Prescription Patterns of Topical Medications in Patients with Atopic Dermatitis: An Investigative Review Using Big Data from the National Health Insurance Corporation

Background@#Topical medications play a crucial role in the treatment of atopic dermatitis (AD). Topical corticosteroids (TCSs) remain the main treatment of choice and topical antibiotics have also been used. However, with the new topical calcineurin inhibitors (TCIs), the prescription patterns of topical agents have changed over time. @*Objective@#To characterize the prescription patterns of topical medications in Korean patients with AD. @*Methods@#We investigated topical medications prescribed to Korean patients with AD using the National Health Insurance Sharing System (NHISS) database over a 14-year period (2002~2015). Additionally, the potency of prescribed TCSs was compared with AD and psoriasis patients. @*Results@#The annual prescription of TCSs showed a slightly decreasing trend without significant change. In particular, in terms of steroid class, prescription of moderate-to-low potency TCSs were increased and the use of high potency TCSs were decreased. TCSs were the most commonly prescribed topical medications for AD. Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals (16.2%, 3.1%, and 1.9%, respectively). Additionally, dermatologists prescribed TCIs more frequently than pediatricians and internists (4.3%, 1.2%, and 0.6%, respectively). Among TCSs, Class 5 was prescribed the most (40.6%) followed by Class 7, 6, 4, 3, 1, and 2. When we compared the potency of TCSs prescribed for AD with psoriasis patients, moderate-to-low-potency TCSs were more commonly prescribed in AD. @*Conclusion@#Prescription patterns of topical medications had changed from 2002 to 2015 and differed according to the type of institution and specialty of the physician.

Comparison of Clinical Outcomes between Arthroscopic Anterior Compartment Debridement with Posterior Compartment Mini-Open Debridement and Arthroscopic Both Compartments Debridement of the Primary Elbow Osteoarthritis / 대한정형외과학회잡지

Purpose@#This study analyzed the effectiveness of arthroscopic anterior compartment debridement with posterior mini-open debridement in patients with mild or moderate primary elbow osteoarthritis (OA). The clinical results of arthroscopic anterior compartment debridement with posterior mini-open debridement were compared with that of arthroscopic both compartments debridement. @*Materials and Methods@#Between January 2010 and December 2016, 46 patients diagnosed with elbow OA underwent arthroscopic anterior compartment debridement with posterior mini-open debridement or arthroscopic anterior and posterior compartments debridement arthroscopic surgery. Of these, 27 patients were finally included in this study. The data were collected retrospectively from the medical records. The subjects were divided into two groups according to the surgical procedure: group 1 (n=16) received arthroscopic anterior compartment debridement with posterior mini-open debridement surgery, and group 2 (n=11) received arthroscopic anterior and posterior compartments debridement surgery. The elbow flexion-extension range of motion (ROM), visual analog scale (VAS), Mayo Elbow Performance Score (MEPS) were analyzed for the clinical outcome before surgery and the last follow-up visit after surgery. @*Results@#The average follow-up period was 21 months (15–32 months). All clinical outcomes (ROM, VAS, and MEPS) were improved after surgery compared to those before surgery (p<0.05) in both groups. Group 1 showed further improvement in flexion (p=0.001) and total ROM (p=0.011) than group 2. On the other hand, there was no significant difference in extension, VAS, and MEPS between the two groups. @*Conclusion@#In patients with primary elbow OA, arthroscopic anterior compartment debridement with posterior compartment mini-open technique produced an excellent clinical outcome after surgery and was particularly helpful in increasing flexion and the total ROM.

