First, I'd like to thank Lieutenant Commander Fogelman for doing the vast majority of the work on this project. It was a joint adventure. We have no significant disclosures. As a background, it's known a lot about media epicondyle injuries and UCL injuries, a lot of publications. There's really not much on the sublime tubercle side of the equation, and there's a single study that's kind of out that had just a handful of patients that suggested that you should not treat these nonoperatively and you should move to operative fixation. The purpose of this was to evaluate this in kind of this teenage adolescent group to determine if we could treat them without surgery, with surgery, what was the best outcome. We had a 15-year process, kind of joint facilities to find enough patients to look at this. There was actually about 40 patients that we used to kind of create a classification scheme that's a separate project we won't totally talk about today, but I'll mention it briefly in the next slide, then narrowed it down to just the throwing athletes to determine if we could make any difference in these throwing athletes. So first, obviously, we collected all the standard stuff, and then we have this kind of classification scheme, which kind of looked at both kind of a simple versus complex, and if you look at the image on the top, there's both the media epicondyle as well as the sublime tubercle injury, whereas just an isolated sublime tubercle on the bottom, and those are kind of like the differences we saw for those kind of simple and complex injuries, and then we looked at kind of outcomes for these patients over time based on their management. In the end, we only had 14 baseball players, half of which were kind of the pitchers, and you can see kind of our follow-up group there, and all of them were in this simple range. They were all just simple sublime tubercle avulsions. None of them had these kind of more complex injuries in this type of sport. And then we did have some variation in terms of their acuteness, and you can see that there. Overall, this is kind of the breakdown of what we found, and honestly, it went kind of luckily just half and half, those that got casted and those that didn't, and you can see some differences in their success and outcomes, but we'll dig into each of these categories next. So if you look at our casting group, on average, they got casted for a month, really got shut down, they got all unionized, I guess we'll call that, and then some didn't require some PT. Obviously, this age group sometimes functions more like a pediatric group where they don't need a lot of physical therapy, and others are a little bit older in their ability to adapt to having been casted for such a long time. The other group was kind of treated more like that original kind of case report with a handful where they just kind of minimized kind of their activity in the short run, hoping that it was going to be more like an ankle sprain and you're going to be able to get them kind of back to their normal routine relatively quicker. It was a broad base of the type of players, and almost all of them underwent a UCL reconstruction afterwards and one just declined to have it. Now once they did have their surgery for that reconstruction, they all did fine. The limitations of all this, obviously, retrospective design, non-randomized, small sample size, and all we had was just the return to sport. So in conclusion, I think that kind of historical idea that if you see this injury, you should look towards doing a UCL reconstruction, or now maybe a UCL repair, maybe is not necessarily true in this age group if you treat them adequately for their fracture, essentially. So if you do true immobilization, then you should be able to be successful in that management, it seems. And then, obviously, unlike those pure ligamentous injuries, we can get good results. So the take-home message for this is that if you cast them and treat them like a child, you can get almost 90% success with that. And if you don't, you treat them like an adult, you're going to see a lot of failures. Thank you. Outstanding. And last, scientific paper, Dr. Katoro is going to talk about the conservative treatment of OCD, the hemocapitalum, among young baseball players. Thank you for the opportunity. So I am from Kyoto, Japan. This is my disclosure. So the purpose of this study was to evaluate our treatment of osteochondritis secans of the hemocapitalum and establish the appropriate treatment. So our conservative treatment was based on the rest of the elbow. All of the treatment were more for scar healing and return to play as soon as possible. But these are sometimes contradictive. And the conservative treatment, we limit any activity to reduce the load on the affective elbow as much as possible. Here is the healing process. After one year, resumed the slowing, and the time passed. It was four years later to heal the complete. It is too slow. And when is the timing of surgery? So when the healing process has stopped, we perform the surgery, depending on whether the lateral wall of the capitalum healed or not. Of course, the osteoscopic debridement is minimally invasive. So treatment strategy. Before resuming the slowing, we have at least waited for the lateral wall of the capitalum to heal. So we checked the results. Subjects, 260 young baseball players. We excluded the 13 players, and 193 players included. We staged the OCD, depending on the Matsubara's report. Here is the stages and ages. Almost 60% was stage 1, 30% was stage 2, 8% was stage 3. Ages are 11 and 13 and 14. There was a significant difference. And the clinical result by stages. 17% was completely healing in stage 1, but there is no complete healing in stage 3. And there was a significant difference. How about return to play? Age was 8.7 months, and almost 30% was less than six months, and 50% was six months more and less than one year. In short, 80% returned to play less than one year. How about surgery? Almost 90% was arthroscopic debridement. So Matsubara said the healing rate was 90% of stage 1. Their conservative treatment was so strict. On the other hand, the aggressive conservative treatment, 60% of the early stage. So our study's result was intermediate point. And the return to play, Matsubara said the healing period was 15 months. And with the aggressive conservative treatment, that was 1.3 months. So our study was 8.7 months, so not so wrong. And how about surgery? With the aggressive conservative treatment, arthroscopic debridement was almost 9%, and our results were equivalent to that. So our results indicated that they are promoting the healing process and return to play as soon as possible, determining the optimum timing of surgery is important. And that point is that healing of the lateral wall of captemum. So there are some limitations, and this is the conclusion. Thank you. That's great. Thank you.

sublime tubercle avulsions

UCL reconstruction

conservative treatment

osteochondritis dissecans

humeral capitulum