Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.
Aged ; Arthroplasty ; Female ; Humans ; Humeral Head* ; Osteonecrosis* ; Risk Factors ; Rotator Cuff* ; Shoulder ; Tears

To define the effectiveness of C-reactive protein (CRP) as indicator for early detection of the post-operative infection, it is essential to exclude possible normal changes of CRP influenced by surgery itself. We analyzed 44 patients who had done orthopaedic surgeries without any evidence of infection preoperative and postoperatively from May to Aug. 1995 at Dongsan medical center, Keimyung University. We checked the levels of Erythrocyte sedimentation rate (ESR) and CRP levels at preoperative and postoperative 1, 3, 5, 7, 9, 11, 13, 15, 17, 19 and 21st day in all cases. In all cases, ESR increased up to 60mm/hr maximally and CRP increased to more than 10mg/dl at least one occasion within the first 3 weeks postoperatively. However CRP showed more rapid changes than ESR. The mean value of the CRP was increased maximally (7.2mg/dl) at 3 day after operation and then decreased rapid until 11 day. ESR was also increased at 3 day after operation, but it sustained high level until 21 day after operation. CRP appears to be more sensitive and rapid indicator as an acute phase reactant for the operation itself because CRP revealed more earlier and accentuated change after the operation. The changes of CRP showed same pattern regardless of operation time, use of tourniquet, use of transfusion and gender. In conclusion, within 3 day after operation, the high titer of CRP can not to be an indicator for early detection of the infection, because normal high titer can be developed by surgery itself. If there notes persistent high titer or more increasing pattern of CRP after postoperative 3 day or abnormal high titer of CRP after 11 day postoperatively, infection may be highly suspicious.
Blood Sedimentation ; C-Reactive Protein ; Humans ; Tourniquets

PURPOSE: This study was aimed to explore and report the short term results of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderlys. MATERIALS AND METHODS: Between March 2009 and Feburary 2012, 35 arthroplasty cases performed by single surgeon and followed up for more than one year were evaluated. They were 21 females and 14 males with mean age of 78 years (range, 71-92 years). Preoperative evaluation was performed by American Society of Anesthesia score. Retrospective evaluation was performed by operative time, transfusion amount, time to operation days, hospital stay and time to full weight bearing. Clinically, ambulatory ability was checked by Parker and Palmer (P&P) score and function of hip was appraised by Harris hip score (HSS). Radiologically, bone healing of fractured trochanteric fragment and presence of subsidence, stress shielding or osteolysis were checked. RESULTS: Fracture type was 11 cases of A2.2, 18 cases of A2.3 and 6 cases of A3.3. Femoral stems used were 8 cases of rectangular tapered wedge type and 27 cases of fluted modular distal fixation type. P&P score improved from mean preinjury score of 7.1 to mean postoperative last follow-up score of 6.5. Median HHS at last follow-up was 75. Mean time to full weight bearing was 47 days (24-79 days). Postoperative complications were one case of linear periprosthetic femoral fracture and one case of postoperative dislocation. CONCLUSION: Cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderlys.
Anesthesia ; Arthroplasty* ; Arthroplasty, Replacement, Hip ; Dislocations ; Female ; Femoral Fractures ; Femur* ; Follow-Up Studies ; Hip* ; Humans ; Length of Stay ; Male ; Operative Time ; Osteolysis ; Postoperative Complications ; Retrospective Studies ; Weight-Bearing

Binding of clathrin assembly protein to clathrin triskelia induces their assembly into clathrin-coated vesicle (CCV) in neurons. The clathrin assembly protein gene (rCALM) was cloned from rat brain cDNA library. rCALM deduced 69 kD molecule has overall 73% amino acid homology compared with that of AP180 protein. The N-terminal domain, where amino acid sequences are very similar with AP180, harbours binding sites for clathrin and inositides, as well as possible phosphorylation sites, but the proline rich C-terminal domain is different from that of AP180. The mRNA expression of rCALM and AP180 by in situ hybridization histochemistry revealed that the rCALM mRNA was more intensely expressed than that of AP180, and the distribution patterns were different from each other. These results suggest that the rCALM mediates the assembly of clathrin in neural and supporting cells of brain, and regulates the clathrin coated-vesicle formation through phosphorylation and inositide metabolism. Copyright 2000 Academic Press.
Age Factors ; Alternative Splicing ; Amino Acid Sequence ; Animal ; Base Sequence ; Brain/physiology* ; Cloning, Molecular ; Gene Expression Regulation, Developmental ; Molecular Sequence Data ; Nerve Tissue Proteins/metabolism ; Nerve Tissue Proteins/genetics* ; Phosphoproteins/metabolism ; Phosphoproteins/genetics* ; Rats ; Sequence Homology, Amino Acid

First-rib fractures may be caused due to high energy direct trauma, violent muscle contracture, or chronic fatigue. Isolated fractures are very rarely noted and may be a potential cause of nonspecific shoulder pain in overhead athletes. Although the exact mechanism underlying first-rib fractures caused by sudden muscular contracture is still not known, many repetitive activities have been associated with with these unique fractures. We present a case of an acute first-rib fracture in a rookie professional baseball pitcher. He returned to the same level of throwing in 5 months with rest and rehabilitation.

