Intra-articular Patterns of Bucket Handle Meniscal Tears and Its Relation to Reducibility

BACKGROUND: The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance. METHODS: From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability. RESULTS: Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction. CONCLUSIONS: Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.

Skin-capsular Mismatch According to Knee Positions for Instrument Insertion via Arthroscopic Portals

Damage to soft tissues, chondral surfaces, and the menisci may result from imprise or overly aggressive establishment of portals in arthroscopic knee surgeries. In this note, we address the relationship between the skin and the capsule at portal sites according to knee positions. Understanding the skin-capsular mismatch may facilitate arthroscopic procedures and indirectly reduce the operation time.

Separation of the Tip of a Coblation Wand within the Knee Joint: A Complication of Arthroscopic Adhesiolysis

Coblation devices are now widely used in arthroscopic surgery and they show a very low incidence of intraoperative complications. We experienced a case where the tip of the wand separated and migrated into the posterior knee compartment in an arthrofibrotic knee. The free wand tip was identified and then extricated from the popliteal hiatus of the knee with using C-arm fluoroscopic control. To the best of our knowledge, this is the first report of its kind involving coblation wands. We describe this complication to show that the use of coblation devices can lead to unexpected problems and it is imperative to inspect all instruments before and after each surgical use.

Primary Sternoclavicular Septic Arthritis in a Healthy Adult: A Case Report

Sternoclavicular septic arthritis is a rare condition and it is usually related to predisposing conditions like intravenous drug abuse, diabetic mellitus, trauma and so on. A delayed diagnosis of this disease may cause severe complications like mediastinitis and chest wall abscess. Computed tomography or magnetic resonance imaging is needed to evaluate the complications. If the above complications are present, then joint resection should be considered. We report here on a case of a 52-year-old man who was diagnosed with primary sternoclavicular septic arthritis and he had no predisposing conditions. The pathogen on the aspiration-culture was S. aureus and it was susceptible to cefminox. The patient was cured with administering only antibiotic therapy for 6 weeks; intravenous cefminox therapy for 4 weeks followed by oral cefminox therapy for 2 weeks.

Total Ankle Arthroplasty : Short Term follow up Results of Semiconstrained Type and Unconstrained Type / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the two prosthesis that used for total ankle arthroplasty. MATERIALS AND METHODS: From Sept. 2003 to Jun 2006, 13 patients and 14 ankles that could be follow up more than 1 months. Semiconstrained type (Group I, 7 cases) and Unconstrained type (Group II, 7 cases) were used for total ankle arthroplasty. Mean age was 63.2 year-old, 12 ankles are men and 2 ankles were women. Mean follow up periods were 29 months. The criteria to compare the clinical result were postoperative range of motion, AOFAS score and residual bone stock of medial malleolus. RESULTS: Postoperative range of motion of group I was 43.6+/-9.4 degrees and of group II was 50.7+/-7.3 degrees (p=0.115). Postoperative AOFAS score of group I was 77.1+/-13.0 points and of group II was 86.0+/-5.7 points (p=0.094). Resected bone stock in medial malleolus of group I was 10.7+/-2.5 mm and of group II was 5.1+/-1.2 mm (p=0.003). Total number of complication in our study was 9 cases. 3 cases were a malleolar fracture, two occurred at intra-operation, the other at follow-up period. Re-operation was done in 6 cases, 3 cases were calcaneal corrective osteotomy, 2 cases were resection of a heterotopic bone and one case was pedicular flap operation for skin problem. CONCLUSION: In our hospital, mobile bearing type prosthesis shows good result than a semiconstrained type in respect of residual bone stock in medial malleolus. Postoperative range of motion and AOFAS score between two groups shows no significant difference. But small number of patients and short term follow up period is a defect in our study, afterward more population and long term follow up period are needed.

Recurrent Inflammation on the Hand due to a High Pressure Injection of Urethane : A Case Report / 대한정형외과학회잡지

We describe a case of a high-pressure polyurethane injection injury to the hand, and discuss how its management differs from other injection injuries. A male patient was transferred to our hospital due to persistent purulent discharge from the 2nd finger, which began 15 days after the injury. The injected foreign body, polyurethane, could not be recognized by the patient and was not indicated radiographically. During surgery, the polyurethane foam was removed. The patient had no functional impairment 24 months after surgery.

