize the clinical manifestations of this syndrome and to investigate the clinical outcomes of arthroscopic surgery. Methods We analyzed 20 patients who received a diagnosis of plica syndrome and underwent arthroscopic debridement between 2006 and 2011. The diagnosis was based on physical examination and MRI findings. Elbow symptoms were assessed using a visual analog scale for pain; the Mayo Elbow Performance Index; and the Disabilities of the Arm, Shoulder and Hand score at a minimum of 2 years after surgery. The thickness of plicae on MRI was compared with the normal data in the literature. Results Plicae were located on the anterior side in 1 patient, on the posterior side in 15, and on both sides in 4. Radiocapitellar joint tenderness and pain with terminal extension were observed in 65% of patients. MRI showed enlarged plicae consistent with intraoperative findings. The mean plica thickness on MRI was 3.7 ± 1.0 mm, which was significantly thicker than the normal value. The mean lengths (mediolateral length, 9.4 ± 1.6 mm; anteroposterior length, 8.2 ± 1.7 mm) were also greater than the normal values. The visual analog scale score for pain decreased from 6.3 to 1.0 after surgery. The Mayo Elbow Performance Index and Disabilities of the Arm, Shoulder and Hand scores improved from 66 to 89 and from 26 to 14, respectively. Conclusions Specific findings of the physical examination and MRI provide clues for the diagnosis of plica syndrome. Painful symptoms were successfully relieved after arthroscopic debridement.

During varus deformity correction in a patient undergoing total knee arthroplasty (TKA), the medial collateral ligament (MCL) could get completely detached from its distal insertion site. Our aim was to evaluate the (1) mid-term clinical outcome and implant survival after conservative treatment in patients with intraoperatively over-released MCL and (2) preoperative risk factors for MCL over-release. A retrospective study was conducted on patients who had undergone a primary TKA between 2001 and 2006. The number of knees with intraoperative MCL over-release (over-released group) was 47 (40 patients); we compared these with the knees that had intact MCL (intact group, 502 knees). Simple anchoring of MCL was performed with no additional protection. The postoperative clinical outcome and implant survival were compared. Risk factors for MCL over-release were identified using multivariate analysis. The average follow-up period was 7.5 years. The mean Knee Society score of the over-released group improved from 23.3 to 92.7 and it was not significantly different from the intact group. Three cases of aseptic loosening occurred in the over-released group and 19 in the intact group (p = 0.423). The survival rates of the implant were 94.4% and 96.1%, respectively, at 13 years postoperatively. Multivariate analysis showed preoperative femoral–tibial angle as the only risk factor for over-release. This study showed that even MCL was over-released inadvertently, but it did not affect the clinical outcome. Preoperative femoral–tibial angle was the only predictable risk factor for MCL over-release.

Decision of available soil depth based on soil physical and hydraulic properties for the 3 rd Landscape Vegetation Project in the Incheon International Airport was attempted. The soil samples were collected from the 8 sites at different depths, 0-20 and 20-60cm, for the three project fields, A, B, and C area. Physical and chemical properties including particle size distribution, organic matter content and electrical conductivity were analyzed. Hydrological properties including bulk density and water holding capacity at different water potential, -6 kPa, -10 kPa, -33 kPa, and -1500 kPa were calculated by SPAW model of Saxton and Rawls (2006), and air entry value was calculated by Campbell model (1985). Based on physical and hydrological limitation, feasibility and design criteria of soil depth for vegetation and landfill were recommended. Since the soil salinity of the soil in area A area was 19.18 dS m -1 in top soil and 22.27 dS m -1 in deep soil, respectively, landscape vegetation without amendment would not be possible on this area. Available soil depth required for vegetation was 2.51 m that would secure root zone water holding capacity, capillary fringe, and porosity. Available soil depth required for landscape vegetation of the B area soil was 1.51 m including capillary fringe 0.14 m and available depth for 10% porosity 1.35 m. The soils in this area were feasible for landscape vegetation. The soil in area C was feasible for bottom fill purpose only due to low water holding capacity.

