Adhesion of External Iliac Vessels Found in a Modified Stoppa Approach to Acetabular Fracture in a Patient with a History of Previous Abdominal Surgery / 대한정형외과학회잡지

Some structures should be noted in the modified Stoppa approach for the treatment of acetabular fractures. Among them, the external iliac vessels should be protected with special care during surgery. If there is any history of previous abdominal surgery or a delay in surgery, it is predicted that the intra-abdominal adhesion will be severe. In this case, thorough preparation and caution are required before surgery because a dangerous situation may arise due to blood vessel damage during surgery. On the other hand, there are no specific reports on these cases. The authors report a case of severe adhesion of the external iliac vessels with a history of previous abdominal surgery.

Delayed Pseudoaneurysm of Deep Femoral Artery Caused by Migration of Lesser Trochanter, Subsequent to an Intertrochanteric Fracture Surgery - A Case Report -

The lesser trochanteric fracture is commonly found amongst intertrochanteric fractures, where pseudoaneurysm of the femoral artery is a rare complication. A pseudoaneurysm could develop due to the penetration injury of the artery by the bone fragment during occurrence of the fracture, or by the insertion of screws during the surgical procedure. Minimal complication is seen when the lesser trochanter is not fixed during the intertrochanteric fracture surgery. However, in the current case, the authors experienced appearance of a delayed pseudoaneurysm of the deep femoral artery caused by migration of the lesser trochanter, which was successfully treated by excision.

Delayed Pseudoaneurysm of Deep Femoral Artery Caused by Migration of Lesser Trochanter, Subsequent to an Intertrochanteric Fracture Surgery - A Case Report -

The lesser trochanteric fracture is commonly found amongst intertrochanteric fractures, where pseudoaneurysm of the femoral artery is a rare complication. A pseudoaneurysm could develop due to the penetration injury of the artery by the bone fragment during occurrence of the fracture, or by the insertion of screws during the surgical procedure. Minimal complication is seen when the lesser trochanter is not fixed during the intertrochanteric fracture surgery. However, in the current case, the authors experienced appearance of a delayed pseudoaneurysm of the deep femoral artery caused by migration of the lesser trochanter, which was successfully treated by excision.

Factors Affecting the Period of Bone Union When Treating Femoral Fractures with a Retrograde Intramedullary Nail / 대한정형외과학회잡지

Purpose@#A retrograde intramedullary nail is commonly used to treat femoral shaft and distal femur fractures. The authors analyzed the treatment results and the factors affecting the period of bone union for thirty-five patients treated with a retrograde intramedullary nail. @*Materials and Methods@#Thirty-five patients who could be followed up for more than twelve months after the treatment with retrograde intramedullary nailing were analyzed retrospectively. The treatment results and the relationship between the period of bone union and the patient’s age, sex, comminution of fracture, presence of open fracture, location of the fracture, and accompanying fractures were evaluated. @*Results@#The average bone union time was 4.50 months. The period of bone union was unaffected by the age, sex, location, and presence of open fractures but was affected by the presence of comminution and accompanying fractures. @*Conclusion@#Retrograde intramedullary nailing is effective for distal and shaft of fractures of the femur. The period of bone union is affected by the presence of comminution and accompanying fractures.

Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics

The Korean Society of Laryngology, Phoniatrics and Logopedics appointed a task force to establish clinical practice guidelines for the management of unilateral vocal fold paralysis (UVFP). These guidelines cover a comprehensive range of management-related factors, including the diagnosis and treatment of UVFP, and provide in-depth information based on current, up-to-date knowledge. Detailed evidence profiles are provided for each recommendation. The CORE databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers, using a predefined search strategy. When insufficient evidence existed, expert opinions and Delphi questionnaires were used to fill the evidence gap. The committee developed 16 evidence-based recommendations in six categories: initial evaluation (R1–4), spontaneous recovery (R5), medical treatment (R6), surgical treatment (R7–14), voice therapy (R15), and aspiration prevention (R16). The goal of these guidelines is to assist general otolaryngologists and speech-language pathologists who are primarily responsible for treating patients with UVFP. These guidelines are also intended to facilitate understanding of the condition among other health-care providers, including primary care physicians, nurses, and policy-makers.

