Cauda Equina Syndrome Occurred by Adhesive Arachnoiditis of the Lumbar Spine with an Unknown Cause / 대한정형외과학회잡지

Spinal adhesive arachnoiditis is an inflammation and fibrosis of the subarachnoid space and pia mater caused by infection, trauma, spinal vascular anomalies, and iatrogenic (surgery and/or puncture). Adhesive arachnoiditis develops various symptoms and signs (gait disturbances, radiating pain, paralysis, and incontinence). On the other hand, adhesive arachnoiditis associated with cauda equina syndrome has not been reported in Korea until now. The authors experienced cauda equina syndrome caused by adhesive arachnoiditis of the lumbar spine with satisfactory results following decompression. We report this case with a review of the relevant literature.

Acute Compartment Syndrome after Anticoagulant Therapy to Misdiagnosed Deep Vein Thrombosis / 대한정형외과학회잡지

Acute compartment syndrome, which is an orthopedic emergency, induces irreversible tissue necrosis by increasing the compartment pressure. In serious cases, this event may result in functional impairment, loss of the lower limb, and death by renal failure. When the patient initially presents with pain and swelling that are similar to deep vein thrombosis, a differential diagnosis between the two diseases is very critical. The authors encountered a case of acute compartment syndrome after anticoagulant therapy in a patient presenting with painful swelling of the left leg following a massage that was initially misdiagnosed as deep vein thrombosis. A fasciotomy was performed on this case with satisfactory results. This paper reports this case with a review of the relevant literature.

The Influence of Initial Magnetic Resonance Imaging Findings on the Compression Rate of Thoracolumbar Osteoporotic Vertebral Compression Fracture / 대한정형외과학회잡지

PURPOSE: To investigate the influence of the size of low intensity zone (LIZ) (T1 image) on the vertebral body and the increase in the compression rate in patients with osteoporotic vertebral compression fracture. MATERIALS AND METHODS: In a retrospective study, 187 patients (198 segments) who were followed-up for at least 3 months and diagnosed with thoracolumbar vertebral compression fracture between October 2011 and October 2016, and treated with conservative therapies, such as bed rest and thoraco-lumbar-sacral orthosis. We measured the size of the vertebral LIZ, and fractures on the upper and lower endplates were observed on the initial magnetic resonance imaging. We analyzed the correlation with the increase in compression rate at the last follow-up. Comparisons of the increase in the compression rate were analyzed through a correlation analysis. RESULTS: The larger the size of the LIZ the greater the difference in the increase of the compression rate. The group with the initially LIZ (80%–100%) was significantly increased to 23.87%±17.90% (p=0.007). In case of fracture of upper and lower endplates, an increase in the compression rate was 19.39%±12.59% in the upper endplate fracture, which was significantly higher than that in the absence of endplate fracture (p=0.002). CONCLUSION: The larger the size of the LIZ (T1 image) and superior endplate fracture observed on the initial magnetic resonance imaging after fracture, the greater the increase in the compression rate. In particular, when the size of the LIZ is greater than 80%, the compression rate was significantly increased.

Femoral Shaft Fracture of a Middle-aged Male Adult during Playing Baseball / 대한스포츠의학회지

In general, femur fractures in the younger patient population are the result of high energy trauma, such as motorcycle accidents or traffic accidents. A 43-year-old healthy man presented with painful swelling of his right thigh. Plane radiographs showed short oblique fracture of the femur shaft with comminution. He had no medical history such as osteoporosis or any metabolic bone disorder. He was a healthy man with no smoking and no alcohol drinking, enjoying sports activity such as baseball and football. He was injured during defense time of a baseball game by rapid turning motion to catch a ball. We performed intramedullary interlocking nailing for the femur shaft fracture and the fracture was uneventually healed with no complication. To our knowledge, femur shaft fracture which occurred during playing baseball in a healthy middle-aged man has not been reported in our country. So we report this case with a review of the literature.

Septic Arthritis after Arthroscopic Meniscal Repair / 대한정형외과학회잡지

The incidence of septic arthritis after knee arthroscopy surgery has rarely been reported in approximately 0.04% to 3.4%. Moreover, septic arthritis after arthroscopic meniscal repair is more rare. There have been some reported cases, but in Korea, it has not been reported thus far. Herein, we report two cases of septic arthritis after arthroscopic meniscal repair with review of literature.

Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid / 대한정형외과학회잡지

An 82-year-old woman underwent surgery for the left intertrochanteric fracture. However, during hospitalization, she complained of pain on the right knee. Radiographs showed moderately degenerative arthritis and intrameniscal calcification. Hyaluronic acid was administered by intraarticular injection. After injection, arthritic symptoms improved. Five days after injection, she complained of severe pain, swelling, and heating sensation in the right knee with chills and fever. Blood test showed elevated white blood cell (WBC) count and C-reactive protein. WBC in synovial fluid increased to 47,250/mm3. Antimicrobial therapy was administered under the impression of acute pyogenic arthritis by adverse reaction of hyaluronic acid injection. Polarization microscope showed calcium pyrophosphate dihydrate crystals. Synovial fluid culture was negative. Finally, she was diagnosed as pseudogout. The symptoms improved within one week. To our knowledge, there has been no report of pseudogout following intraarticular injection of hyaluronic acid in Korea. Therefore, we report this case with a review of the literature.

Analysis of Treatment Results of Unstable Distal Clavicle Fractures Using Hook Plate / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the treatment results and complications in unstable distal clavicle fractures which were treated with a Hook plate, and, in particular, to compare the functional results before and after removal of the Hook plate. MATERIALS AND METHODS: We examined 20 cases in 20 patients who underwent removal of Hook plates after bony union was obtained in an unstable fracture of the distal clavicle (Neer type II) from March 2009 to December 2012. The average follow-up period after initial surgery was 12 months (8-20 months). Plates were removed at 18 weeks (ranged from 10-36 weeks) after initial fixation. University of California at Los Angeles (UCLA) and Korean Shoulder Scoring System (KSS) scores were used for clinical functional evaluation, and plain radiographs were used for radiological evaluation. RESULTS: In radiological evaluation, bony union was obtained at an average of 11.4 weeks (ranged from 8-14 weeks) in all of the 20 patients. All of the 20 patients showed limited range of motion, mild pain, and discomfort of the shoulder before removal of the Hook plate, and all of the 20 patients showed better results in UCLA and KSS score after removal of the plate, when compared to before removal. Stress fracture as a major complication, was united completely with a 'figure of 8' bandage and deep wound infection was resolved after repeated debridement and antibiotic treatment with satisfactory functional results. CONCLUSION: Hook plate in treatment of unstable fracture of the distal clavicle is considered to be a useful method because rigid fixation can be obtained. However, there are some complications, such as limited range of motion, pain, and discomfort of the shoulder joint, before removal of the Hook plate. Therefore, we think that removal of the Hook plate as soon as possible if bony union is obtained would be desirable.

Muscular Injury of Iliacus and Gluteus Maximus after Mountain Climbing / 대한스포츠의학회지

Iliacus muscle is the strongest hip flexor of gluteal region that acts with psoas muscle, whereas gluteus maximus muscle is the largest muscle engaged in extension and external rotation of the hip. Mountaineering requires strong contractile force of both flexor and extensor around the hip. A 57-year-old man presented to our hospital with severe pain in left groin after mountaineering for 5 hours without a break. Magnetic resonance imaging revealed incomplete rupture of iliacus muscle and strain of gluteus maximus muscle. Conservative treatment was done. At 3 months of follow-up, he returned to normal life. If we are going to climb mountain, it is important to start warming up with some stretches, take a break while climbing, and use climbing sticks. There have been no report about athletic injury of both iliacus and gluteus maximus after mountaineering. So we report this case with a review of the literature.

Costoclavicular Syndrome Secondary to Nonunion of a Displaced Fracture of the Clavicle, Misdiagnosed as a Simple Muscle Strain: A Case Report

Thoracic outlet syndrome is a relatively common disease. However, costoclavicular syndrome as a condition secondary to nonunion of a displaced fracture of the clavicle is very rare. Most clavicular fractures in adults are united with no or minimal persistent symptoms. Also, symptomatic nonunion of a displaced fracture of the clavicle is rare. A 55-year-old male initially presented with persistent forearm pain after slip-down was initially diagnosed with simple muscle strain. However, he was given a delayed diagnosis of costoclavicular syndrome, caused by compression of the subclavian artery due to trauma in the fibrotic nonunion of the right clavicle without apparent symptoms. We obtained satisfactory results by surgical treatment. Here we report this case with a review of the literature.

Interposition of Extensor Pollicis Longus Tendon in Smith's Fracture in a Child: A Case Report

Entrapment of the extensor pollicis longus tendon is reported rarely on Smith's fractures in children. In our case, a 15 year old boy with Smith's fracture received treatment of closed reduction at another hospital. When he visited our hospital, a wide gap at the fracture site was detected on radiograph and the thumb movement was limited. We have doubt the entrapment of the soft tissue, especially the tendon. We decided on open reduction. In the operation field, entrapment of the extensor pollicis longus tendon at the gap of the fracture site was found through dorsal approach. In addition, fracture treatment with K-wire fixation after reduction of extensonr pollicis longus tendon reduction was done. Therefore, we report this case with a review of the literatures.

Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle

PURPOSE: The purpose was to describe comparative analysis of the surgical outcome of percutaneous K-wire fixation of bony mallet fingers reduced with towel clip and 18-gauge needle. METHODS: We analyzed the bony mallet finger patients with more than twelve months follow-up after percutaneous K-wire fixation. The patients were randomly divided into two groups. Eighteen fingers were treated with closed reduction using towel clip and 18 other fingers were treated with closed reduction using 18-gauge needle. RESULTS: Radiographs showed bony union and no subluxation in all cases after K-wire removal. The average extension lag was 2.8degrees/1.9degrees, and range of motion of distal interphalangeal joint was 70.3degrees/75degrees respectively. According to Crawford's criteria, excellent results were obtained in 9/11 fingers, good results in 8/7 fingers, and poor result in 1/0 finger, respectively. CONCLUSION: 18-gauge needle reduction in percutaneous K-wire fixation is considered less invasive and useful method for treatment of bony mallet finger with comparable results with towel clip reduction.

Parosteal Lipoma of the Femur with Hyperostosis: A Case Report / 대한골관절종양학회지

Parosteal lipoma is a rare kind of lipoma that occurring adipous tissue around the periosteum. It has been reported most commonly in the femur, the radius, the tibia and the fibular. Treatment consists of resecting the lipomatous tumor with further exeresis of the bone and periosteal excrescence in cases with hyperostosis. The authors report a rare case of parosteal lipoma occurring at the medial portion of the femur shaft with a review of the relevant literatures.

Bizarre Parosteal Osteochondromatous Proliferation in the Proximal Phalanx of the Third Toe: A Case Report / 대한골관절종양학회지

Bizarre parosteal osteochondromatous proliferation (BPOP) otherwise known as Nora's lesion, is a benign surface tumor of the small tubular bone of the hands and feet with high probability of local recurrence. The report of BPOP in the foot is very rare in our country. We report a case of BPOP of proximal phalanx of right 3rd toe in 44-year-old female, successfully managed by en-bloc marginal excision with a review of the literatures.

Closed Reduction and Percutaneous K-Wire Fixation of Bony Mallet Finger Using an 18 Gauge Needle

PURPOSE: To evaluate the clinical results of the treatment of the percutaneous Kirschner wire fixation of bony mallet finger using an 18 gauge needle. MATERIALS AND METHODS: From September 2002 to September 2009, we performed closed reduction using an 18 gauge needle and percutaneous fixation with Kirschner wire for 15 cases of bony mallet finger and followed up at least 1 year. The fractures were classified by the Wehbe and Schneider's method. Indications of operative treatment were fractures involving more than 30% of articular surface, fracture fragments displaced more than 3 mm, or subluxation of the distal interphalangeal joint. The results were evaluated by the Crawford criteria. RESULTS: All the fractures united, with an average healing time of 5.3 weeks(4-6 weeks). According to Crawford criteria, 10 cases were excellent, 5 cases were fair at a mean follow-up of 13 months. There were no pin tract infections and migrations of the pin. CONCLUSION: Percutaneous Kirschner wire fixation of mallet finger using an 18 gauge needle is an easy technique which can achieve anatomical reduction and diminish operation-related complications.

Treatment of Metacarpal Shaft Fractures with Retrograde Intramedullary Kirschner-Wire Fixation

PURPOSE: The purpose of this study is to evaluate the clinical results of retrograde intramedullary fixation of metacarpal shaft fractures using two pre-bent Kirschner wires. MATERIALS AND METHODS: Between March 2006 and May 2008, 19 cases (17 patients) of metacarpal shaft fractures were treated with the retrograde intramedullary Kirschner-wire fixation and followed at least one year. The exclusion criteria were thumb metacarpal fractures, comminuted fractures and irreducible metacarpal spiral shaft fracture by closed manipulation. At final follow up all the cases were assessed with total active motion(TAM), rotational deformity, bony union and angular deformity based on the plain radiographes. RESULTS: At the last follow-up, all cases achieved bony union. Five cases showed less than 5degrees of dorsal angular deformity. The average union period was 6.3 weeks (range, 5-9weeks). Fifteen cases (79%) showed excellent results, four cases good results based on TAM. No case showed rotational deformity. Two cases had skin irritation by distal wire end, which was subsided after wire removal. CONCLUSIONS: In patients with a metacarpal shaft fracture, retrograde intramedullary fixation using two pre-bent K-wires can provide satisfactory clinical results.