Purpose To compare mechanical properties of a multistrand suture technique for flexor tendon repair with those of conventional suture methods through biomechanical and clinical studies. Methods We describe a multistrand suture technique that is readily expandable from 6 to 10 strands of core suture. For biomechanical evaluation, 60 porcine flexor tendons were repaired using 1 of the following 6 suture techniques: Kessler (2-strand), locking cruciate (4-strand), Lim/Tsai's 6-strand, and our modified techniques (6-, 8-, or 10-strand). Structural properties of each tenorrhaphy were determined through tensile testing (ultimate failure load and force at 2-mm gap formation). Clinically we repaired 25 flexor tendons using the described 10-strand technique in zones I and II. Final follow-up results were evaluated according to the criteria of Strickland and Glogovac. Results In the biomechanical study, tensile properties were strongly affected by repair technique; tendons in the 10-strand group had approximately 106%, 66%, and 39% increased ultimate load to failure (average, 87 N) compared with those in the 4-, 6-, and 8-strand groups, respectively. Tendons in the 10-strand group withstood higher 2-mm gap formation forces (average, 41 N) than those with other suture methods (4-strand, 26 N; 6-strand, 27 N; and 8-strand, 33 N). Clinically, we obtained 21 excellent, 2 good, and 2 fair outcomes after a mean of 16 months (range, 6–53 mo) of follow-up. No patients experienced poor results or rupture. Conclusions The 10-strand suture repair technique not only increased ultimate strength and force at the 2-mm gap formation compared with conventional suture methods, it also showed good clinical outcomes. This multistrand suture technique can greatly increase the gap resistance of surgical repair, facilitating early mobilization of the affected digit. Type of study/level of evidence Therapeutic IV.

Purpose The purpose of this study is to evaluate the risk of sequential bilateral total knee arthroplasty (TKA) under 1 anesthesia in patients 75 years or older. Materials and methods Patients aged 75 years or older who underwent sequential bilateral TKA (bilateral group, n=159) and unilateral TKA (unilateral group, n=159) between 2002 and 2012 were selected. All patients were evaluated for underlying medical diseases, such as cardiac, pulmonary, and renal problems, and high-risk patients were recommended to postpone the surgery. We compared the underlying diseases, major postoperative complications, and the length of hospital stay between bilateral and unilateral groups. Results The prevalence of underlying diseases of the bilateral group was 74.8% and major complications occurred in 6 patients (3.8%). The prevalence of underlying diseases of the unilateral group was 52.4% and complications were observed in 4 patients (2.4%). Although the complication rate of the bilateral group was slightly higher than that of the unilateral group, the difference was not statistically meaningful (p=0.204). The length of hospital stay was 21.9 days for the bilateral group and 24.9 days for the unilateral group. Conclusions There was no significant difference in postoperative complications between groups. The result shows that bilateral TKA can be relatively safe compared with unilateral TKA in patients 75 years or older. However, careful selection of low-risk patients is advised.

Introduction The prevalence of sesamoid bone in hand is known to be variable among populations of various geographic origins. Since counting with radiographs might be inaccurate due to superimposition of adjacent digits, we tried to overcome this obstacle using 3D-reconstructed CT in Korean patients. The purpose was to provide an accurate incidence of sesamoid bones using 3D-CT. Methods Sesamoid bones were examined in 427-CT images. 3D-CT images were analyzed by one observer and parts of hands (411-hands) were evaluated with radiograph to compare with CT results. Statistical analysis between the CT and radiograph results was performed. Results Sesamoids of metacarpo-phalangeal (MP) joint of the thumb were always present on both radial and ulnar sides, except for 9-cases (2.1%) where they were not present on radial side and 6-cases (1.5%) where they were not present on ulnar side. MP joint of the little finger was the second most prevalent location (62.8%). The sesamoid of the index finger MP joint and thumb interphalangeal joint was observed in 44% and 42.4%, respectively. There was a rare incidence in the MP joints of middle and ring finger (0.7%). The incidence of sesamoid bone was statistically different between the two counting methods for the MP joints of index and little finger and thumb interphalangeal joint ( P Discussion We could observe five frequent sesamoid bones in the MP joints of the thumb, index, and little finger, and the interphalangeal joint of the thumb in Korean individuals. 3D-CT images revealed the accurate incidences of hand sesamoid bones.