Normal Korean Femoral Neck Anteversion, Acetabular Anteversion and Combined Anteversion Measured with Computed Tomography / 대한정형외과학회잡지

PURPOSE: The authors measured the anteversion of the femoral neck and acetabulum and the sum of the two values in normal Korean people by computed tomography. The authors examined the normal range of the values to analyze the difference in sex and sides as well as the relationship between the femoral neck and acetabular anteversion. MATERIALS AND METHODS: The authors measured the anteversion of the femoral neck and acetabulum in 118 normal Korean adult males and 114 females aged between 21 and 49 on both the right and left sides by computed tomography and calculated the sum of anteversion. The authors analyzed the mean and standard deviation, and investigated the sex differences and side differences, as well as the relationship between the acetabular anteversion and femoral neck anteversion statistically. RESULTS: The anteversion of the acetabulum in males was 15.3°±6.1° on the right side and 15.3°±6.6° on the left side. The anteversion of the femoral neck in males was 5.3°±7.6° on the right side and 1.5°±9.2° on the left side according to the Hernandez et al. method. The anteversion of acetabulum in females was 16.8°±5.4° on the right side and 16.3°±5.8° on the left side. The anteversion of femoral neck in females was 10.3°±8.2° on the right side and 7.9°±8.2° on the left side according to Hernandez et al. method. No difference in acetabular anteversion, and a significant difference in the femoral neck anteversion on both the right and left sides were observed between males and females. No difference of acetabular anteversion was observed between the right and left sides, but a significant difference in femoral neck anteversion was noted between the right and left sides measured by either the Hernandez et al. method or Weiner et al. method. The Pearson coefficient revealed no correlation between the femoral neck anteversion and acetabular anteversion. CONCLUSION: No difference in the acetabular anteversion was observed, but there was a significant difference in femoral neck anteversion between males and females. A significant difference in femoral neck anteversion was observed between the right and left sides. No correlation was noted between the anteversion of the femoral neck and acetabulum.

Spinopelvic Orientation on Radiographs in Various Body Postures: Upright Standing, Chair Sitting, Japanese Style Kneel Sitting, and Korean Style Cross-Legged Sitting

BACKGROUND: Several previous studies reported on the impact of upright standing and chair sitting on the sagittal spinopelvic alignment. However, there are no studies on the impact of the two Asian (Korean and Japanese) style floor-sitting positions on the sagittal spinopelvic alignment. The purpose of this study was to evaluate the impact of four different body postures (standing, chair sitting, kneel sitting, and cross-legged sitting) on the sagittal spinopelvic alignment. METHODS: Sixteen selected healthy volunteers (10 males and six females) were subjects of this pilot study. In all subjects, radiographs were taken in comfortable standing and sitting positions. All spinal curvatures including lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on the radiographs. RESULTS: In standing position, the average LLA, SS, PT, and PI were 37.1°, 35.3°, 15.7°, and 51.0°, respectively. In chair sitting, the average LLA, SS, PT, and PI were 17.9°, 20.3°, 28.2°, and 49.5°, respectively. In kneel sitting (Japanese style), the average LLA, SS, PT, and PI were 31.8°, 38.3°, 14.2°, and 52.5°, respectively. In cross-legged sitting (Korean style), the average LLA, SS, PT, and PI were 9.8°, 13.4°, 38.3°, and 51.7°, respectively. LLA in standing (37.1°) and kneel sitting (31.8°) were very similar. Remarkable reduction in LLA was observed in Korean-style cross-legged sitting (9.8°), and LLA in chair sitting (17.9°) was about half of that in standing. SS was similar in standing (35.3°) and kneel sitting (38.3°), and it was reduced remarkably in cross-legged sitting (13.4°). PT was largest in cross-legged sitting (38.3°), and it was similar between standing (15.7°) and kneel sitting (14.2°). PIs were similar in all positions. CONCLUSIONS: The kneel sitting position did not show significant differences with the standing position when assessed using four parameters related to the sagittal spinopelvic alignment, whereas chair sitting and cross-legged sitting positions significantly altered the spinopelvic alignment compared to the standing position.

