Isolated Symptomatic Scapho-Lunate Coalition without Accompanying Anomalies / 대한정형외과학회잡지

A carpal coalition that indicates the fusion of two carpal bones resulting from the failure of differentiation is a rare condition compared to the tarsal coalition. The most common carpal coalition is the luno-triquetral coalition, followed by the capitate-hamate coalition. Most of these coalitions are usually asymptomatic. Thus far, only a few cases of a coalition between the scaphoid and lunate with accompanied anomalies in the ipsilateral hand, such as accessory carpal bone or ray deficiency, have been reported. We present, for the first time, a case of a symptomatic isolated scapho-lunate coalition without any accompanying anomalies.

Non-osseous Coalition of the Third Metatarsal-Lateral Cuneiform Joint: A Case Report / 대한족부족관절학회지

This paper reports a rare case of the symptomatic third metatarsal (MT3) - lateral cuneiform (LC) in a 55-year-old male who presented with complaints of severe intermittent pain in his right foot. Plain radiographs and computed tomography scans revealed sclerosis and irregularity at this joint. The intraoperative findings demonstrated a fibrocartilaginous coalition. The pain had improved one year after removing the MT3-LC joint by en bloc and arthrodesis.

A Study on the Foot and Ankle Disease of Shelter-based Homeless People / 대한족부족관절학회지

PURPOSE: Foot and ankle disease (FAD) is a frequent cause of morbidity among the homeless population. Various conditions, exacerbated by malnutrition, poor lifestyle habits, psychiatric disorders, physical injuries, poor hygiene, and limited access to healthcare, have been described in this population. The purpose of this study was to investigate the cognition and management status of FAD in shelter-based homeless people. MATERIALS AND METHODS: Fifty-two male and twenty-five female volunteer homeless individuals were recruited from two homeless shelters. Each person completed a questionnaire assessing any presence of pain, pain management, as well as foot and ankle care status. A foot and ankle surgeon examined the physical status of the individual's foot and ankle, including tenderness and instability. A radiologic evaluation was done for 18 male and 11 female homeless people who agreed to participate in this test for the existence osteophyte or joint space narrowing representing osteoarthritis and some reference angles for hallux valgus, flatfoot and cavus foot. RESULTS: Homeless people had higher prevalence of body mass index, diabetes, and smoking than the general population. The most prevalent infectious disease was fungal infection (male 78%, female 68%), with a low compliance of management for FAD. CONCLUSION: Although most of shelter-based homeless people showed an acceptable foot and ankle management status, the potential risk for FAD development and exacerbation of mild FAD was high.

Surgical Results of the Cephalomedullary Nail for the Femoral Intertrochanteric Fracture: Comparison between Non-experienced Surgeons and Experienced Surgeon / 대한고관절학회지

PURPOSE: Cephalomedullary nail (CM nail) in the treatment of femoral intertrochanteric fractures is in the lime light in recent years. The purpose of this study is to compare surgical outcomes between experienced surgeon and non-experienced surgeons in respect of CM nail for femoral intertrochanteric fractures. MATERIALS AND METHODS: The 129 patients underwent CM nail for femoral intertrochanteric fracture more than six months of follow-up from April 2011 to March 2014 in Seoul Medical Center (Seoul, Korea) were participated in this study. For this study, group A consisted of experienced surgeons who performed more than 500 times of CM nail, and group B consisted of non-experienced surgeons who performed less than 50 times of CM nail. Clinical and radiologic outcomes, complications and the need for reoperation between both groups were compared in the study. RESULTS: According to clinical result, both the mean operation time and transfusion volume were significantly longer and greater in group B (P<0.05). In the radiologic outcomes, adequacy of reduction, tip-apex distance and numbers of case placed in the Cleveland zones 5, 6 and 8; there was no statistical difference between both groups. Moreover, rate of complication and reoperation had same results as radiologic outcomes. CONCLUSION: There was no significant difference with statistical data in complications from CM nail for femoral intertrochanteric fractures between experienced surgeon and non-experienced surgeon. Although the operation time and transfusion volume were significantly longer and greater in the case of operation by non-experienced surgeon, satisfactory performance was seen in the complications and the need for reoperation.