Arthroscopic Full-Thickness Rotator Cuff Repair in Elderly Patients / 대한정형외과학회잡지

PURPOSE@#To examine the clinical and structural outcomes of an at least two-year follow-up of arthroscopic full-thickness rotator cuff repairs with a single-row or suture-bridge technique in patients more than 65 years of age.@*MATERIALS AND METHODS@#Patients diagnosed with a full-thickness rotator cuff tear who were more than 65 years of age, underwent arthroscopic rotator cuff repair after at least six months of conservative treatment, agreed to take a follow-up magnetic resonance imaging (MRI) six months postoperatively, and visited outpatient for at least two years were enrolled in this study. Clinical evaluations were done using The University of California Los Angeles score, Constant Shoulder Score, and visual analogue scale evaluated two years after the surgery. The structural integrity was analyzed using follow-up MRI. During surgery, a suture-bridge technique was used if the rotator cuff tendon could cover half of the footprint under constant tension. Otherwise, single-row repair was performed.@*RESULTS@#The samples were 158 cases, consisting of 93 single-repairs and 65 suture-bridge repairs. A preoperative comparison of the age distribution, fatty degeneration of supraspinatus and infraspinatus muscle, medial retraction of torn cuff tendon, and tear size between the two groups were not significant. The clinical scores were improved significantly in all cases. The distribution of the structural integrity by Sugaya classification were 49 cases in type 1 (31.0%), 62 cases in type 2 (39.2%), 30 cases in type 3 (19.0%), 11 cases in type 4 (7.0%), and six cases in type 5 (3.8%). The re-tear rate of the single-row group was 9.7% (nine out of 93 cases) and 12.3% (eight out of 65 cases) for the suture-bridge group.@*CONCLUSION@#Satisfactory clinical and radiological outcomes were achieved after arthroscopic full-thickness rotator cuff repair in patients more than 65 years of age. Both single-row and suture-bridge techniques would be beneficial for the elderly.

Ultrasonography of Malignant Clear Cell Hidradenoma: A Case Report

Clear cell hidradenoma is a tumor that originates from a sweat gland and typically involves the dermis and subcutaneous tissue. Malignant clear cell hidradenoma is very rare, and surgical excision is usually performed without imaging. There are few reports of the ultrasonographic findings of malignant clear cell hidradenomas. Herein, we present the ultrasonographic characteristics of a malignant clear cell hidradenoma.

Ultrasonography of Malignant Clear Cell Hidradenoma: A Case Report

Clear cell hidradenoma is a tumor that originates from a sweat gland and typically involves the dermis and subcutaneous tissue. Malignant clear cell hidradenoma is very rare, and surgical excision is usually performed without imaging. There are few reports of the ultrasonographic findings of malignant clear cell hidradenomas. Herein, we present the ultrasonographic characteristics of a malignant clear cell hidradenoma.

A Case of Cervical Chondrocutaneous Branchial Remnant Comprised of Hyaline Cartilage

No abstract available.

Epidemiology and Identification of Organisms Causing Superficial Dermatomycoses at Tertiary Hospitals in Korea: A Prospective Multicenter Study / 대한의진균학회지

BACKGROUND@#Superficial dermatomycoses are fungal infections of the skin, hair, or nails and are most commonly caused by dermatophytes. Superficial dermatomycoses are very common diseases in the field of dermatology; however, their prevalence and clinical characteristics vary with geographical areas and populations. Moreover, pathogenic species change constantly over time.@*OBJECTIVE@#This multicenter study aimed to investigate the epidemiologic and clinical findings of tinea corporis, tinea faciale, and tinea capitis in Korea during 2016-2017. In addition, we sought to identify the pathogenic organism causing these three different types of fungal infections.@*METHODS@#Total 453 patients from the dermatology clinics of 13 tertiary hospitals in Korea were enrolled in this study. Information regarding demographic characteristics, comorbidities, occupation, family history of superficial dermatomycoses, suspected routes of infection, and treatment was collected. Fungal cultures and molecular analyses were performed for patients with tinea corporis, tinea faciale, and tinea capitis.@*RESULTS@#Of the 453 patients, 275 were men and 178 were women. With respect to past history, 214 patients (53.4%) had at least one comorbidity. Tinea corporis (27.3%) was the most common form of superficial dermatomycosis, followed by tinea pedis (23.2%) and tinea unguium (16.6%). Overall, the fungal culture positivity was 77.8% (126/162). Trichophyton rubrum was the most common causative organism for tinea corporis (66.7%, 68/80) and tinea faciale (43.8%, 14/23), while Microsporum canis was the most common causative organism for tinea capitis (36.7%, 11/23).@*CONCLUSION@#Trichophyton rubrum was consistently the most common causative organism of superficial dermatomycoses, except for tinea capitis in Korea.

