The Effect of COX-2 Inhibitor on the Expression of MMP-13 during Early Fracture Healing Phase in Rats

PURPOSE: This study investigated the effect of COX-2 inhibitor on the expression of MMP-13 in the healing process of fracture. MATERIAL AND METHODS: Adult Sprague-Dawley rats were divided into two groups of twenty five rats each. Unilateral femoral shaft fractures were created artificially under displacement in all two groups. COX-2 inhibitor was only given to the experimental group from the postoperative day 1. At 2 weeks after fracture the rats were sacrificed and the callus from each group was used for histologic examination and real time RT-PCR for MMP-13 expression. RESULTS: Histologically, proliferation of osteoblasts and formation of osteoid was less abundant in the experimental group. In real time RT-PCR, the mean expression of MMP-13 is 2.84+/-2.50 in the control group compared with 1.16+/-1.05 in the experimental group. CONCLUSION: In the early stage of fracture healing, COX-2 inhibitor suppress the expression of MMP-13.

Long Term Follow up Results of the Operative Treatment of the Acromioclavicular Joint Dislocation with a Wolter Plate

PURPOSE: To evaluate the long-term clinical and radiological results of the operative treatment of the acromioclavicular dislocation with a Wolter plate. MATERIALS AND METHODS: We reviewed clinical and radiological data of twenty patients (mean age: 37 years) who underwent the operative treatment of acromioclavicular joint dislocation using a Wolter plate from September, 1999 to December, 2002 with minimum of five years follow-up (average 6 years 7 months). The clinical outcomes of twenty patients were evaluated by UCLA scoring and radiological results of fifteen patients with available radiograph were evaluated by Zanca view and stress view. RESULTS: The mean UCLA score was mean 33 points (range, 27~35) at final follow up. By clinical evaluation, twelve cases (60%) were excellent, six cases (30%) were good and two cases were poor (10%). By radiological evaluation, eight cases (54%) were excellent (without displacement), five cases (33%) were good (displacement 5 mm). Erosive change in acromioclavicular joint was seen in poor case. CONCLUSION: Wolter plate fixation may be a useful modality for treating acromioclavicular joint dislocation. Great care should be taken to make the hook hole at the appropriate position during operation for long-term prognosis.

Comparative Evaluation of Percutaneous Endoscopic Discectomy and Microdiscectomy Using Tubular Retractor System at L4-5 Level / 대한척추외과학회지

STUDY DESIGN: A prospective, non-randomized study OBJECTIVES: To evaluate the early clinical results of percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy (MD) using a tubular retractor. SUMMARY OF THE LITERATURE REVIEW: There are few reports comparing the clinical results of different minimal invasive surgical procedures for disc herniation. MATERIALS AND METHODS: Out of 41 patients who underwent a discectomy at the L4-5 level, 16 patients (Group I) underwent PELD and 25 patients (Group II) underwent MD. The surgical techniques were based on the patient's selection. The characteristics of the operation(operation time, time for C-arm, amount of removed disc) were compared with the clinical outcomes by evaluating the SLR (straight leg raising test), leg VAS (visual analogue scale), ODI (Oswestry Disability Index), hospital day, changes in disc height. RESULTS: Group I showed a larger amount of disc removed and exposure time for the C-arm than group II (p<0.05). However, the hospital day was shorter in group I than in group II (p<0.05). There were no differences in the leg VAS, ODI, the change in disc height and surgery time between the two groups at the last follow up. One case in group I had a neuropraxia of the L5 root that had recovered fully at postoperative 3months. In group II, there was one case of a postoperative hematoma and 2 cases of a dural tear. CONCLUSION: Although the early clinical outcomes were similar in both groups, group I showed a larger amount of disc removed and more exposure time to radiation but a shorter hospital stay.

