Clinical challenges and advancements in diagnosing Staphylococcus aureus-associated musculoskeletal infections / 고신대학교의과대학학술지

Musculoskeletal infections (MSKI) present a significant health challenge, with a rising incidence linked to the aging population and advancements in orthopedic surgical care. Staphylococcus aureus is the most prevalent pathogen associated with orthopedic infections. The conventional culture method for identification of pathogen frequently lacks accuracy and is challenged by false-positive or false-negative results. Inflammatory markers such as the erythrocyte sedimentation rate and C-reactive protein are not site-specific or accurate, as they can be confounded by other medical conditions. Identifying the dominant pathogen and monitoring treatment response following surgical debridement and antibiotics therapy continues to pose challenges. Understanding the pathogenesis of MSKI is crucial for the development of innovative diagnostics and alternative therapeutics. S. aureus immune evasion stands out as a key component of the pathogenic mechanism, complicating clinical decisions. Other unique mechanisms such as biofilm and abscess formation, as well as osteocyte-lacuno canalicular network invasion, underscore the need for aggressive debridement and the complete removal of infected implants and bone tissues. Ongoing efforts focus on exploring and developing innovative diagnostics, such as serum immunoassays, next-generation sequencing of infected tissue, transcriptomics of peripheral blood mononuclear cells, and serum proteomics. These endeavors offer promising avenues for improved diagnostics, medical management, and innovative therapeutics for MSKI.

Supportive Bone Cement Replacement for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: To report early results of supportive bone cement replacement for medium to large size osteonecrotic femoral heads in young patients. MATERIALS AND METHODS: Forty-one osteonecrotic femoral heads in 38 patients, who received operation from Mar. 1998 to Feb. 2000, were reviewed. The mean age of the patients was 34.2 years (men; 33, women; 5). The preoperative mean Harris score was 48.6. Radiologic staging of Ficat showed I in 2 hips (5%), II-A in 7 hips (17%), II-B in 8 hips (20%) and III in 24 hips (59%). According to the index of necrotic extent (INE) by MRI, 8 hips (20%) were grade B and the remaining 33 hips (80%) were grade C. The operative method used was debridement of necrotic bone and bone cement replacement. Mean length of follow- up was 24.6 months. Three hips were lost to final follow-up. RESULTS: Postoperative immediate pain relief was observed in 38 hips (86%). Mean Harris score at the final follow-up was 77.3. Radiologic progression of stage was observed in 11 hips (27%), and no progression in the remaining 30 hips (73%). Arthoplasty was performed in 6 hips (15%), which were INE C in all cases. CONCLUSION: Supportive bone cement replacement is easier than other salvage techniques and produced a good result. INE was an important factor effecting postoperative results. Long term follow up is necessary.

Computed Tomographical Evaluation of C1-2 for Transarticular Posterior Screw Fixation / 대한정형외과학회잡지

PURPOSE: To avoid neurovascular injuries and to establish the ideal trajectory of screw insertion, a computed tomographical evaluation was conducted. MATERIALS AND METHODS: Twenty volunteers without cervical disease were employed for this study. Axial and oblique CT scans were selected for evaluation. Oblique CT scans were obtained in the direction of provisional screw insertion, starting from the junction of the lamina and the inferior articular facet of the axis and extending to the center of anterior tubercle of the atlas. In the axial and oblique reconstructed views, the screw length, the diameters of the medial and lateral cortexes of the isthmus, the vertical distance, and the angle of C1 were measured. RESULTS: The screw lengths averaged 37.6 mm (35.1-40.5 mm) in males and 37.2 mm (33.6-43.4 mm) in females. The diameters of the medial cortex of the isthmus were 4.3 mm (3.3-5.2 mm) in males and 4.0 mm (2.8-5.6 mm) in females. No measurement was statistically different between males and females. CONCLUSION: Due to individual variations of atlantoaxial anatomy, especially in terms of the size of cortical diameter of the isthmus, 3-D reconstruction CT is a useful tool for planning transarticular C1-2 screw insertion.

Posterior Lumbar Interbody Fusion with Cancellous Allograft / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study compared the clinical results of the posterior lumbar interbody fusion (PLIF) using a cancellous allograft with the conventional autologous iliac bone graft. SUMMARY OF LITERATURE REVIEW: The allograft is known to produce a similar effect as that of a nonvascular autogenous bone implantation. However, the implantation process occurs more slowly with the various degrees of the inflammatory reaction caused by the immunological reactions. MATERIALS AND METHODS: From June 1999 to February 2002, 39 patients were operated on by a single surgeon. There were 14 cases with 1 level, 4 cases with 2 levels posterior fusion with a cancellous allograft (objective group), and 20 cases with 1 level and 1 case with 2 levels posterior fusion with a conventional bone graft (control group). The clinical results and standing lateral views of the lumbar spine were compared and analyzed in order to assess the fusion rate, the changes in the distance between the two vertebral bodies and changes in the lordotic angle formed between the fused bodies immediate after surgery and at the final follow-up. RESULTS: During the early post-operative period, the control group showed superior results. However, there were no significant differences between the two groups at the final follow-up. There were no statistically significant differences in the fusion rate, the changes in the intervertebral distance, and the lordotic angle. CONCLUSION: PLIF using a cancellous allograft and a locally harvested autograft showed acceptable radiological union rate and clinical results. It is believed that this is an excellent surgical technique with a shorter operation time, less bleeding, less pain and no morbidity of the donor site.