BACKGROUND: The aim of this study was to evaluate the interobserver reliability of measurements of the Acromiohumeral Distance (AHD) first described by Golding et al., the Critical Shoulder Angle (CSA), the Acromion Index with Glenoid Humeral (GH) and Glenoid Acromial (GA) distances, following the measuring method by Nyffeler et al., the Lateral Acromion Angle (LAA), as well as the morphology of the acromion according to Bigliani and the humeral head position according to Maloney in X-rays and MRI. Furthermore, the study assessed the correlation of measurement results in X-ray with those in MRI for AHD, CSA, GA, GH, AI, and LAA.
METHODS: A total of 187 patients who underwent shoulder joint X-ray and MRI examinations from 09/2016 to 05/2023 were included in the study. Patients with poor imaging quality, arthrosis or radical prior surgeries, like shoulder prosthetic surgery, status post humerus fractures, that have undergone surgery and therefore changed the anatomical features were excluded, what lead to a total study population of 78. X-ray measurements were performed by two observers in the true anteroposterior view, so that the humeral head and the glenoid are shown without overlap, providing a clear view into the joint space. MRI measurements were performed in oblique coronal MRI slices, using the most accurately depicted glenoid surface as a landmark.
RESULTS: Interobserver measurement results showed a significance with p < 0.001 for the assessment of acromion type according to Bigliani, humeral head offset assessment according to Maloney, and AHD. No significance was found for interobserver reliability in measuring LAA. Additionally, there was a high correlation of measurement results in X-ray with measurements in MRI for, CSA, GH/GA, and consequently AI, a good correlation for AHD but no correlation could be shown for LAA.
CONCLUSIONS: These findings provide valuable insights into the robustness of radiological parameters for evaluating shoulder pathology, offering promising prospects for clinical applications and further research. Nevertheless, the specific methodological considerations and patient characteristics should be taken into account when interpreting the results to ensure their accurate application in clinical practice.

UNASSIGNED: This study aimed to demonstrate the feasibility of lag screw exchange for painful lateral soft tissue impingement in patients initially treated with cephalomedullary nailing (CMN) for an intertrochanteric hip fracture.
UNASSIGNED: Ten patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively.
UNASSIGNED: Average age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange.
UNASSIGNED: Lag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. Level of Evidence: IV.

Psoas tendon impingement is not a frequently encountered condition, but impingement at the muscular level is not reported in the literature. The term refers to the mechanical impingement of the psoas muscle with secondary myositis. We report a case of psoas muscle impingement by a lumbar disc-osteophyte complex. This study reports on a 61-year-old female who presented to our facility complaining of severe low back pain with increased intensity in the past two weeks. Radiographic imaging and magnetic resonance imaging revealed psoas muscle impingement by lumbar disc-osteophyte. No signs of nerve compression or infection were found. The patient responded well to conservative treatment, including non-steroidal anti-inflammatory drugs and physical therapy. No studies have reported psoas impingement syndrome due to the lumbar disc-osteophyte complex. More research is needed to better understand this condition.

BACKGROUND: Osteochondroma is one of the most common benign bone tumors, and it may cause bone and joint deformities and limited range of motion of an adjacent joint. The pes anserinus region is one of the most frequent sites of osteochondroma, but knee locking caused by osteochondromas in the pes anserinus region is extremely rare.
METHODS: We describe a 13-year-old Japanese girl\'s extra-articular knee locking that occurred when the semitendinosus tendon got caught in osteochondroma that had developed in the pes anserinus region. The osteochondroma was surgically resected. The postoperative outcome has been excellent, with no recurrence of knee locking or tumor one-year post-surgery.
CONCLUSIONS: When a young person develops knee locking, the possibility of extra-articular as well as intra-articular locking should be considered. Osteochondroma, one of the causes of extra-articular locking, can be treated with surgery with good postoperative results.