The Comparison between ITST(TM) (Intertrochanteric/Subtrochanteric) & DHS (Dynamic Hip Screw) in Unstable Femur Intertrochanteric Fracture

PURPOSE: To evaluate between DHS and ITST nail (2nd generation) on the treatment of unstable femur intertrochanteric fracture in patients over 70 years old. MATERIALS AND METHODS: 61 cases of unstable intertrochanteric fracture (grouped 37 patients with DHS and 24 patients with ITST) who were taken the operation from Mar. 2003 to Sep. 2007 were analysed regarding to union time, sliding length of lag screws, operation time, blood loss, postoperative complications and functional recovery score by Skovron. RESULTS: The mean union time was 14.7 weeks in study group (ITST). The mean union time was 16.2 weeks in control group (DHS). The lag screw slidings were 7.2 mm in study group and 8.7 mm in control group. The operation times were 57.9 min in study group and 76.9 min in control group. The amount of blood loss were 67.7 ml in study group and 227.4 ml in control group. The complications were 4 cases in study group and 4 cases in control group. The Skovron recovery scores were 76.5% in study group and 73.7% in control group. CONCLUSION: From a practical point of short operation time, less amount of bleeding and less complication, author think that the ITST nail is useful implant for treatment of unstable femur intertrochanteric fracture in patient of old age.

Topographic Locomotive Analysis of (99m)Tc-HDP Uptake of Acute Rhabdomyolysis and Musculotendinous Unit Injury due to Excessive Swimming Exercise in Novice: A Case Report / 핵의학분자영상

No abstract available.

Arthroscopic Repair for Traumatic Peripheral Tear of Triangular Fibrocartilage Complex

PURPOSE: To assess the results of an arthroscopic repair for traumatic peripheral tears of triangular fibrocartilage complex (TFCC, Palmer type Ib). MATERIALS AND METHODS: 10 patients with traumatic peripheral TFCC tear were treated with outside-in technique with arthroscope and evaluated with an average follow-up of 19 months (range, 15 to 28 months). The clinical outcomes were assessed with investigation of pain, range of motion, grip strength, return to job and patient's satisfaction. RESULTS: The arthroscopic repair of traumatic peripheral TFCC tear resulted in significant pain relief and increase in functional ability of wrist, that is, 8 excellent, 1 good and 1 fair results. At last follow-up, the average of flexion was 79° (range 76~86°), average of extension was 78° (range 70~84°), average pronation was 85° (range 75~91°) and average supination was 87° (range 79~92°). Nine patients except one were back to their original job. CONCLUSION: Arthroscopic repair of traumatic peripheral TFCC tear could be used for pain relief and increase in functional ability of wrist.

Arthroscopic Repair for Traumatic Peripheral Tear of Triangular Fibrocartilage Complex

PURPOSE: To assess the results of an arthroscopic repair for traumatic peripheral tears of triangular fibrocartilage complex (TFCC, Palmer type Ib). MATERIALS AND METHODS: 10 patients with traumatic peripheral TFCC tear were treated with outside-in technique with arthroscope and evaluated with an average follow-up of 19 months (range, 15 to 28 months). The clinical outcomes were assessed with investigation of pain, range of motion, grip strength, return to job and patient's satisfaction. RESULTS: The arthroscopic repair of traumatic peripheral TFCC tear resulted in significant pain relief and increase in functional ability of wrist, that is, 8 excellent, 1 good and 1 fair results. At last follow-up, the average of flexion was 79° (range 76~86°), average of extension was 78° (range 70~84°), average pronation was 85° (range 75~91°) and average supination was 87° (range 79~92°). Nine patients except one were back to their original job. CONCLUSION: Arthroscopic repair of traumatic peripheral TFCC tear could be used for pain relief and increase in functional ability of wrist.

The Results of Modified Brostrom Procedure for the Treatment of Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate clinical and radiographical results of treatment of chronic lateral ankle instability with modified Brostrom procedure. MATERIALS AND METHODS: This is a retrospective study of 22 cases in 22 patients treated with modified Brostrom procedure under the diagnosis of chronic lateral ankle instability from May 2000 to August 2004. Average age was 32.3 years. Average follow-up period was 23 months. Preoperative and postoperative radiographs of ankle anteroposterior view, lateral view and varus stress view were analyzed. The clinical evaluation was performed according to the Americal Orthopaedic Foot and Ankle Society scales. RESULTS: After the modified Brostrom procedure, Americal Orthopaedic Foot and Ankle Society scales score was improved by average 28 points. Among the 22 cases, 13 cases were excellent, 3 cases good, 4 cases fair, and 2 cases poor with satisfaction of 73%. Five cases had intermittent ankle pain of whom 3 cases had difficulty during competitive sports activity. Lateral tilting of talus improved by average 5.4 degrees on varus stress view. CONCLUSIONS: The modified Brostrom procedure is one of the most effective methods for treating of chronic lateral ankle instability.