Osborne’s modified decompression involves repairing Osborne’s ligament beneath the ulnar nerve after simple decompression for idiopathic cubital tunnel syndrome. In this retrospective interrupted time series, 31 patients underwent modified simple decompression and 20 patients underwent conventional simple decompression. In the modified simple decompression group, the ulnar nerve length was measured at operation in full elbow flexion and extension before and after repair of Osborne’s ligament. Ulnar nerve instability during elbow motion was measured using ultrasonography before operation and at 12 months after operation. In patients treated by modified simple decompression, the ulnar nerve length in full elbow flexion reduced significantly after repair of Osborne’s ligament. At 12 months after surgery, the grade of ulnar nerve instability was lower in the modified simple decompression group than in the conventional simple decompression group. The clinical outcomes did not differ significantly between the groups at 24 months after operation. Level of evidence: III

Background and Objectives: Monteggia fracture-dislocations are rare but critical injuries in children. Accurate early diagnosis is essential to avoid long-term complications; however, such injuries are frequently missed. Therefore, this study aimed to assess the diagnostic accuracy of Monteggia fractures among physicians of varying specialties and experience levels and to identify factors influencing diagnostic performance. Materials and Methods: This retrospective study analyzed the radiographic interpretations of pediatric elbow and forearm injuries by six physician groups: orthopedic residents, general orthopedic surgeons, pediatric orthopedic surgeons, general radiologists, and subspecialized musculoskeletal radiologists. The final diagnosis established by pediatric radiology experts served as the reference standard. Influential variables, such as image quality, splint application, and age-related ossification, were evaluated. Results: In total, 120 patients were included, 40 (33.3%) of whom were diagnosed with Monteggia fractures and 80 (66.7%) with other fracture types. The diagnostic accuracy of Monteggia fractures varied significantly according to the physician’s experience. First-year residents and non-subspecialty radiologists had the highest rate of missed diagnoses. While other fracture types were occasionally influenced by technical factors, most missed Monteggia fracture cases stemmed from recognition failure. Subtle imaging features, plastic deformation of the ulna, and the omission of dedicated elbow views contributed to the misdiagnosis. Awareness and training improved performance, and a high index of suspicion was identified as crucial. Early follow-ups and standardized imaging protocols were identified as effective safeguards. Conclusions: Experience level, awareness, and imaging protocol quality were identified as being central to the accurate diagnosis of pediatric Monteggia fractures. Implementing educational strategies, promoting systematic imaging reviews, and reinforcing team-based approaches may reduce the rate of missed diagnoses.

An 18-year-old boy with fibrodysplasia ossificans progressiva lost weight at an accelerated rate due to gastrointestinal symptoms, resulting in a weight loss of 36 kg in 1 year. His first outpatient abdominal computed tomography (CT) result was unremarkable. Since the patient had biliary vomiting during hospitalization, his CT was reexamined, and the superior mesenteric artery syndrome diagnosis was confirmed. Thus, clinicians must consider superior mesenteric artery syndrome when presented with weight loss.

Magnetic resonance imaging (MRI) is one of the most widely used tests in orthopedic areas. Gadolinium-based magnetic resonance (MR) contrast media are commonly used for MRI tests. They are known to be safe with little side effects and low incidence of acute adverse reactions. Although not common, immediate hypersensitivity reaction can occur in some patients after administration of gadolinium-based MR contrast media, causing skin rash, vascular edema, dyspnea, abdominal pain, hypotension, altered mental status, cardiopulmonary arrest, and even death. During a knee joint MRI test in a 5-year-old boy, anaphylaxis, a serious symptom, occured after injecting gadolinium-based MR contrast medium. Here we report this case along with a literature review.

Background/Objectives: Valgus alignment shifts load toward the lateral compartment, and even a mild shift may matter when that compartment already contains a torn meniscus and an osteochondral lesion. We describe a skeletally immature knee in which a torn discoid lateral meniscus (DLM), an osteochondral lesion of the lateral femoral condyle and mild valgus coexisted. Case Presentation: A 14-year-old boy presented with longstanding right knee pain, lateral joint line tenderness and a positive McMurray test. The hip–knee–ankle (HKA) axis showed 4° of valgus (contralateral 0.5°), with a mechanical lateral distal femoral angle (mLDFA) of 84.6°, a medial proximal tibial angle (mMPTA) of 90.0° and mechanical axis deviation (MAD) 10.78 mm lateral. Imaging and arthroscopy showed a torn, centrally shifted DLM and a 1.4 × 1.6 cm ICRS grade 4 lesion of the lateral femoral condyle. Saucerization with repair, microfracture, and temporary hemiepiphysiodesis of the medial distal femoral and proximal tibial physes were performed in one stage. Results: At five months, the HKA was 0.7° varus (mLDFA, 87.2°; mMPTA, 88.3°) and the screws were removed; the repaired meniscus measured 9 mm in width without extrusion. At two years, the HKA was neutral (mLDFA, 87.0°; mMPTA, 87.7°; MAD, 0 mm) without rebound, and the patient was asymptomatic; no validated patient-reported outcome measure was collected. Conclusions: As a short-term result in a single patient, this case illustrates the feasibility of incorporating temporary hemiepiphysiodesis into a joint-preserving strategy in a selected skeletally immature knee. It is not evidence of efficacy; longer-term follow-up is needed to judge joint preservation.

배정연, et al. J Korean Orthop Assoc. 2020 Dec;55(6):487-494. https://doi.org/10.4055/jkoa.2020.55.6.487