PURPOSE: This study aimed to evaluate the diagnostic characteristics and clinical results after surgical repair of traumatic superimposed posterior rotator cuff tear in the setting of preexisting retracted supraspinatus tendon tear.METHODS: A total of 20 patients (mean age, 62.1 years) were included and all patients had significant traumatic events mean 3.7 weeks prior to the surgery. Preoperative acromiohumeral distance (AHD, mean 3.2 mm) and arthritis change were analyzed on plain radiograph and magnetic resonance imaging was evaluated for the nature and extent of torn tendon, and fatty degeneration (FD) of all cuff muscles to validate if the tears were traumatic or chronic.RESULTS: Complete repairs were achieved in 15 patients and partial repair including posterior cuff in five. Functional and radiographic results were statistically evaluated and repair integrities were assessed with ultrasound at average 17.3 months. Overall functional outcome scores were significantly improved and 17 patients (85%) were satisfied with their symptoms. AHD was significantly recovered (mean, 6.7 mm), but two patients showed progression of arthritic change. Retears after the complete repair were three patients (20%), who showed poor outcome, with advanced preoperative FD of posterior cuff muscles. Five patients with partial repair of posterior cuff revealed improved functional score with no sign of retear of posterior cuff on ultrasound.CONCLUSION: Early recognition of traumatic superimposed posterior cuff tears and surgical repair can reliably restore shoulder function, and partial repair of posterior cuff also can be expected favorable outcomes in supraspinatus tear with advanced FD.
Arthritis ; Humans ; Magnetic Resonance Imaging ; Muscles ; Rotator Cuff ; Shoulder ; Tears ; Tendons ; Ultrasonography

Lumbar spondylolysis is a frequent cause of low back pain especially in adolescents involved in sporting activities. It is considered as a fatigue-type defect in the pars interarticularis or isthmus resulted from repetitive hyperextension and rotation on the spine; however, there is still confusion in regard to imaging findings of the location and direction of the defect. We report two unique cases of fifth lumbar spondylolysis in professional baseball hitter and adolescent pitcher; early-stage unilateral incomplete isthmus fracture and bilateral fracture in a different configuration, respectively. Computed tomography demonstrated vertical and more coronally oriented fracture lines compared with typical spondylolytic defect, and repetitive rotation in the same direction of pitching might cause a different type of fracture on the contralateral isthmus with the preexisting unilateral defect. Intriguingly, early-stage unilateral fracture in hitter was united after only 6 weeks of rest and rehabilitation and able to return to the game.

Spinoglenoid notch cysts, a certain expansion form of paralabral ganglion cyst, are often associated with superior labrum anterior to posterior (SLAP) lesions in overhead athletes. We report a unique case of spinoglenoid notch cyst that extended to posterosuperior bony glenoid in a 16-year-old high school male baseball fielder. Magnetic resonance imaging showed multilobulated spinoglenoid notch ganglion cyst associated with posterosuperior SLAP lesion, and computed tomography (CT) revealed distinct osseous erosion of posterosuperior glenoid. The cyst was enlarged on serial follow-up imaging, and his symptoms were continued, arthroscopic decompression was performed via posterosuperior capsulotomy. The concomitant SLAP lesion was not repaired, but only marginal debridement was performed. At 6 months after surgery, he returned to game without symptoms, and the bony glenoid lesion was almost remodeled on follow-up CT. In adolescent athletes, significant osseous erosion by spinoglenoid notch cyst may be accentuated due to the skeletal immaturity of posterosuperior glenoid.

Abdominal oblique muscle injuries are relatively common in professional baseball players and can result in substantial loss of playing time. It is usually caused by a sudden movement of the torso in sports involving repetitive activity requiring trunk rotation and it tend to occur on the contralateral side of the dominant arm. We report a unique case of sequentially occurred bilateral abdominal internal oblique muscle rupture in a right-handed professional baseball batter over two seasons. Each internal oblique rupture had a different mechanism of the injury, the non-dominant side occurred during bat swing and the dominant side during bent leg sliding. After rest and rehabilitation, each injury was recovered to play in about 1 month.

Traditional soft tissue Bankart repair has high failure rates in the setting of a critical glenoid bone defect in recurrent shoulder dislocation.Hence, coracoid transfer, particularly the Latarjet procedure, can be performed to reduce the recurrence. A commercialized guide can be used during the Latarjet procedure. On the other hand, it is difficult to handle the guide parallel to the glenoid articular surface because of the predetermined fixed direction of the guide, and the guide pin is so thin that it can be broken in the wrong direction of insertion. Screw holes can also be drilled using the free hand technique without a guide, but it is inaccurate in maintaining a parallel direction or constant spacing between the screw holes. This study devised an instrument by cutting a 3.5 mm locking compression plate used in fracture surgeries, and the Latarjet procedure was performed relatively easily.