Pure varus posteromedial rotatory instability of the elbow: Radiographic findings, treatment, and outcomes.

Introduction: Although varus posteromedial rotatory instability (VPMRI) is a subtle elbow injury that involves anteromedial coronoid facet (AMCF) fracture and ligamentous injuries, treatment options and outcomes of VPMRI remains controversial. The aim of this study was to investigate radiographic findings, treatments, and outcomes of a large series of VPMRI.

Methods: We retrospectively reviewed 91 pure VPMRI cases with AMCF fracture (O'Driscoll classification anteromedial type) which were treated at 6 hospitals.

Patterns of injury mechanism observed in terrible triad.

Introduction: The purpose of this study was to classify the injury mechanism of terrible triad (TT) and suggest a treatment method according to the mechanism.

Materials And Methods: Forty TTs with magnetic resonance imaging (MRI) scans and 3-dimensional computed tomography (3D CT) were enrolled. 3D CT scans of coronoid fractures were used for classifying into O'Driscoll type representing injury mechanisms and measuring sizes.

Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries.

Background: Traumatic distal triceps tendon rupture results in substantial disability in the absence of an appropriate diagnosis and treatment. To the best of our knowledge, differences in the degree of injury according to the injury mechanisms and associated lesions are not well known.

Questions/purposes: In this study, we asked: (1) What differences are seen in triceps tear patterns between indirect injuries (fall on an outstretched hand) and direct injuries? (2) What are the associated elbow and soft tissue injuries seen in indirect and direct triceps ruptures?

Methods: Between 2006 and 2017, one center treated 73 elbows of 72 patients for distal triceps tendon rupture.

Rapid harvesting of stem cell sheets by thermoresponsive bulk poly(-isopropylacrylamide) (PNIPAAm) nanotopography.

To date, cell sheet engineering-based technologies have actualized diverse scaffold-free bio-products to revitalize unintentionally damaged tissues/organs, including cardiomyopathy, corneal defects, and periodontal damage. Although substantial interest is now centered on the practical utilization of these bio-products for patients, the long harvest period of stem cells- or other primary cell-sheets has become a huge hurdle. Here, we dramatically reduce the total harvest period of a cell sheet (from cell layer formation to cell sheet detachment) composed of human bone marrow mesenchymal stem cells (hBMSCs) down to 2 d with the help of bulk thermoresponsive poly(N-isopropylacrylamide) (PNIPAAm) substrate nanotopography, which is not achievable via the previous grafting methods using PNIPAAm.

Prediction of the anterior shoulder pain source by detecting indirect signs for partial articular subscapularis tendon tears through conventional magnetic resonance imaging.

Purpose: To evaluate the diagnostic efficacy of indirect signs for proximal articular-positioned, partial (< 50%), subscapularis tendon tears (facet 1 tears) via conventional magnetic resonance imaging (MRI).

Methods: A retrospective study was conducted on 67 patients of Yoo's type 1 or 2A tears. Forty-five arthroscopic subacromial decompression and acromioclavicular resection cases served as controls.

Soft tissue injury patterns in posteromedial rotatory instability with dislocation compared with posteromedial dislocation of the elbow joint.

Background: We sought to determine injury mechanisms and soft tissue injury patterns of dislocation caused by posteromedial rotatory instability (PMRI) and simple posteromedial (PM) dislocation of the elbow joint that appear similar on simple radiographs.

Methods: In this retrospective case-series study, we reviewed 13 patients with PMRI dislocation and 10 patients with simple PM dislocation. Three-dimensional computed tomography and magnetic resonance imaging were performed in both groups.

Treatment of posteromedial and posterolateral dislocation of the acute unstable elbow joint: a strategic approach.

Background: The purpose of this study was to evaluate the different treatment strategies for posterolateral and posteromedial elbow dislocation.

Methods: The study enrolled 21 patients with unstable simple elbow dislocation including 16 cases of posterolateral dislocation (PLDL) and 5 cases of posteromedial dislocation (PMDL). In patients with PLDL, the medial side was evaluated and repaired first, followed by the lateral side.

Dual reconstruction of lateral collateral ligament is safe and effective in treating posterolateral rotatory instability of the elbow.

Purpose: Although reconstruction of the lateral ulnar collateral ligament (LUCL) has been considered the procedure of choice for posterolateral rotatory instability (PLRI), recent studies have reported that the entire lateral collateral ligament complex (LCLC), rather than its posterior part only, contributes to preventing PLRI. Thus, it was hypothesized that dual reconstruction of the radial collateral ligament (RCL) and LUCL for the treatment of elbow PLRI could provide favourable clinical results regardless of the mechanism of injury.

Methods: This retrospective study reviewed the clinical results of 21 patients who underwent dual reconstruction of the RCL and LUCL between 2011 and 2016.

Posteromedial Elbow Dislocations without Relevant Osseous Lesions: Clinical Characteristics, Soft-Tissue Injury Patterns, Treatments, and Outcomes.

Background: Although simple posterolateral or posterior elbow dislocations are relatively common and usually stable after closed reduction, simple posteromedial dislocations are extremely rare and poorly characterized. We investigated the clinical characteristics, soft-tissue injury patterns, treatments, and outcomes of a series of posteromedial elbow dislocations without relevant osseous lesions.

Methods: We retrospectively reviewed 20 cases of simple posteromedial elbow dislocations without relevant osseous lesions that were treated at 7 fellowship training hospitals during a 10-year period.