Primary Repair in Tears Affecting Two or More Rotator Cuff Tendons

PURPOSE: The current study assessed the factors affecting outcomes of primary repair procedures in tears of multiple rotator cuff tendons. MATERIALS AND METHODS: Among the cases of rotator cuff tears involving two or more tendons receiving operations between 1997 and 2003, The clinical results of 19 cases with more than 2 years follow-up were evaluated by the UCLA score. We evaluated the correlation of trauma, active motion, acromiohumeral distance, tear size, and surface area with the UCLA score using Pearson's linear correlation coefficient (PLCC). RESULTS: UCLA scores increased significantly in all cases, from 9 to 26.1 on average. However, the results were good in 53%, and poor in 47% according to Ellman's criteria. Trauma, active elevation, acromiohumeral distance, and tear size did not correlate with the UCLA score, but the tear surface area was inversely correlated with the score (PLCC=- 0.696). Cases with degeneration of the infraspinatus muscle above Goutallier grade III on MRI showed worse results than cases with less degeneration. CONCLUSION: The clinical results of primary repair of rotator cuff tears involving multiple tendons were satisfactory in 53% of patients. Large tear surface area and severe degeneration of the infraspinatus were poor prognostic factors.

Neurolymphomatosis Involving Sciatic Nerve: A Case Report / 대한정형외과학회잡지

The term "Neurolymphomatosis" includes the infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. A neurolymphomatosis has not been classified as a distinct entity. Hence, its characteristic symptoms are often missed, and oncologists or neurological consultants fail to obtain an accurate diagnoses. We encountered a case of non-Hodgkins lymphoma involving the sciatic nerve, which has never been reported in the orthopedic literature in Korea. We report a case of neurolymphomatosis with a brief review of the literature.

Repair of Osteochondral Defect Using Chitosan-collagen Sponge intheRabbit's Knee / 대한정형외과학회잡지

PURPOSE: To determine the suitability of using a chatoyant-collagen sponge as a scaffold for transplanting a chondrocyte into a full-thickness articular cartilage defect. MATERIALS AND METHODS: The in vitro characterization of a chatoyant-collagen sponge infiltrated with the chondrocyte was combined with an in vivo assessment of the early articular cartilage repair in a rabbit's knee by H&E and MTT staining. These porous chatoyant-collagen sponges were implanted into the osteochondral defects made in the left patellofemoral grooves of 12 rabbits. The osteochondral defects were untreated in the right side and used as controls. The experimental animals were sacrificed 1, 3, 6 and 12 weeks after implantation and the repaired tissue was evaluated by a gross and histological evaluation using the Wakitani score. RESULTS: More primary cells cultured from the articular cartilage of the rabbit's knee were found to attach to and survive within a porous chatoyant-collagen sponge than with a chatoyant sponge. In gross and histological examination, the experimental group showed indications of repair, which appeared similar in color and texture to the surrounding articular cartilage. The Wakitani scoring in the experimental group at 6 (Ave. 10.7) and 12 (Ave. 7.3) weeks were superior to those in the control group at 6 (Ave. 8.7) and 12 (Ave. 3.7) weeks (6 wk: p=0.03, 12 wk: p=0.02). CONCLUSION: Scaffolds composed of porous a chatoyant-collagen sponge enhance the growth of cartilaginous repair and make a milieu for the survival of chondrogenic cells both in vitro and in vivo.

The Effect of Hyaluronic Acid on the Expression of MMP-13 in Healing Process of Bone Defect in Rats / 대한정형외과학회잡지

PURPOSE: Matrix metalloproteinase (MMP)-13 has a degradation effect on type II collagen and is expressed in osteoblastic cells and hypertrophic chondrocytes. However, the role of MMP-13 is not completely understood. This study investigated the effect of exogenous Hyaluronic acid (HA) on the expression of MMP-13 in the healing process of bone defects. MATERIALS AND METHODS: After making a bone defect in the metaphysis of the distal femur in rats, HA was instilled into the defect in the experimental group. In the control group, a bone defect was made but HA was not instilled. Two weeks after the experiment, the rats were sacrificed and the callus that filled the bone defects was obtained. A histological examination and real time reverse transcription polymeric chain reaction (RT-PCR) were performed to investigate the healing response and expression of MMP-13. RESULTS: Histologically, the proliferation of osteoblasts and the formation of osteoid were more active in the experimental group. Nevertheless, the level of MMP-13 expression was significantly lower in the experimental group than in the control group. CONCLUSION: From the results of this study, it appears that exogenous HA inhibits the expression of MMP-13 at the early stage of bone healing.