Three Cases of Generalized Granuloma Annulare Successfully Treated with Methotrexate / 대한피부과학회지

Granuloma annulare is a benign granulomatous skin disease, clinically characterized by dermal papules tending to form annular shapes. Granuloma annulare is classified into localized, generalized, subcutaneous, and perforating types. Localized granuloma annulare is likely to resolve spontaneously, while generalized granuloma annulare usually takes a chronic course. Topical steroids, phototherapy, isotretinoin, dapsone, hydroxychloroquine, and other various treatments have been proposed, but some cases have been resistant to all of those treatment modalities. We experienced 3 cases of generalized granuloma annulare demonstrating a recalcitrant course that were successfully treated with methotrexate and propose that methotrexate may be an effective option for recalcitrant generalized granuloma annulare treatment.

A Case of Rudimentary Polydactyly: Is It Truly Related to Polydactyly? / 대한피부과학회지

Rudimentary polydactyly is a congenital anomaly of the hand clinically ranging from a small wart-like tumor to a pedunculated structure near the thumb or little finger. The histology reveals a marked neural proliferation, dilated blood vessels, and some Meissner corpuscles in the dermis. The etiology is unknown and there are a few theories. First, Hare believed that it represented a vestigial form of supernumerary finger, and termed it rudimentary polydactyly. Since then, Shapiro et al. has argued that rudimentary polydactyly is an amputation neuroma after finding histological similarity between acquired traumatic neuroma and rudimentary polydactyly. Recently Brehmer- Andersson et al. asserted that rudimentary polydactyly is a neuroma that can arise in any area containing Meissner corpuscles after observing a penile lesion with similar histology as rudimentary polydactyly. We report a case of rudimentary polydactyly characteristically not showing any prominent Meissner corpuscles. With this case, we provide support for the theory of Shapiro et al.

A Modified Mac Suture Bridge Technique: Clinical and Radiological Outcomes of the Treatment of Rotator Cuff Tear with Poor Tissue Quality / 대한정형외과학회잡지

PURPOSE: Base on the concept of the Mac stitch, we designed the modified Mac-suture bridge technique to improve the outcome of arthroscopic repair of rotator cuff tear with poor tissue quality. Moreover, we evaluated both the radiological and clinical outcomes of the surgery to assess the effectiveness of the newly designed technique. MATERIALS AND METHODS: From January 2010 to December 2014, a total of 52 patients (25 males, 27 females) with rotator cuff tear, with poor tissue quality according to both radiological and intraoperative findings, who underwent arthroscopic rotator cuff repair using the modified Mac-suture bridge technique and followed-up for at least 1 year were included in this study. The mean patient age at the time of surgery was 60 years. The average follow-up period was 20 months. We evaluated the clinical outcomes by checking the range of motion and compared the following, both preoperatively and postoperatively: American Shoulder and Elbow Surgeon (ASES) score, University of California, Los Angeles (UCLA) score, Constant shoulder score (CSS), visual analogue scale (VAS). In addition, we analyzed 42 series of postoperative magnetic resonance imaging by using the Sugaya's classification for the evaluation of the repair integrity. RESULTS: All clinical scores showed significant improvement (ASES score improved from 56.75 to 83.44, UCLA score from 20.52 to 29.23, CSS from 64.04 to 80.90, and VAS from 6.17 to 1.62; p<0.001). The range of motion was also improved; forward flexion improved from 108° to 158°, abduction from 109° to 160°, external rotation from 27° to 50°, and internal rotation from 31° to 57° (p<0.001). Satisfactory radiologic results were noted on postoperative magnetic resonance imaging, consisting of 15 cases (35.7%) type I, 22 cases (52.4%) type II, 3 cases (7.1%) type III, 2 cases (4.8%) type IV, and no type V, according to the Sugaya's method. CONCLUSION: The modified Mac-suture bridge technique provided satisfactory results both radiologically and clinically for the treatment of rotator cuff tear with poor tendon tissue quality. It could possibly be a good alternative to previous techniques of arthroscopic repair.