Transforaminal Lumbar Interbody Fusion for the Treatment of Nonunion after Posterolateral Lumbar Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of a transforaminal lumbar interbody fusion for the treatment of non-union after a posterolateral spinal fusion. LITERATURE REVIEW SUMMARY: In the case of nonunion after a posterolateral spinal fusion, the anterior column should be reconstructed. However, due to epidural scarring and fibrosis, the approach to the anterior column by conventional posterior lumbar interbody fusion (PLIF) is difficult. The authors have modified the original transforaminal lumbar interbody fusion (TLIF) developed by Dr. Harms, which offers potential advantages and provides a surgical alternative to the traditional methods. MATERIALS AND METHODS: Between January 2002 and August 2003, 10 cases of TLIF for the treatment of non-unions after a posterolateral spinal fusion were performed. There were 8 male and 2 female cases. The mean age of the patient was 63.3 years, ranging from 53 to 75 years. The levels of the TLIF were the L4-5 and L5-S1 in 9 and 1 cases, respectively. The mean interval between the revision and previous operations was 21.3 months, ranging 12 to 48 months. In the preoperative radiography, bony defect in posterolateral fusion mass, halos around screws and abnormal motions in the stress view were observed. Using the previous midline approach, exposure of the bilateral articular and transverse processes were performed. With a small osteotome, the superior articular process was removed along a line parallel to the superior margins of the pedicular screw head, to allow access to the neural foramen and lateral aspect of the disc space. The TLIF was performed through this space by inserting cages. The loosened screw was replaced by one that was thicker, coupled with a cancellous bone graft in the foramen. RESULTS: The average operation time and blood loss were 224 min. and 727 cc, respectively. Using Kirkaldy-Willis categories, the results were excellent in 1 case, good in 7, fair in 1 and poor in a further 1 case, with 1 case of nonunion was observed postoperatively. CONCLUSIONS: The transforaminal lumbar interbody fusion for the treatment of nonunion after a posterolateral spinal fusion is a reliable and safe technique, which seems to have the merit of less morbidity.

Transforaminal Lumbar Interbody Fusion for the Treatment of Nonunion after Posterolateral Lumbar Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of a transforaminal lumbar interbody fusion for the treatment of non-union after a posterolateral spinal fusion. LITERATURE REVIEW SUMMARY: In the case of nonunion after a posterolateral spinal fusion, the anterior column should be reconstructed. However, due to epidural scarring and fibrosis, the approach to the anterior column by conventional posterior lumbar interbody fusion (PLIF) is difficult. The authors have modified the original transforaminal lumbar interbody fusion (TLIF) developed by Dr. Harms, which offers potential advantages and provides a surgical alternative to the traditional methods. MATERIALS AND METHODS: Between January 2002 and August 2003, 10 cases of TLIF for the treatment of non-unions after a posterolateral spinal fusion were performed. There were 8 male and 2 female cases. The mean age of the patient was 63.3 years, ranging from 53 to 75 years. The levels of the TLIF were the L4-5 and L5-S1 in 9 and 1 cases, respectively. The mean interval between the revision and previous operations was 21.3 months, ranging 12 to 48 months. In the preoperative radiography, bony defect in posterolateral fusion mass, halos around screws and abnormal motions in the stress view were observed. Using the previous midline approach, exposure of the bilateral articular and transverse processes were performed. With a small osteotome, the superior articular process was removed along a line parallel to the superior margins of the pedicular screw head, to allow access to the neural foramen and lateral aspect of the disc space. The TLIF was performed through this space by inserting cages. The loosened screw was replaced by one that was thicker, coupled with a cancellous bone graft in the foramen. RESULTS: The average operation time and blood loss were 224 min. and 727 cc, respectively. Using Kirkaldy-Willis categories, the results were excellent in 1 case, good in 7, fair in 1 and poor in a further 1 case, with 1 case of nonunion was observed postoperatively. CONCLUSIONS: The transforaminal lumbar interbody fusion for the treatment of nonunion after a posterolateral spinal fusion is a reliable and safe technique, which seems to have the merit of less morbidity.

The Larsen Procedure for Chronic Ankle Lateral Instability / 대한정형외과학회잡지

Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.