暂无摘要。

Iliotibial band pathologies can result in lateral knee pain. These are commonly seen in runners and cyclists. Lateral knee pain following knee arthroplasty can be due to distal iliotibial band enthesopathy or impingement by the femoral component. Cementoplasty is a common procedure performed during treatment of osseous lesions. We describe a case of ITB friction syndrome due to small focus of cement following cementoplasty for GCT (giant cell tumour).

A 43-year-old female patient reported persistent iliopsoas-related groin pain following periacetabular osteotomy (PAO) combined with femoroplasty via a direct anterior approach due to CAM morphology. Concomitantly with the planned removal of screws, hip arthroscopy was performed, and the iliopsoas tendon was found to run intraarticularly, resulting in the tendon being impaired in its mobility and being entrapped. The tendon was arthroscopically released. The patient reported relief of the groin pain after the arthroscopic tendon debridement. During PAO combined with capsulotomy, the postoperatively observed intraarticular position of the iliopsoas tendon should be prevented by careful closure of the joint capsule.

UNASSIGNED: Factors that affect patellofemoral (PF) osteoarthritis (OA) after unicompartmental knee arthroplasty (UKA) remain unclear. We report a case in which the lateral placement of the femoral component resulted in rapidly progressive OA in the medial patellar facet.
METHODS: The patient was an 84-year-old woman who had increased pain in the left knee due to varus knee OA for 1 year and underwent medial UKA. One month after the surgery, the patient complained of limited knee flexion of 90° with anterior knee pain, and around 7-mm lateral placement of the femoral component was observed on a postoperative radiograph and computed tomography scan. Six months after the surgery, rapidly progressive OA with subchondral bone depression in the medial facet was observed and this has been ongoing till the last follow-up of 3 years. The knee flexion is limited 105° now, and the patient complains of quadriceps weakness with anterior knee pain when stair-climbing and standing up from a chair.
UNASSIGNED: Lateral placement of the femoral component in medial UKA may cause progressive PF OA with limited knee flexion and anterior knee pain, which could be attributed to impingement between the femoral component and the medial patellar facet.
CONCLUSIONS: Surgeons should be careful regarding the lateral placement to prevent symptomatic PF OA from occurring after medial UKA.

BACKGROUND: Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention.
UNASSIGNED: A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall.
METHODS: Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization.
RESULTS: The patient\'s symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur.
CONCLUSIONS: This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.

OBJECTIVE: During pronation, the distal biceps tendon and radial tuberosity internally rotate into the radioulnar space, reducing the linear distance between the radius and ulna by approximately 50%. This leaves a small space for the distal biceps tendon to move in and could possibly cause mechanical impingement or rubbing of the distal biceps tendon. Hypertrophy of the radial tuberosity potentially increases the risk of mechanical impingement of the distal biceps tendon. The purpose of our study was to determine if radial tuberosity size is associated with rupturing of the distal biceps tendon.
METHODS: Nine patients with a distal biceps tendon rupture who underwent CT were matched 1:2 to controls without distal biceps pathology. A quantitative 3-dimensional CT technique was used to calculate the following radial tuberosity characteristics: 1) volume in mm3, 2) surface area in mm2, 3) maximum height in mm and 4) location (distance in mm from the articular surface of the radial head).
RESULTS: Analysis of the 3-dimensional radial tuberosity CT-models showed larger radial tuberosity volume and maximum height in the distal biceps tendon rupture group compared to the control group. Mean radial tuberosity volume in the rupture-group was 705 mm3 (SD: 222 mm3) compared to 541 mm3 (SD: 184 mm3) in the control group (p = 0.033). Mean radial tuberosity maximum height in the rupture-group was 4.6 mm (SD: 0.9 mm) compared to 3.7 mm (SD: 1.1 mm) in the control group, respectively (p = 0.011). There was no statistically significant difference in radial tuberosity surface area (ns) and radial tuberosity location (ns).
CONCLUSIONS: Radial tuberosity volume and maximum height were significantly greater in patients with distal biceps tendon ruptures compared to matched controls without distal biceps tendon pathology. This supports the theory that hypertrophy of the radial tuberosity plays a role in developing distal biceps tendon pathology.
METHODS: Level III.