A Case Series of Symptomatic Distal Biceps Tendinopathy.

Background: The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture.

Methods: Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.

What Injury Mechanism and Patterns of Ligament Status Are Associated With Isolated Coronoid, Isolated Radial Head, and Combined Fractures?

Background: Isolated coronoid, isolated radial head, and combined coronoid and radial head fractures are common elbow fractures, and specific ligamentous injury of each fracture configuration has been reported. However, the osseous injury mechanism related to ligament status remains unclear.

Questions/purposes: The objectives of this study were: (1) to determine what ligamentous injury patterns (medial or lateral collateral) and bone contusion patterns (medial or lateral) are associated with isolated coronoid, isolated radial head, and combined coronoid and radial head fractures; (2) to correlate the osseous injury mechanism based on these findings with isolated coronoid, isolated radial head, and combined coronoid and radial head fractures; and (3) to determine whether isolated and combined coronoid fractures have different fracture lines through the coronoid (tip or anteromedial facet), speculated to be caused by different injury mechanisms.

Endoscopic Olecranon Bursal Resection for Olecranon Bursitis: A Comparative Study for Septic and Aseptic Olecranon Bursitis.

Background: Open excision of the olecranon bursa has been performed traditionally. However, surgical complications such as wound healing problems and recurrence may occur after the surgery. The purpose of this study was to report on the clinical outcomes of endoscopic olecranon bursal resection performed in both septic and aseptic olecranon bursitis.

Isolated coronoid fracture: Assessment by magnetic resonance imaging for concomitant injuries.

Background: Ligamentous injury associated with isolated coronoid fracture had been sparingly reported. Concealed or unclear fractures and ligamentous or articular cartilage lesions are promptly acknowledged by magnetic resonance imaging (MRI) but cannot be entirely pictured in regular radiological assessments. In isolated coronoid fracture, the fragment size is very small and due to the complex anatomy surrounding the coronoid radiographic imaging may not be sufficient.

The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures.

Background: As there is substantial variation in the classification and diagnosis of lateral clavicle fractures, proper management can be challenging. Although the Neer classification system modified by Craig has been widely used, no study has assessed its validity through inter- and intrarater agreement.

Purpose: To determine the inter- and intrarater agreement of the modified Neer classification system and associated treatment choice for lateral clavicle fractures and to assess whether 3-dimensional computed tomography (3D CT) improves the level of agreement.

Drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation: natural course and contributing factors.

Background: We performed this study to investigate the natural course and factors affecting the incidence of drop sign immediately after stabilization of an unstable posterolateral (PL) dislocation of the elbow.

Methods: Twenty-three patients who underwent a stabilization procedure for persistent instability after closed reduction of PL dislocation of the elbow were enrolled. The natural course was evaluated with simple radiographs taken at regular intervals after the operation.

Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture.

Background: The purpose of this study was to suggest a strategic approach to the management of anteromedial coronoid facet (AMCF) fracture that is related to posteromedial rotational instability of the elbow through investigation of the surgical outcome of diverse combinations, including internal fixation of AMCF fractures and repair of collateral ligament injury.

Methods: The study enrolled 18 patients. On the basis of the size of the coronoid fracture and the degree of the soft tissue injuries that were evaluated with computed tomography, magnetic resonance imaging, and varus stress test under anesthesia, these fractures were managed differently.

Collateral ligament injury in the displaced radial head and neck fracture: correlation with fracture morphology and management strategy to the torn ulnar collateral ligament.

Background: The purpose of our study was to correlate the morphology of displaced radial head and neck (DRHN) fractures with associated ligament injuries and evaluate the outcomes of management of the torn ulnar collateral ligament (UCL).

Methods: Twenty-nine surgically treated patients presenting with a DRHN fracture were classified using the Charalambous classification by 3-dimensional computed tomography. Accordingly, the collateral ligament and overlying muscle injuries and bony contusions were investigated with magnetic resonance imaging.

Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow?

Background: Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear.

Questions/purposes: We asked if posterior radiocapitellar synovial plica excision made any additional improvement in pain or function after arthroscopic ECRB release.

New mechanism of the posterior elbow dislocation.

Purpose: To suggest a new model on the most common kind of posterior elbow dislocation using MRI findings on acute elbow injuries.

Methods: Fifteen patients with simple elbow dislocation (Group A) and 19 patients sustaining pure ligament injuries (Group B) were enrolled in this study. Using MRI scans, bony contusion at radial head and posterior capitellum (lateral bone contusion) and medial aspect of the ulnohumeral joint (medial bone contusion) were investigated with the injury patterns of the collateral ligament and overlying muscles.

Dual reconstruction of the radial collateral ligament and lateral ulnar collateral ligament in posterolateral rotator instability of the elbow.

Recent studies have found that the radial collateral ligament (RCL) plays a key role in the lateral stability of the elbow joint, and there is no truly isometric location for LUCL tendon graft reconstruction tunnels using the original technique. However, no report has been issued on the treatment including RCL reconstruction and the modification of LUCL reconstruction in patients with posterolateral rotatory instability (PLRI). Three patients with PLRI were treated using two different ways and produced good results.

Use of thoracodorsal artery perforator flap for soft tissue reconstruction in children.

Perforator free flap (PFF) is now performed with increasing frequency for soft tissue reconstruction in adults. When compared with conventional free skin flaps, PFFs are thinner and have less donor-site morbidity because only the skin is harvested. The advancement of the PFF design has spurred the identification of many skin flaps based on the perforator principle.