Purpose This study aimed to establish normal values for wrist carpal alignment measured by 3-dimensional computed tomography (CT) and to show the inter- and intraobserver reliability of this measurement compared with simple radiography. Methods The study utilized 3-dimensional CT and simple radiography of wrist joints in 30 asymptomatic volunteers. The wrist position was standardized using a custom-designed positioning device. Three independent observers measured carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radiocapitate angle, radius-third metacarpal angle, scapholunate angle, lunocapitate angle, and lunate-third metacarpal angle. Results Based on 3-dimensional CT measurement, the mean values of these parameters were: 12.9° ± 1.8° for the distal radius articular angle; 1.2° ± 3.8° for the radiolunate angle; 54.2° ± 5.6° for the radioscaphoid angle; 1.9° ± 2.2° for the radiocapitate angle; –1.0° ± 2.5° for the radius-third metacarpal angle; 52.9° ± 6.9° for the scapholunate angle; 0.7° ± 4.1° for the lunocapitate angle; –2.3° ± 4.6° for the lunate-third metacarpal angle. All parameters showed high inter- and intraobserver reliability in the 2 modalities. Conclusions The normal values and ranges for carpal alignment angles were evaluated by using 3-dimensional CT. We could obtain high reliability in 3-dimensional CT as well as plain radiograph for the measurement of carpal alignment. Type of study/level of evidence Diagnostic II.

The purposes of this study were to evaluate the clinical results of arthroscopic débridement and to identify preoperative factors that influence the outcome.Forty-three elbows with primary osteoarthritis in 43 patients treated with arthroscopic débridement were retrospectively evaluated. At a mean follow-up of 38 months (range, 18-77 months), the visual analog scale (VAS) score for pain, the arc of elbow motion, and the Mayo Elbow Performance Index (MEPI) score were assessed. The relationships between postoperative MEPI score and postoperative motion arc and preoperative factors including age, sex, involvement of the dominant arm, duration of symptoms, demand of elbow activity, VAS score, previous history of failed surgery, and arc of elbow motion were statistically evaluated.The mean VAS score for pain, the mean arc of flexion-extension, and the mean MEPI score significantly improved after the operation (all P values .001). Multivariate regression analysis revealed that among preoperative variables, arc of motion was found to be the only independent prognostic factor that affected both postoperative elbow function (P = .024) and final arc of motion (P .001). The cutoff value of preoperative arc of motion for the final arc of motion was determined to be 80° (P .001). Involvement of the dominant arm was found to be another independent factor that affected postoperative MEPI scores (P = .016).Arthroscopic débridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome. Based on the fact that preoperative motion arc is the independent factor that can predict clinical outcome, arthroscopic treatment is highly recommended for patients who have a motion arc of 80° or more as it yields reliable results.

