Background: Surgical management of a massive rotator cuff tear (RCT) is always challenging. This study describes the clinical and radiological outcomes of patients who underwent bridging grafts using a plantaris tendon for an irreparable RCT. Methods: Thirteen patients with a massive RCT were treated with arthroscopic interposition of a folded plantaris tendon autograft between June 2017 and January 2020. For clinical evaluation, a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, and range of motion values were collected. For radiographic evaluation, standardized magnetic resonance imaging and ultrasonography were performed to check the integrity of the interposed tendon. Results: A statistically significant improvement at the final follow-up was evident in scores for the VAS (−3.0, P=0.003), ASES (24.9, P=0.002), D ASH (−20.6, P=0.001), and Constant-Murley values (14.2, P=0.010). In addition, significant improvement was shown in postoperative flexion (17.3°, P=0.026) and external rotation (27.7°, P<0.001). In postoperative radiologic evaluations, the interposed tendons were intact at the last examination in 12 of the 13 patients. No complications related to donor sites were reported. Conclusions An arthroscopic bridging graft for irreparable RCTs using a modified Mason-Allen stitch and a plantaris autograft resulted in improved short-term radiological and clinical outcomes. Graft integrity was maintained for up to 2 years in most patients.Level of evidence: IV.

Purpose: Acute kidney injury (AKI) following sepsis is associated with higher mortality; however, reliable biomarkers for AKI development and recovery remain to be elucidated. Materials and Methods: Patients with sepsis admitted to the medical intensive care unit (ICU) of Severance Hospital between June 2018 and May 2019 were prospectively analyzed. Patients were divided into those with and without AKI within 48 hours. Patients with septic AKI were subdivided into AKI-recovery and non-recovery groups based on whether their kidney injury recovered within 7 days. Results: A total of 84 patients were enrolled. The baseline creatinine (2.9 mg/dL vs. 0.8 mg/dL vs. 1.2 mg/dL, p<0.001), Charlson Comorbidity Index (4.5 vs. 2.0 vs. 3.0, p=0.002), Sequential Organ Failure Assessment (10.0 vs. 6.5 vs. 8.0, p<0.001), and Acute Physiology and Chronic Health Evaluation II scores (32.0 vs. 21.5 vs. 30.5, p=0.004) were higher in the non-recovery AKI group compared to the non-AKI and AKI-recovery groups. The Kaplan-Meier curves revealed that non-recovery from AKI was associated with lower survival (p<0.001). High-lactate (p≤0.05) and kynurenine levels (p≤0.05) were associated with non-recovery of renal function following AKI. The areas under the curve for predicting non-recovery from AKI were 0.693 and 0.721 for lactate and kynurenine, respectively. The survival rate was lower in the high-kynurenine (p=0.040) and high-lactate (p=0.010) groups. Conclusion The mortality of patients who recovered from AKI was comparable to that of patients without AKI. Lactate and kynurenine could be useful biomarkers for the diagnosis and recovery of AKI following sepsis.

Background: The aim of this study was to investigate the clinical presentations, patterns of soft-tissue injuries, and outcomes of treatment of elbow dislocations in patients with preexisting cubitus varus. Methods: Four cases of elbow dislocation in patients with preexisting cubitus varus, which were treated at 3 residency training hospitals, were retrospectively reviewed. Soft-tissue injury patterns were investigated using magnetic resonance imaging (MRI).Clinical outcomes were assessed at an average of 50.8 months (range, 34–82 months) after treatment using the Mayo Elbow Performance Score (MEPS) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Results: The mean patient age was 49.5 years (range, 33–57 years). All patients had a posteromedial elbow dislocation, which was an indirect injury caused by a fall onto an outstretched hand. One patient had failed closed reduction; 3 others had redislocation or gross instability after closed reduction. Significant tears of the lateral collateral ligament complex and common extensor group were shown in MRI. All patients had surgical treatment including lateral complex repair only (n = 2), repair of both sides’ complexes (n = 1), and corrective osteotomy with lateral complex repair (n = 1). At the final follow-up, the mean MEPS was 92.5 ± 8.7 and the mean QuickDASH score was 4.5 ± 6.4. Conclusions Elbow dislocation in patients with preexisting cubitus varus may present as posteromedial dislocation with acute instability. Surgical treatment of this injury led to acceptable clinical outcomes.

