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High-energy caused intertrochanteric fractures in adult patients

Background: Although intertrochanteric fractures (IF) are common, the majority of IF occur in elderly patients with low-energy injuries. Highenergy caused IF are uncommon and the outcomes after treatment have few been reported. Following far advancement of modern medicine and technology, the prognosis may be quite different. Purpose: The purpose of this retrospective study intended to report the treatment outcomes of high-energy caused IF at our institution. A guide for treating such uncommon but potentially difficultly managed injuries might be established. Methods: For the 3.5-year period, 655 IF were treated. Thirty-six IF occurred due to high-energy injuries (5.5%, 36/655). Patients aged from 18-59 years (average, 32 years) with a male to female ratio of 6 to 1. Associated injuries were common (non-skeletal injury, 27.8%; skeletal injury, 47.2%). Three patients died before surgical treatment started (8.3%, 3/36). Thirty-three IF were surgical treated after an average of 4.5 days (range, 1.5-15.0 days). Three types of internal fixators were used: sliding hip screws (SHS), reconstructive locked nails, and dynamic condylar screws (DCS). In principle, stable IF was treated with SHS and unstable IF, nailing or DCS. Postoperatively, early ambulation with protected weight bearing was encouraged. The Harris Hip Score (HHS) was used to evaluate the subjective hip function. Results: Twenty-seven patients were followed for an average of 1.8 years (range, 1.1-4.2 years). Twenty-six IF healed with a union rate of 96% and an average union time of 3.7 months (range, 2.5-6.0 months). One aseptic nonunion was treated with cancellous bone grafting and healed uneventfully. Two deep infections occurred and repeated debridement was performed. Satisfactory hip function (by HHS) was achieved in 89% of patients (24/27). Conclusion: High-energy caused IF is uncommon. When it occurs, multiple associated injuries may co-exist concomitantly. Current techniques with various internal fixators for IF may achieve a high success rate and a low complication rate. Referring to the current and previously reported studies, the prognosis after surgical treatment is normally satisfactory.

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Patients with biceps long head tendinopathy prefer biceps tenodesis than tenotomy. A preliminary report in a medical center in Taiwan

Background: Both biceps tenotomy and tenodesis are effective treatment options for treating anterior shoulder pain. Purpose: The purpose of this study is to investigate the patient's preference and associated factors on the decision making between biceps tenotomy and tenodesis. Methods: Questionnaires were completed by the patients who were admitted for arthroscopic surgery due to shoulder pain on the day before the surgery. Patients' current symptoms, patients' concern, patients' selection, and their personal demographic information were collected. A total of 34 patients were included, with 23 male patients and 11 female patients. Results: Of 34 patients, 76% preferred to have biceps tenodesis surgeries. The preference between different gender groups and age groups were not different. Factors predictive of choosing a biceps tenodesis included importance of the appearance of biceps, concerns regarding cosmetic deformity with a tenotomy, and wills on revision surgery for biceps ＂Popeye＂ appearance (p = 0.021, 0.006, and 0.039, respectively). Whereas, factors predictive of choosing a biceps tenotomy included high level of acromioclavicular joint pain and concerns regarding a longer recovery time with a tenodesis (p = 0.018 and 0.004). Conclusion: Based on the finding in this preliminary study, we concluded that high proportion of patients with biceps long head tendinopathy favored biceps tenodesis than biceps tenotomy, even in patients older than age of 55 years. There are 5 predictive factors that can assist surgeons in making decisions for selecting between biceps tenotomy and tenodesis.

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Preoperative simulation of pedicle subtraction osteotomy for treating sagittal deformity of the spine-Comparison of prediction accuracy of 2 computerized protocols

Introduction: Pedicle subtraction osteotomy (PSO) is a powerful technique to correct sagittal malalignment of the spine. Inadequate correction during PSO may lead to poor functional outcome. Purpose: We used Surgimap to prove the efficacy of preoperative simulation. Methods: Two protocols of preoperative simulation were compared for their prediction accuracy of sagittal parameters including pelvic incidence minus lumbar lordosis (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA) in twenty-four patients. PT method targeted 20° of PT postoperatively. Fixed wedge angle (FWA) method aimed to simulate a 30° wedge correction at the level of PSO. The location of PSO was decided by the results of simulation. The differences between these two methods were evaluated by Student’s t-test. Results: PT method could predict post-operative SVA, PI-LL and PT more accurately than FWA method although statistical significance was shown only in the SVA parameter. The achievement rate was around 80% in three parameters by PT method. Larger variation of achievement rates was noticed in FWA method (59.9–80.2%). The difference of osteotomy angle (proposed osteotomy angle according to simulation minus actual osteotomy angle) was significantly smaller in PT method (3.25 ± 1.42°) than in FWA method (7.17 ± 5.39°). Conclusion: PT method could provide more reliable simulation of PSO than FWA method, even though computerized simulation software did not take possible reciprocal changes in the unfused segments into considerations. PT method of simulation could provide suggestions of PSO location and angle for pre-operative planning of PSO. Since sagittal parameters are highly correlated to clinical functions, better outcomes could be expected if accurate correction is achieved.