Atypical Tuberculous Spondylitis: A Report of Two Cases

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe atypical patterns of tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Few reports of tuberculous spondylitis have discussed atypical cases, which resulted in a poor prognosis due to the delay in early diagnosis and proper treatment. MATERIALS AND METHODS: A 74-year-old female underwent an incision and drainage, and posterior decompression and fusion (PDF) due to tuberculous epidural abscess after vertebroplasty of a compression fracture at T12. A 52-year-old female underwent interbody fusion and posterior lateral fusion (PLF) because of aggravation of an abscess and neurologic symptoms following non-invasive intervention to treat atypical tuberculous spondylitis. RESULTS: Clinical symptoms and serological tests of the patients were improved at postoperative 6 months. CONCLUSIONS: When a patient presents with focal bony or soft tissue abnormality on an image study, the possibility of non-typical tuberculous spondylitis has to be considered when infective spondylitis or a tumor is detected. Moreover, an invasive diagnosis tool such as biopsy will be needed for proper management.

Giant Intramuscular Lipoma in the Back after a Blunt Trauma: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of a giant intramuscular lipoma after a blunt trauma. SUMMARY OF LITERATURE REVIEW: Lipomas are the most frequent benign tumor of the mesenchymal tissue. Although the etiopathogenesis is not complete understood yet, it is known that lipoma develope with a 1% rate after traumas in the related localizations. Traumata induce hematoma and initiates inflammatory reactions in fatty tissue and can trigger the development of lipoma. MATERIALS AND METHODS: 2 years after a blunt trauma a 56years male patient developed a back mass. A massive lipoma was confirmed clinical and radiological. RESULTS: A total excision was performed and the result was histopathologic confirmed. CONCLUSIONS: Patients who develop hematoma after a trauma need a close lipoma progress observation which decrease the invasive treatment of post-trauma hematoma.

Dysphagia Caused by Osteochondroma of the Cervical Vertebral Body: A Case Report / 대한골관절종양학회지

A 56 year-old female presented with dysphagia 8 weeks ago and newly developed dysphonia 2 weeks ago. The radiology study and swallowing difficulty evaluation study revealed the esophagus and the posterior wall of the laryngopharynx to be severely compressed by the mass of the anterior 4th and 5th vertebral body of cervical spine. En bloc excisional biopsy of the bony mass was performed, which completely resolved the clinical symptoms. We report a rare case of osteochondroma occurring at the anterior portion of cervical spine leading to dysphasia and dysphonia with a review of relevant literature.

Synchronous Development of Spinal Cord Tumor: Meningioma and Schwannoma: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of thoracic spinal meningioma and lumbar spinal schwannoma found in one patient. SUMMARY OF LITERATURE REVIEW: patients with different types of spinal cord tumor, specifically meningioma and schwannoma, are rare in medical literature. MATERIALS AND METHODS: A 66 year-old female presented with complaints of walking difficulty. She had masses on the thoracic and lumbar spine and underwent open excision and biopsy. RESULTS: Three months after operation, the patient could walk independently and no recurrence was found at 1-year follow up. CONCLUSIONS: Thoracic spinal meningioma and lumbar spinal schwannoma occurring in one individual were treated successfully by operative management.

Ganglion Cyst in Acetabular Fossa of the Hip Joint: Case Report

Ganglions commonly occur on the hand, wrist, knee, ankle and foot, with occasional development around the hip joint. Ganglion in the acetabular fossa is rare. We present a case of a ganglion in the acetabular fossa of the hip with treatment.

Primary Cementless Total Hip Arthroplasty with a Sandwich Type in Ceramic-Ceramic Articulation (Minimum 10-Year Follow up Results)