Operative Treatment of Medial Epicondylitis: A Comparative Analysis of the Clinical Outcomes between the Suture Anchor Group and the Non-suture Anchor Group

BACKGROUND: The purpose of this study was to make a comparative analysis of the clinical outcomes after the operative treatment of refractory medial epicondylitis between the suture anchor group and the non-suture anchor group. METHODS: We enrolled 20 patients (7 men and 13 women) with recalcitrant medial epicondylitis who were able to receive operative treatment in a minimum of an 18-month follow-up. The mean age was 48.6 years (range, 36-59 years). The patients were allocated into either the suture anchor group (7 patients) or the non-suture anchor group (13 patients). We evaluated clinical outcomes using the visual analog scale (VAS), the pain grading system of Nirschl and Pettrone, and postoperative grip strength. RESULTS: The VAS score decreased from 8.8 to 2.0 for the suture anchor group and from 8.6 to 1.3 for the non-suture anchor group (p=0.16). The postoperative grip strength was 95%, 93% of the non-treated arm in both groups (p=0.32). The postoperative satisfaction level was good in 5 patients and fair in 2 for the suture anchor group and excellent in 5 patients, good, in 4, and fair, in 4 for the nonsuture anchor group (p=0.43). The clinical outcomes did not show a statistically significant difference between the two groups. CONCLUSIONS: We found that patients with recalcitrant medial epicondylitis were treated reliably with satisfactory clinical outcomes whether or not suture anchors were used. We believe the use of suture anchors when more than 50% of the tendon origin is affected provides an effective and favorable treatment modality.

Lunate Excision and Tendon Ball Implantation in Lichtman Stage IIIB Kienbock's Disease in Middle-Aged Patients

PURPOSE: Our purpose was to assess the results of lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienbockos disease in middle-aged patients. METHODS: Ten patients with Lichtman stage IIIB Kienbock's disease who underwent lunate excision and tendon ball implantation and followed up at least 24 months were analyzed. There were 4 males and 6 females. The mean age at the time of surgery was 55.4 years (range, 48-67 years), and follow-up period ranged from 24 to 68 months (mean, 46 months). Radiocarpal joint pain, grip strength, return to daily living activity, range of motion were evaluated and radiologic findings of preoperative, postoperative and last follow-up were evaluated. RESULTS: All patients returned to daily living activity after 6 months of surgery. At the last follow up, 8 patients had no pain and 2 patients experienced mild pain occasionally. The mean improvement of extension arc was 14.5degrees, and the mean flexion arc improved 8.5degrees. The mean grip strength was 88% of unaffected side. The mean carpal height ratio was 0.49 preoperatively, 0.47 at final follow-up. No patients showed osteoarthritis change at the last follow-up. The mean Cooney's wrist function were 83, 4 patients had excellent, 4 had good, and 2 had fair. CONCLUSION: Lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienbock's disease in middle-aged patients showed satisfactory clinical, functional and radiological results. So this can be a reasonable treatment option.

Operative Treatment of Medial Epicondylitis: A Comparative Analysis of the Clinical Outcomes between the Suture Anchor Group and the Non-suture Anchor Group