Prevalence of Diffuse Idiopathic Skeletal Hyperostosis Diagnosed by Whole Spine Computed Tomography: A Preliminary Study

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of the enthesis. The diagnosis has been mainly based on the chest or whole spine lateral plain film. Recently, chest or thoracolumbar computed tomography (CT) has been reported to be more reliable for the diagnosis of DISH. The purposes of this study were to investigate the prevalence and location of DISH and evaluate the prevalence of comorbidities, such as ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), using whole spine CT. METHODS: Whole spine CT scans of patients over 16 years of age who were examined at Cheju Halla General Hospital between February 2011 and December 2016 were reviewed for this study. The diagnosis of DISH was made according to the modified Resnick criteria. The prevalence of DISH in each age decade and its location were evaluated. Also, the prevalence of OPLL and OLF in DISH patients was investigated. RESULTS: The overall incidence of DISH was 24.4% (40 of 164 cases). There was no case of DISH in patients in their 40s and younger. The percentile incidences of DISH in patients in their fifth, sixth, seventh, eighth, and ninth decades were 20.0% (4 of 20 cases), 32.3% (10 of 31 cases), 40.0% (10 of 25 cases), 34.5% (10 of 29 cases), and 27.3% (6 of 22 cases), respectively. A strong positive correlation between the age decade and the incidence of DISH was noted (r = 0.853, p = 0.007). DISH patients had higher incidences of OLF (22.5%) and OPLL (37.5%). The most common location of DISH was the middle thoracic spine (90.0%) followed by the lower thoracic spine (87.5%). There was one case of DISH involving only the cervical spine. CONCLUSIONS: The incidence of DISH diagnosed by CT was higher than we expected. Whole spine CT can be a valuable modality to evaluate the location of DISH in the cervical and lumbar spine and the comorbidity rates of OLF and OPLL.

The Meniscofemoral Ligament Mimicking a Lateral Meniscus Tear

A 58-year-old male patient who had developed left knee pain with a history of trauma was referred to our hospital. Physical examination and further examination by magnetic resonance imaging revealed results that closely resemble a horizontal tear of the lateral meniscus and a tear of the medial meniscus. Arthroscopically, we found a cord-like structure originating from the posterior 1/3 portion of the lateral meniscus and passing obliquely toward the medial femoral condyle in front of the posterior cruciate ligament without a tear of the lateral meniscus. In this report, we describe a rare case of anterior meniscofemoral ligament that was clearly seen on arthroscopy and mimicked a meniscal tear, which is also known as a pseudo-tear of the meniscus.

Migration and invasion of drug-resistant lung adenocarcinoma cells are dependent on mitochondrial activity

A small proportion of cancer cells have stem-cell-like properties, are resistant to standard therapy and are associated with a poor prognosis. The metabolism of such drug-resistant cells differs from that of nearby non-resistant cells. In this study, the metabolism of drug-resistant lung adenocarcinoma cells was investigated. The expression of genes associated with oxidative phosphorylation in the mitochondrial membrane was negatively correlated with the prognosis of lung adenocarcinoma. Because the mitochondrial membrane potential (MMP) reflects the functional status of mitochondria and metastasis is the principal cause of death due to cancer, the relationship between MMP and metastasis was evaluated. Cells with a higher MMP exhibited greater migration and invasion than those with a lower MMP. Cells that survived treatment with cisplatin, a standard chemotherapeutic drug for lung adenocarcinoma, exhibited increased MMP and enhanced migration and invasion compared with parental cells. Consistent with these findings, inhibition of mitochondrial activity significantly impeded the migration and invasion of cisplatin-resistant cells. RNA-sequencing analysis indicated that the expression of mitochondrial complex genes was upregulated in cisplatin-resistant cells. These results suggested that drug-resistant cells have a greater MMP and that inhibition of mitochondrial activity could be used to prevent metastasis of drug-resistant lung adenocarcinoma cells.