An intra-articular osteoid osteoma is a very rare cause of elbow pain, and its diagnosis and treatment remain challenging. Delayed diagnosis may lead to arthritic change of the joint. In this study, the authors present the occurrence of intra-articular osteoid osteoma in the right elbow of a 15-year-old male patient who presented with prolonged pain and limited motion owing to delayed diagnosis. After confirming the nidus of osteoid osteoma from radiographic evaluation, the lesion was completely removed arthroscopically. The patient presented a complete relief of symptoms and full range of motion. This is the first domestic report of successful arthroscopic treatment of an intra-articular osteoid osteoma of the elbow.
Adolescent ; Arthroscopy ; Delayed Diagnosis ; Diagnosis ; Elbow ; Humans ; Joints ; Male ; Osteoma, Osteoid ; Range of Motion, Articular

BACKGROUND: We sought to develop a novel index based on the skeletal muscle mass that reflects the change of quality of life (QOL), and is the most appropriate index for the body composition of the elderly in Korea. Whether lower extremity skeletal muscle mass index (LESMI) is an appropriate novel new index to diagnose patients with sarcopenia was also evaluated. A cut-off value for each index was reported to facilitate the diagnosis of patients with sarcopenia in a Korean population. METHODS: We used the 5th Korean National Health and Nutrition Examination Survey data from 2010. We analyzed 409 elderly patients, including 231 men and 178 women, aged ≥65 years. Patients were diagnosed by calculating their skeletal muscle index based on the skeletal muscle mass measured using dual energy X-ray absorptiometry. Obesity and osteoporosis were used to screen data and EuroQOL-5 dimension as a health questionnaire. RESULTS: The prevalence of sarcopenia in each index was obtained based on its cut-off value for diagnosing sarcopenia. There was a significant difference between the obesity rate of elderly patients diagnosed with sarcopenia and those who were not based on each index. There was no significant difference in the prevalence of osteoporosis between the groups. Sarcopenia diagnosis based on the LESMI was significantly correlated with QOL. CONCLUSIONS: LESMI, a novel index based on skeletal muscle mass, reflects changes in QOL and is appropriate for the body composition of elderly people in Korea.
Absorptiometry, Photon ; Aged ; Body Composition ; Diagnosis ; Female ; Humans ; Korea ; Lower Extremity ; Male ; Muscle, Skeletal ; Nutrition Surveys ; Obesity ; Osteoporosis ; Prevalence ; Quality of Life ; Sarcopenia

There have been many studies regarding the relationship between long-term use of bisphosphonate and atypical femoral fractures in the literature. However, studies regarding atypical fractures of the upper limbs are severely limited, especially in Korea. Here, we report an atypical fracture of the ulna in a patient with bisphosphonate medication for a relatively short period of 3 years without any history of fractures at other sites.
Femoral Fractures ; Humans ; Korea ; Osteoporosis ; Ulna* ; Upper Extremity

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.
Alcoholism ; Comorbidity ; Fracture Fixation ; Fractures, Multiple ; Methods ; Osteonecrosis ; Osteoporotic Fractures ; Risk Factors ; Smoke ; Smoking ; Soft Tissue Injuries

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.
Alcoholism ; Comorbidity ; Fracture Fixation ; Fractures, Multiple ; Methods ; Osteonecrosis ; Osteoporotic Fractures ; Risk Factors ; Smoke ; Smoking ; Soft Tissue Injuries

Primary cutaneous cryptococcosis is a fungal infection caused by Cryptococ cus neoformans which is frequently occurred in the immunosuppressed host. The treatment of primary cutaneous cryptococcosis is mainly fluconazole, and the prognosis is relatively good. We report a case of primary cutaneous cryptococcosis due to intravenous line on the left forearm after lumbar stenosis surgery in a patient with rheumatoid arthritis, who finally underwent second, fourth, and fifth ray amputation.
Amputation ; Arthritis, Rheumatoid* ; Constriction, Pathologic ; Cryptococcosis* ; Fluconazole ; Forearm ; Humans ; Immunocompromised Host ; Injections, Intravenous ; Prognosis ; Surgical Flaps