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Use of a 3-D CT reconstruction image to locate the adductor tubercle and to measure the joint-line distance in knee arthroplasty

Background: There are difficulties in locating the adductor tubercle (AT) to measure the joint line distance on a radiograph because of landmark identification and the geographic magnification associated with the use of the radiograph. Purpose: The objective of this study was to determine if employing a three-dimensional computed tomography (3-D CT) image could overcome these disadvantages, making the AT an eligible image landmark. Methods: First, initial validation of the 3-D CT measurement was performed using a bone specimen study, where the AT to the joint line distance (ATJL) was measured on each of 10 femoral bone specimens physically and also on respective 3-D CT images. Second, 40 clinical 3-D CT images were employed to analyze the intraobserver and inter-observer reliability in the clinical setting. Lastly, these clinical 3-D CT data were compared to the intraoperative ATJL measurement in our previous publication, using statistical analysis to seek for further validation. Results: The intraclass correlation coefficient (ICC) for the bone specimen study was 0.95, which implied a high agreement between the measurement made by the caliper and on the 3-D CT image. In the clinical study, the statistical analysis showed an excellent intra-observer and inter-observer reliability for ATJL measurements (ICC: 0.964 and 0.939). When compared to the data of the intra-operative ATJL measurement in our previous publication, the Kolmogorov- Smirnov test showed the similarity of the two techniques. Conclusion: The accuracy and reliability of measurement of the ATJL on the 3-D CT image have been well demonstrated in this study. We suggest using this technique to plan the joint line position before surgery in revision knee arthroplasty involving significant bone loss.

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Simultaneous Bennett's fracture and trapezium fracture in an adolescent: A case report and literature review

An adolescent baseball player was hit by a pitch directly on the hand when batting. X-ray examination showed the presence of both Bennett's fracture and trapezium fracture. The fractures were successfully treated with closed reduction, percutaneous Kirschnerwire fixation and casting. Both fractures healed successfully. The patient who experienced no pain had fully functional recovery and returned to play.

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Traumatic rupture of the anterior tibial tendon following closed ankle and foot fracture: A case report and literature review

A 22-year-old man presented with traumatic rupture of the anterior tibial tendon associated with a closed ankle fracture. The tendon rupture was not diagnosed before surgery but was recognized at the time of open reduction. The tendon was repaired and the fracture was internally fixed. Six months after the operation, the patient had nearly full range of pain-free ankle movement and normal gait. To our knowledge, such a case has not been reported previously. Although anterior tibial tendon rupture is rare, it should be suspected in cases of closed ankle fracture, irrespective of the mechanism of injury.

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A rare case of supracondylar humerus fracture after the Outerbridge-Kashiwagi procedure: A case report

Outerbridge-Kashiwagi procedure (O-K procedure) or ulnohumeral arthroplasty is a procedure for treating degenerative osteoarthritis of the elbow. Although a previous biomechanical study has demonstrated a decrease in maximum strength of the distal humerus after fenestration, there is limited literature reporting distal humerus fractures as a complication of this procedure. We present an elderly woman with supracondylar humerus fracture that occurred after a low energy trauma six months after the O-K procedure. The thin medial column after ulnohumeral arthroplasty was a possible reason for the supracondylar humerus fracture six months after the surgery. Surgeons should be especially careful during the fenestration to avoid the related complications.

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A case report: Simultaneous bilateral posterior shoulder and unilateral central acetabular fracture dislocations secondary to epileptic seizure

Fracture dislocations of extremities are a possible complication following epileptic seizures. Management mainly depends on the severity of the injury and the current medical status of the patient. We describe a rare case of bilateral posterior shoulder and unilateral central acetabular fracture dislocations without direct trauma after a convulsive seizure related to lung cancer with brain metastases. Two weeks after the seizure, we performed an open reduction and internal fixation (ORIF) with locking plate to treat bilateral posterior shoulder fracture dislocations when the patient’s neurological condition became more stable. However, nonoperative treatment was selected for the acetabular fracture dislocation because of the patient’s advanced-stage cancer. Since the patient was responding well to the newest target therapy for his lung cancer, and his life span is beyond our estimate, we, therefore, performed a total hip replacement 6 months later because of traumatic osteoarthritis development. The clinical outcome was satisfactory at the 6-month follow-up. Due to medical progress in non-small cell lung cancer treatment, we consider aggressive treatment may be necessary even in such advanced stage patients.