BACKGROUND: The purpose of this study was to make a comparative analysis of the clinical outcomes after the operative treatment of refractory medial epicondylitis between the suture anchor group and the non-suture anchor group. METHODS: We enrolled 20 patients (7 men and 13 women) with recalcitrant medial epicondylitis who were able to receive operative treatment in a minimum of an 18-month follow-up. The mean age was 48.6 years (range, 36-59 years). The patients were allocated into either the suture anchor group (7 patients) or the non-suture anchor group (13 patients). We evaluated clinical outcomes using the visual analog scale (VAS), the pain grading system of Nirschl and Pettrone, and postoperative grip strength. RESULTS: The VAS score decreased from 8.8 to 2.0 for the suture anchor group and from 8.6 to 1.3 for the non-suture anchor group (p=0.16). The postoperative grip strength was 95%, 93% of the non-treated arm in both groups (p=0.32). The postoperative satisfaction level was good in 5 patients and fair in 2 for the suture anchor group and excellent in 5 patients, good, in 4, and fair, in 4 for the nonsuture anchor group (p=0.43). The clinical outcomes did not show a statistically significant difference between the two groups. CONCLUSIONS: We found that patients with recalcitrant medial epicondylitis were treated reliably with satisfactory clinical outcomes whether or not suture anchors were used. We believe the use of suture anchors when more than 50% of the tendon origin is affected provides an effective and favorable treatment modality.

Osteosarcoma of the Metacarpal Bone / 대한정형외과학회잡지

Osteosarcoma commonly develops around the knee joint, and rarely in the hand. Patients with osteosarcoma of the hand often present with pain and swelling, and osteosarcoma of the hand has a biological behavior that differs from that of osteosarcoma at conventional sites. However, although it usually occurs in the older age group, compared with conventional osteosarcoma, the most common sites of hand osteosarcoma correlate with the most active growth and longest growing bones in the hand like conventional osteosarcoma, particularly in the metacarpophalangeal joints in the second and third digits. However, development of osteosarcoma in the metacarpal bone of the hand in an elderly patient has not yet been reported in the country. Thus, we report on two cases of osteosarcoma in the metacarpal bone of the hand in elderly patients, treated by ray amputation of the digit and preoperative and postoperative chemotherapy.

Reconstruction of Acetabular Posterior Wall Fractures

BACKGROUND: The results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction. METHODS: Thirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D'aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated. RESULTS: The clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome. CONCLUSIONS: This study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way.

A Comparative Study of Three Different Fixation Techniques for Displaced Two- and Three-Part Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: To analyze and compare the results of three different surgical methods - closed reduction and percutaneous pinning (Group I), bifurcated plate and tension band wiring (Group II), locking compression plate (Group III), - for displaced two- and three-part proximal humeral fractures. MATERIALS AND METHODS: Sixteen patients were treated with a closed reduction and percutaneous pinning, 19 with bifurcated plate and tension band wiring and 18 with locking compression plate. All patients were followed up for more than 1 year, and were reviewed and evaluated with respect to radiological and clinical results. The radiological results were evaluated by bony union and humerus neck shaft angle using the Paavolainen method. The clinical results were evaluated by Neer's evaluation criteria. RESULTS: Bony union rate, time period to achieve bony union, neck shaft angle and clinical results in Groups II and III were better than those in Group I (p<0.05). There were no significant differences between Groups II and III. We observed trends for worse clinical outcomes in patients older than 65 years compared with those in patients younger than 65 years. Clinical outcome for patients older than 65 years in Group III (average 87.5 points) was better than that for the same age group in Groups I (average 77.2 points) and II (average 79.3 points), but the cohorts were too small to obtain statistical significance. Complication rate in Groups II, III was lower than that in Group I (p=0.005). CONCLUSION: The radiological and clinical results in Groups II and III were significantly better than those in Group I, and there were no significant differences between Groups II and III. We thought that bifurcated plate and tension band wiring and locking compression plate were useful surgical methods for displaced two- and three-part proximal humeral fractures.

Early Intrathoracic Migration of K-wire Used for Fixation of Proximal Humerus Fracture / 대한정형외과학회잡지

We report a case of early intrathoracic migration of Kirshner wire (K-wire), which had been-used for fixation of proximal humerus fracture. A 74 year-old-woman visited the emergency room due to sudden onset of dyspnea. A chest x-ray and CT scan taken at the emergency room demonstrated 3 K-wires that had been applied to the proximal humerus fracture, 1 K-wire in the anterior chest wall, and mild pneumothorax of the right lung. An emergency removal of K-wire using thoracoscopy was performed and a chest tube was inserted for the treatment of pneumothorax during thoracic surgery. We removed residual 3 K-wires from the right proximal humerus and fixed right proximal humerus fracture by open reduction and internal fixation using a proximal humerus locking plate. We think that if a proximal humerus fracture is fixed using smooth K-wire, patients require close follow-up with the use of x-ray until the K-wire has been removed, in addition, it is very important to take steps to prevent K-wire migration.