PURPOSE: To evaluate the minimum 10-year follow up results of primary total hip arthroplasty (THA) performed using a sandwich-type (alumina-polyethylene-titanium) ceramic bearing. MATERIALS AND METHODS: Thirty four patients (40 hips) who underwent a THA with sandwich typed liners from November 1998 to December 2000 were analyzed. Among the 34 patients, 25 were men and nine were women. Mean follow-up was 134 months (range, 120~145 months) and mean patient age at the time of THA was 47.1 years (range, 24~65 years). The clinical results were evaluated using the Harris hip score and level of thigh pain with a limping gait. The radiographic evaluation was done in terms of the endosteal new bone formation, radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: The mean preoperative Harris hip score of 50.2 points (range, 31~87 points) was improved to 90.9 points (range, 75~99 points) at the final follow-up and thigh pain with limping gait in one case. All cases had fixation by bony ingrowth. No radiographically detectable loosening was observed in any hip. Fracture of ceramic liner in one case required change of the polyethylene liner. CONCLUSION: At the minimum 10-year follow up, survival rate as the end-point was favorable. However, fracture of the ceramic is still a major problem. Satisfactory results can be obtained by more precise surgical technique for acerabular inclincation and anteversion, and by improving the quality of the ceramic.

Enchondroma of the Calcaneus: A Case Report / 대한골관절종양학회지

Enchondroma is a benign tumor mainly developed in the hand and uncommon in the foot. Even if it is in the foot, most are in the phalanges and distal metatarsals of the foot. Enchondroma in the calcaneus is very rare. A 44-year-old male suffered from left heel pain for several months, authors treated it with curettage and bone graft, it was histologically confirmed as an enchondroma in the calcaneus. The authors presented a rare case presentation of an enchondroma in the calcaneus with pain.

Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years

PURPOSE: To retrospectively analysis of results of operatively treatment for femoral neck fracture occurred in twenties to thirties. MATERIALS AND METHODS: 20 patients were selected whom we were able to follow up at least 2 years after internal fixation for femoral neck fracture in twenties to thirties from 1998 to 2005. Mean age was 32.2 (21~39) and average follow up period was 26.3 (24~45) months. According to preoperative X-ray, there were 6 cases for Garden classification stage I, 10 for stage II and 4 for stage III, and 7 cases for subcapital fracture, 9 for transcervical fracture, 4 for basicervical fracture. In all cases, operations were performed within 12 hours after the injury. The operations were done after satisfying reduction with the Garden alignment index, with three cannulated screws for internal fixation. Postoperative results were analyzed by clinical symptoms and radiological examinations during follow up periods. RESULTS: In immediately postoperative radiological examination, satisfying anatomical reduction with Garden alignment index was obtained in all cases, and unions were obtained within 4.5 months after the operation (3~6 month). Avascular necrosis of femoral head occurred in 7 cases of all patients (35.0%). The average time of occurrence of avascular necrosis of femoral head after operation was 10.7 months (9~15 months). Avascular necrosis was occutted 5 (31.3%) in fracture without displacement (Garden stage I, II), 2 (50.0%) in fracture with displacement (Garden stage III) and 4 in subcapital fracture, 3 in transcervical fracture. CONCLUSION: The incidence of avascular necrosis of femoral head after the operation for displaced and nondisplaced femoral neck fracture between twenties and forty years was no significant difference.

Multiple Extradural Arachnoid Cyst : A Case Report / 대한척추외과학회지

Multiple extradural arachnoid cysts of the spine are extremely uncommon in children with only a few cases reported. The authors report a case of multiple extradural spinal arachnoid cysts in children with a review of the relevant literature.

Kimura's Disease of the Distal Arm: A Case Report

Kimura's Disease is a very rare, chronic inflammatory disorder with an unknown etiology, and this illness is primarily seen in young Asian males. The typical clinical features consist of painless subcutaneous masses in the head or neck region, and especially in the salivary gland and submandibular region. It is often accompanied with a regional lymphadenopathy, peripheral blood eosinophilia and elevated serum IgE levels. Histologically, it is characterized by prominent germinal centers in the involved lymph nodes, together with eosinophilic infiltration in these lymph nodes. The treatment modalities for this disease are steroid therapy, radiation therapy and surgical excision. Its clinical course is of a benign nature. We report here on a case of a 28 year old man who had a soft tissue mass in his left arm. We excised this mass and the microscopy confirmed that he suffered from Kimura's disease on microscopic examination in his left distal arm.