Mode of Fixation Failures of Dynamic Hip Screw with TSP in the Treatment of Unstable Proximal Femur Fracture: Biomechanical Analysis and a Report of 3 Cases / 대한정형외과학회잡지

There are few reports of the failure mode of a dynamic hip screw with a trochanteric stabilizing plate (TSP) in the treatment of unstable proximal femur fractures. We present 3 cases of fixation failure of a TSP used to treat unstable intertrochanteric fractures. All cases had the same type of failure mode, which represented a fatigue fracture of the distal screw at the junction of a plate and screw. Non-union occurred in 2 cases, and one case was an incidental finding 4 years after union. Biomechanical analysis and SEM (scanning electron micrograph) examination was also performed. Adding TSP to the plate might increase the level of shear stress and slip motion in the distal screw followed by a fatigue fracture. SEM of the surface of the broken screw revealed a multiple cycle and low stress fatigue fracture. Recommendations are made regarding the implant design and surgical technique.

Antibiotic Sensitivity of Pathogenic Bacteria of Osteomyelitis: Trend of recent 5 years, especially on Staphylococcus aureus / 대한정형외과학회잡지

168 patients with osteomyelitis who were admitted and operated in Department of Orthopedic Surgery, Seoul National University Hospital between January in 1972 and December in 1976 ware reviewed and analized. The following results were obtained. 1. 138 strains of bacteria were isolated from 167 pus culture in osteomyelitis, about 82.6% 2. Of these, 112 strains are staphillococcus aureus. (81.2%). 3. Degrees of Sensitivity to antibiotics were as follows: in sensitive order, cephalothin was 99.0%, gentamycin 98.0%, cloxacilnli 94.5%, lincocin 92.0%, kanamycin 86.3%, streptomycin 81.2%, and chloramphenicol 80.6% was resulted, 4. Resistant rate to antibiotics were as follows: in resistant order, penicillin 88.8%, oxytetracycline 79.6%, tetracycline 76.2%, and ampicillin 72.2% was resulted.

Cystic Lesions in Os Calcis / 대한정형외과학회잡지

The authors experienced six patients who were admitted in Department of Orthopedic Surgery at Seoul National University Hospital during the period of March 1966 to February 1976 with cystic lesions in calcaneus by radiographic findings. The following results were obtained. Among the six patients, four were osteomyelitis, one was eosinophilic granuloma and the other was fibromyxoid sarcoma. They were all similar in radiographic findings, but were different each other in pathologic findings. 2. Diagnosis is very difficult only with the patients history, hematologic and radiographic findings and the pathologic findings is the most important in the final confirmative diagnosis from benign cystic lesions to malignant one. 3. We describe about the kinds and points of the differential diagnosis. of the other discases from the reported six cases.

Marfan Syndrome: A Case Report / 대한정형외과학회잡지

Marfan Syndrome is a rare congenital disease characterized by the abnormalities of Sheletal system, eye and cardio-vascular system which was initially desiribed by Marfan in 1896. One case of marfan syndrome was treated at the department of Orthopedic Surgery, College of Medicine, Seoul National University for multiple skeletal deformities. Moderate degree of scoliosis was treated with Milwaukee brace and finger deformities with Z-plasty and full thickness skin graft.

Surgical treatment of the Spine Tuberculosis / 대한정형외과학회잡지

Two hundreds cases of spine tuberculosis were treated surgically for the period of 7 years between 1970 and 1976 at Seoul National University Hospital and following results were obtained. 1. Many patients failed to be treated with conservative method. Spontaneous fusion was found in 10% of 200 cases with long duration of disease. Anterior fusion was performed in 166 cases and posterior fusion was carried out in 34 cases. In those 34 cases, anterior currettage was combined in 7 cases, anterior fusion combined in 19 cases in which 7 cases were performed anterior and posterior fusion at one stage. Posterior fusion alone was carried out only in 8 cases. 2. Anterior fusion is indicated for: a. decompression in cord involvement b. confirmation of diagnosis c. involvement of one joint space in children d. mild to moderate kyphosis in adult 3. Anterior and posterior fusion is indicated in: a. severe kyphosis for solid funsion b. involvement of more than two joint spaces in children to prevent increasing kyphosis c. one stage operation was technically possible and has many advantages 4. Posterior fusion is indicated in: a. poor general condition b. technically difficult cases.