Osteomyelitis Resulting from Chronic Septic Olecranon Bursitis: Report of Two Cases

We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.

Double-Layered Medial Meniscus / 대한정형외과학회잡지

We report on the case of double-layered medial meniscus, which was overlying anterior to mid portion of the medial meniscus. The upper accessory meniscus was connected to the anterior portion of the normal medial meniscus. And its periphery was connected to the joint capsule. The posterior portion of the upper accessory meniscus was connected to the joint capsule. This case demonstrates an interesting and rare anatomical abnormality of the medial meniscus. We report on the case with a review of the literature.

Osteomyelitis Resulting from Chronic Septic Olecranon Bursitis: Report of Two Cases

We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.

Calcaneal Insufficiency Avulsion Fracture in a Well-Controlled Type 2 Diabetic Patient: A Case Report / 대한족부족관절학회지

The calcaneal insufficiency avulsion fracture usually occurs in an area of fused apophysis in adults without significant history of trauma or overuse activities. It is an uncommon injury which has been described in patients with complicated diabetes, Charcot neuroarthropathy, amyloidosis with neuropathy, severe osteoporosis, and other conditions. Discussion of the issue of fracture location is still not sufficient. We report on a case of a 50-year-old male who experienced a non-traumatic diabetic calcaneal insufficiency fracture. Intraoperatively, a biopsy specimen was obtained from the exposed fracture site for histological study. We assume that the calcaneal fused apophyseal line is the weak point of failure due to various incomplete mixtures of trabecular bone, woven bone, and cartilaginous tissues, and may fail when repeated tensile stress is imposed.

The Stability Score of the Intramedullary Nailed Intertrochanteric Fractures: Stability of Nailed Fracture and Postoperative Patient Mobilization

BACKGROUND: Intertrochanteric fractures of the femur are the most common type of fracture, and are an increasing occurrence due to the aging of the population. The objectives of our study are to predict the fate of intertrochanteric fractures treated with intramedullary hip nails by assessing the postoperative fracture stability utilizing the newly developed scoring system, and to help rehabilitate these patients. METHODS: Eighty-two patients with intertrochanteric fractures that were treated with intramedullary hip nails between December, 2004 and January, 2011 were subjected to this study. The patients who could be followed for a minimum of one year postoperatively were enrolled. The immediate postoperative conditions were determined by radiograms: reduction status (3 parameters/4 points: contact accuracy of posteromedial cortex, severity of angulation, and distraction), fixation status (3 parameters/3 points: tip-apex distance, location of tip of the lag screw, entry point of the intramedullary nail), and fracture type (1 parameter/1 point: stable or unstable type by the Kyle's classification). Postoperative reduction loss and fixation failure were checked by radiograms taken at a minimum 3 months postoperative. RESULTS: Reduction loss and fixation failure were observed in 14 consecutive patients (17%). The fixation failure rate was 100% (2 patients) in score 1, 60% (3 out of the 5 patients) in score 2, 39% (3 out of the 8 patients) in score 3, and 50% (4 out of the 8 patients) in score 4 groups. There were fixation failures only in 1 out of 13 patients with score 5, and in 1 out of 18 patients with score 6. There was no fixation failure in 17 patients with score 7 and 11 patients with score 8. CONCLUSIONS: Maintenance of the fracture reduction by the stable fixation in the patient scores over 5 could be predicted by the postoperative radiograms.