The Effects of Tourniquet Pressure on the Postoperative Thigh Pain and Blood Loss in Total Knee Arthroplasty

PURPOSE: We wanted to analyze the effects of tourniquet pressure on the postoperative thigh pain and blood loss of patients who undergo total knee arthroplasty. MATERIALS AND METHODS: This prospective randomized study focused on one-hundred sixty-one unilateral total knee arthroplasties that were done with using a tourniquet. The tourniquet pressures were 300 mmHg in group I (seventy-four cases) and 100 mmHg higher than the systolic blood pressure in group II (eighty-seven cases). We analyzed the postoperative thigh pain with using a visual analog scale (VAS), and we assessed the hemoglobin levels and the hematocrits. RESULTS: The incidence of postoperative thigh pain in group II was statistically lower than that of group I. The intensity of the postoperative thigh pain of group II was lower than that of group I at both 6 hours and 72 hours after surgery. There were no statistical differences in blood loss between the two groups. CONCLUSION: Using a tourniquet pressure of 100 mmHg above the systolic blood pressure during total knee arthroplasty can reduce the postoperative thigh pain. When comparing the above technique with a TKA using 300 mmHg of tourniquet pressure, there was no statistically significant difference of the postoperative blood loss.

Breakage of Metal Shell in Total Hip Replacement using CLS Expansion Press-Fit Cup: A Case Report

Acetabular metal shell breakage is very rare after a total hip replacement. We encountered one case of metal shell breakage at approximately 8 years after the total hip replacement arthroplasty using a CLS expansion cup without a trauma history. Breakage of the metal shell was confirmed during revision surgery. We report this rare case with a review of the relevant literature.

Indirect Decompression using Segmental Screw Fixation for Cervical Myelopathy Caused by C1-2 Subluxation: Technical Note / 대한정형외과학회잡지

The main aims of surgery for severe cord compression and myelopathy caused by atlantoaxial subluxation are decompression of the spinal cord and achievement of rigid fixation and fusion. Direct decompression by resecting the bony structures that compress the spinal cord includes transoral decompression and resection of the posterior arch of the atlas. The shortcomings of these procedures are a high complication rate and a relatively low rate of union. Indirect decompression can be performed by a reduction of the subluxation and fixation without bone resection. To the best of our knowledge, there are no domestic reports on the use of indirect decompression for severe cord compression and myelopathy for atlantoaxial subluxation. We report a case of a patient that had atlantoaxial subluxation and severe myelopathy; satisfactory reduction of the subluxation and decompression with an improvement in the myelopathy symptoms was achieved by indirect decompression using segmental screw fixation.

Disability Evaluation in Spinal Fracture / 대한척추외과학회지

No abstract available.

Atlantoaxial Fixation using C2 Subarticular Screws and C1 Lateral Mass Screws : A Technical Report / 대한정형외과학회잡지

Segmental screw fixation is a useful procedure for the surgical treatment of atlantoaxial subluxation. Currently, C1 lateral mass screws and C2 pedicle screws are the standard screws used in this procedure. However, the C2 pedicle screw can cause serious complications such as vertebral artery injury. Recently we suggested a new trajectory for the C2 screw, the subarticular screw, which has a lower probability of vertebral artery injury compared with the pedicle screw, based on a study using 1 mm-sliced CT scan images and simulation software. We report the first case of segmental screw fixation using C2 subarticular screws along with C1 lateral mass screws. The patient had atlantoaxial subluxation and myelopathy and showed satisfactory results after surgery.

Efficacy of the Preventive Abduction Brace in Dementia Patients After Bipolar hemiarthroplasty of the Hip

Purpose: To evaluate the efficacy of the preventive abduction brace in dementia patients after bipolar hemiarthroplasty of the hip. Materials and Method: A review of 30 patients who had dementia prior to bipolar hemiarthroplasty of the hip. 20 females and 10 males were evaluated and their mean age was 80.4 years old (range, 68 to -92 years old). The average MMSE-K in dementia patients was 14.2 (range, 8 to 20). The reasons for the bipolar hemiarthroplasties were femoral neck fractures in all the cases. We analyzed the dislocation rates of those who had preventive abduction braces applied prospectively. Results: The average follow-up period after hemiarthroplasty was 2.2 years. All 30 patients had preventive abduction braces and no dislocations occurred after the bipolar hemiarthroplasties. Conclusion: Hip dislocations were not detected in those patients who preventive abduction braces applied. The present findings suggest that having a preventive abduction brace will definitely reduce the dislocation rate in dementia patients who have difficulties with rehabilitation after their operations.