The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique / 대한정형외과학회잡지

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.

Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The aim of this study was to analyze the clinical symptoms and function and the nerve electrophysiological changes between the pre-operative and long-term post-operative states of patients who underwent surgical treatment with endoscopic release of the carpal tunnel for idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: This study was performed in 48 patients and 88 wrists with idiopathic carpal tunnel syndrome. All patients were treated with endoscopic carpal tunnel release using a single portal. The preoperative and the 3 years 5 months long-term postoperative clinical symptoms and function were evaluated using the Boston carpal tunnel questionnaire. The nerve electrophysiological status was evaluated using the Bland grade system. RESULTS: When the preoperative Bland grade was 2, 3, 4, 5, and 6, the range of the change of the symptom severity score was 1.38, 1.68, 2.40, 1.61 and 1.28, respectively, and the range of the change of the functional status score was 0.60, 1.34, 1.58, 0.93 and 0.88, respectively, at the long-term follow-up. The clinical symptoms were signifi cantly improved at the fi nal follow-up when the preoperative Bland grade was 2, 3, 4 and 5. The function was signifi cantly improved for all the preoperative Bland grades. On the nerve electrophysiological study, there was statistical improvement of the distal motor latency of the motor nerve and the nerve conduction velocity and amplitude of the sensory nerve. When the preoperative Bland grade was 2, 3, 4, 5 and 6, the extent of improved grade was 0.60, 0.75, 2.17, 2.87 and 4.25, respectively, at the long-term follow-up, and the Bland grade was signifi cantly improved when the preoperative Bland grade was 3, 4, 5 and 6. However, there was no statistical signifi cance between the Bland grade and the clinical state at the long-term follow-up. CONCLUSION: The clinical and nerve electrophysiological states were significantly improved at the long-term follow-up after endoscopic carpal tunnel release. When the preoperative Bland grade was 3, 4 and 5, the clinical symptoms, function and the nerve electrophysiological states were signifi cantly improved at the long-term follow-up.

Treatment of Kienbock's Disease Using the 4+5 Extensor Compartmental Vascularized Bone Grafting Procedure: Early Experience / 대한정형외과학회잡지

PURPOSE: Kienbock's disease can be treated with a vascularized bone graft to provide relief of wrist joint symptoms and prevent collapse of the lunate. We evaluated the functional outcome and subjective satisfaction in patients with Kienbock's disease treated with the 4+5 extensor compartmental vascularized bone graft. MATERIALS AND METHODS: We included 6 patients in the study. 3 males and 3 females with an average age of 37.5 years (range 21-49). Kienbock's disease was staged by Lichtman classifi cation based on plain radiography. Three patients were in stage II and three in stage IIIA. Cooney's wrist function score was used to evaluate changes in severity of pain, functional status, range of motion, and grip strength. We also assessed subjective patient satisfaction, carpal height ratio and bone union on the radiographs, and the occurence of complications. The mean follow-up period was 30 months. RESULTS: Four patients had excellent and two had good outcomes of wrist function. Three patients showed excellent subjective satisfaction, and three were good. All patients showed radiographic bone union and no further progression of lunate necrosis. The presurgical carpal height ratio was similar to the value at last follow-up, and there was no radiographic carpal bone collapse. For two cases of Lichtman stage IIIA, the slight degenerative arthritis at the lunocapitate joint observed preoperatively did not change. Skin necrosis and pin track infection were not observed. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft is a reliable procedure for Lichtman stage II and IIIA patients with Kienbock's disease, as it achieved not only pain relief and improvement of range of motion but also maintenance of the intercarpal bone relationship on radiographs, with relatively few complications.