Preoperative Voice Parameters Affect the Postoperative Speech Intelligibility in Patients with Cochlear Implantation

OBJECTIVES: Verbal communication depends on a good function of voice and speech organs. Some of the voice characteristics of deaf people differ considerably from those of speakers with normal hearing. After cochlear implantation (CI), auditory control of voice production is possible and the quality of the voice is improved. CI improves quality of voice, speech and hearing with deafness. The aim of our study was to investigate the relationship between acoustic analysis before CI and the speech intelligibility before and after CI. METHODS: Twelve prelingually deafened children implanted unilaterally at the age of 3.4-9 years were included in the study. For all of the children an acoustic analysis of the Slovene vowel 'a' was performed before CI. The fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR) were studied before the implantation. For all of the children the speech intelligibility was performed before and 12 months after CI. Preoperative hearing was divided on existing residual hearing. The results of the acoustic analyses and speech intelligibility before and after CI were compared for preoperative hearing. The results of the speech intelligibility were compared for the age of operation and preoperative acoustic analysis (F0, jitter, shimmer, NHR). RESULTS: Preoperative hearing had no influence on preoperative voice analysis. The children with residual hearing had a high grade of speech intelligibility before and after CI. The preoperative shimmer had positive correlation with postoperative 12 month speech intelligibility (r=0.618, P=0.032). The preoperative jitter had positive correlation with postoperative 12 month speech intelligibility, but was not statistically significant (r=0.479, P=0.116). CONCLUSION: Shimmer on preoperative voice analyses had influence on speech intelligibility after CI.

Diagnosis and Therapy for Dysphonia in the Professional Voice User / 대한이비인후과학회지

Characteristics of voice problems occurring with professional voice users are not too different from those with general public. However, they react sensitively to relatively subtle changes of voice and have strong demands for their treatments as well. Consequently, treatments for the professional voice users should be implemented in the form of team approach consisting of not only otolaryngologists with plenty of treatment experience and sufficient knowledge but also speech-language pathologist, vocal coach. While treating professional voice users is burdensome and a challenging problem even to otolaryngologists rich in experience, knowledge and experience obtained through treating them will be much help for voice treatments of other general public. In this article, the authors have reviewed approaches and treatment directions for voice problems occurring with professional voice users.

Chronic Osteomyelitis of the Lumbar Transverse Process

Pyogenic spondylitis involving only the posterior element of a vertebra is rare. To the best of our knowledge, there have been no reports of osteomyelitis of the transverse process. We report here on a 45-year-old male with a one month history of swelling associated with lower back pain. The magnetic resonance imaging showed a paraspinal soft tissue mass, and computed tomography revealed a fine osteolytic lesion in the right transverse process of the 5th lumbar spine, and this was all consistent with chronic osteomyelitis. A mixed staphylococcal infection was identified. Open drainage, resection of the transverse process and intravenous injection of anti-staphylococcal antibiotics resolved the back pain and reduced the erythrocyte sedimentation rate to normal. Pyogenic osteomyelitis of the transverse process is extremely rare, which can cause a misdiagnosis or a delayed diagnosis. Careful consideration of this disease is needed when evaluating patients who complain of back pain.

Synoivial Chondromatosis of the Ankle Joint and Flexor Hallucis Longus Tendon Sheath / 대한족부족관절학회지

Synovial chondromatosis is a benign lesion forming multiple round cartilagenous nodules or osseous loose bodies in joint cavity. Predilection sites are known as knee, hip and elbow joints. However, the involvement of ankle joint was rarely reported in the literature. Moreover, extraarticular chondromatosis in synovial sheath or bursa of extremities is extremely rare. We present a case of synovial chondromatosis of the left ankle joint and flexor hallucis longus tendon sheath.

Hemiarthroplasty Using a Modular Hip Segment in a Patient with a Long Stem Total Knee Prosthesis

Femoral neck fractures frequently occur in elderly patients and the treatment strategies for this are well documented. Revision knee arthroplasty using a long intra-medullary stem has recently been increasingly used for treating complications such as infection, aseptic loosening or instability. The current case had a femoral neck fracture with a well-fixed, long stem knee prosthesis, which reached to near the lesser trochanter of the femur. The authors performed the surgery using impaction of the modular hip segment; its inner diameter was fit to the outer diameter of the femoral stem of the knee prosthesis. At two years postoperative follow-up, the result was excellent without loosening or osteolysis.