Journal of Yeungnam Medical Science

In Sook Lee

2 Articles

Avulsion injuries: an update on radiologic findings: Changwon Choi, Sun Joo Lee, Hye Jung Choo, In Sook Lee, Sung Kwan Kim; Yeungnam Univ J Med. 2021;38(4):289-307. Published online August 13, 2021; DOI: https://doi.org/10.12701/yujm.2021.01102

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Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.

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Preoperative arterial embolization of heterotopic ossification around the hip joint: Jin Hyeok Kim, Chankue Park, Seung Min Son, Won Chul Shin, Joo Yeon Jang, Hee Seok Jeong, In Sook Lee, Tae Young Moon; Yeungnam Univ J Med. 2018;35(1):130-134. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.130

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Abstract PDF

Heterotopic ossification (HO) around the hip joint is not uncommon following neurological injury. Often, surgical treatment is performed in patients with restricted motion and/or refractory pain due to grade III or IV HO according to Brooker classification. The major complication that occurs as a result of surgical HO removal is perioperative bleeding due to hyper-vascularization of the lesion. Here, we report a case of preoperative embolization in a 51-year-old male patient presenting with restricted bilateral hip range of motion (ROM) due to HO following a spinal cord injury. In the right hip without preoperative arterial embolization, massive bleeding occurred during surgical removal of HO. Thus, the patient received a transfusion postoperatively due to decreased serum hemoglobin levels. For surgery of the left hip, preoperative embolization of the arteries supplying HO was performed. Surgical treatment was completed without bleeding complications, and the patient recovered without a postoperative transfusion. This case highlights that, while completing surgical removal for ROM improvements, orthopedic surgeons should consider preoperative arterial embolization in patients with hip HO.

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Preoperative Arterial Embolization for Heterotopic Ossification of the Hip
Nicolas Papalexis, Giuliano Peta, Costantino Errani, Marco Miceli, Giancarlo Facchini
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