Purpose To investigate the effects of arthroscopic wrist synovectomy on the clinical course of rheumatoid arthritis in a large series with long-term follow-up. Methods We performed arthroscopic synovectomy on 56 wrists in 49 patients with rheumatoid arthritis. At a mean follow-up of 7.9 years (range, 5–12 y), we evaluated pain and patient satisfaction using a visual analog scale and assessed overall function using the Mayo wrist score. Radiographic stage was graded according to Larsen stage. We determined clinical outcomes on the recurrence of wrist synovitis, which we evaluated by symptoms of pain and swelling and physical examination. Preoperative variables were statistically analyzed to find factors that could influence the results. Results The mean visual analog scale score for wrist pain decreased from 6.3 to 1.7, and the mean Mayo wrist score (evaluated in 39 wrists) improved from 48 (range, 5–70) to 76 (range, 55–100). The mean visual analog scale score for patient satisfaction was 7.9. At final follow-up, synovitis was controlled in 42 wrists (75%) and recurred in the others. The mean Larsen stage progressed from 2.2 to 3.3. Analysis of preoperative variables revealed no factors that significantly affected clinical outcomes in terms of sex, age, duration of wrist symptom, preoperative serologic inflammatory markers, or Larsen stage. Conclusions Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication. Type of study/level of evidence Therapeutic IV.

The purpose of this study was to report clinical and radiologic results of arthroscopic biceps tenodesis with 1 suture anchor in rotator cuff tear patients.During a 2-year period, 84 consecutive patients (45 men; 39 women) who underwent arthroscopic tenodesis were evaluated retrospectively. Mean age was 58 years. The primary indication for surgery was rotator cuff tear in 96.4%. Tenodesis was performed with 1 suture anchor placed in the bicipital groove with 2 knots, 1 lasso-type and 1 that pierced the tendon. At final follow-up at a mean of 33.2 months, visual analog scale pain (pain-VAS) score, shoulder scores (American Shoulder and Elbow Surgeons [ASES] and Constant score), Popeye deformity (PD), anterior arm pain, and elbow flexion power were evaluated. Postoperative magnetic resonance images were evaluated in 60 patients to determine the integrity of the tenodesis and the location of the suture anchor.The average pain-VAS decreased from 5.3 to 1.4 (P.001). ASES and Constant scores significantly increased, from 42.9 and 56.2 to 85.2 and 82.5, respectively. PD occurred in 11 patients (12.9%), and 2 (2.3%) had self-consciousness; however, no patients complained about the deformity and the PD did not correlate with poorer clinical scores. Six patients (7.1%) complained of anterior cramping pain. Elbow flexion power was similar compared with the contralateral side. In postoperative magnetic resonance imagine analysis, 15 patients (25%) showed distal migration of tenodesed biceps tendon, although only 6 (7.1%) had clinical PD. Postoperative clinical outcomes were not influenced by the location of the suture anchor within the bicipital groove.Arthroscopic biceps tenodesis with 1 suture anchor resulted in good clinical outcomes at 2 years postoperatively. PD was seen in 12.9% of the patients.

Water balance components of a bare soil with slope varying from 5% to 30% in Chuncheon, South Korea, were simulated using the E-DiGOR model, which proposed an interactive way to quantify runoff, drainage, soil water storage, and evaporation. Daily computations were carried out during the period of 1980 to 2009 for the identified soil-topography-climate combination. A strong correlation between measured pan evaporation and calculated potential soil evaporation was observed (R2 = 63.8%, P < 0.01) based on the monthly data of the past 30 years (hereafter 'long-term'). When examining long-term dynamics of simulated soil evaporation, monthly mean potential and actual soil evaporations ranged from 9.1 and 9.0 mm in December to 110.5 and 75.2 mm in June and July, respectively. The ratio of actual to potential soil evaporation (Ea/Ep) had a close linkage with soil water content. The higher the soil water amount, the greater the Ea/Ep ratio was. A nonlinear relationship between rainfall and surface runoff was obtained at a given slope. Excess surface runoff and subsurface flow (percolation + interflow) occurred throughout the rainy months from July to September, with peaks in July. The ratio of direct surface runoff to rainfall increased with the natural logarithm of slope. The long-term mean annual direct surface runoff and subsurface flow at the maximum slope were 408.1 and 437.6 mm, respectively. Furthermore, mean annual surface runoff from the slope of 30% was approximately 2 times higher than that from the slope of 5%.