Surgical Treatment of Tennis Elbow / 대한정형외과학회잡지

Five cases of tennis elbow seen during the time period from Jaunary 1983 to January 1985 had operative treatment. Of the five clinical cases, four elbows in three patients were treated with Nirschl and Pettrone operation. This operative technique included exposure of the extensor carpi radialis brevis, excision of the identified lesion, and repair. The following results were obtained. 1. Correct analysis of the patient's emotional stability was essential prior to undertaking surgical procedure for tennis elbow. 2. The results of Nirschl and Pettrone operation were graded as excellent in three elbows and fair in one.

Radiological Study of Spondylolysis in Korean Laborer / 대한정형외과학회잡지

The spondylolysis is a defective ossification in the pars interarticularis of the neural arches without displacement of the vertebral body. The authors analysed 810 lumbar spines of adult Korean laborers on the basis examined to determine the anatomic characteristics of spondylolysis. The following results were obtained. 1. The overall incidence in laborer was 6.8%. 2. The most frequent site of the involvement was the fifth lumbar vertebra. of radiologic study and 3. Spina bifida in spodylolysis was approximately 1.7 times as frequent as is normally expected. 4. Lumbarization in spondylolysis was approximately 5.8 times as frequent as is normally expected. 5. Sacralization was not found in 55 cases of spondylolysis.

The Usefulness of Non-operative Treatment of Distal Radius Fracture in Elderly Patients

PURPOSE: To disclose the correlation between the functional and radiologic results of the treatment of distal radius fracture in elderly patients by non-operative versus operative treatment. MATERIALS AND METHODS: From January 1995 to December 2000, 36 patients, more than 60 years old with fractures of distal radius were treated and followed up for more than one year. We classified them using the Fernandez classification and evaluated functional and radiological results according to the subjective point system of Cole & Obletz and objective evaluation by Scheck. RESULTS: In functional result, excellent to good results were obtained in 12 cases (71%) in the non-operative group and 14 cases (74%) in the operative group, there were no evidence of statistical difference between two groups (p>0.05). In radiographic results, mean radial inclination, loss of radial length and volar tilt were 13degree, 12.3 mm, 7.2degrees in the non-operative goup and 5.2degrees, 5.1 mm, 3.3degrees in the operative group on last follw-up radiographs, there were evidence of statistical difference between two groups (p<0.05). CONCLUSION: Operative treatment is radiographically better result in distal radius of elderly patients but functional satisfaction is not significantly related with radiographic result. When we decide the treatment of elderly patients, non-operative treatment can be useful method, considering with patient's age and activity status.

Operative treatment of the patellofemoral malalignemnt syndrome: Distal realignment(modified maquet op)

No abstract available.

Bankart Procedure through Lateral Capsulotomy in Traumatic Anterior Instability of the Shoulder / 대한정형외과학회잡지

PURPOSE: To determine the outcome of the Bankart procedure through lateral capsulotomy approach by objective and subjective evalua-tion in traumatic anterior instability of the shoulder. MATERIALS AND METHODS: Thirty-seven patients with traumatic anterior instability, who underwent the Bankart procedure through lateral capsulotomy, were investigated with an average follow-up of 23 months. Every effort was made to maximize the range of motion by repairing the Bankart lesion and closing the capsulotomy to allow as much external rotation as feasible. In 18 cases, superior capsular shift (13) or Neer 's capsular shift (5) were combined to deal with capsular redundancy. Outcome was assessed using range of motion, Pennsylvania Shoulder Function Score, pain, residual symptom and satisfaction. RESULTS: Recurrence of instability was not encountered. Function score increased significantly and all patients were satisfied with the results. However, 8 patients (22%) complained of feeling apprehensive about sports activities. CONCLUSION: The Bankart procedure through lateral capsulotomy appears to minimize unwanted external rotation limitations and enable capsular redundancy to be dealt with adequately.

A clinical study for the multiple skeletal injuries of the patients with depressed level of consciousness / 대한정형외과학회잡지

No abstract available.

Dynamic Instability of Lumbar Spine without Spondylolisthesis / 대한정형외과학회잡지

Although flexion and extension lateral views were known the most preferable diagnostic method of instability of lumbar spine, many authors had reported that there were some findings which suggested instability of lumbar spine in plain films. This study was undertaken to analyze clinical aspect and plain film findings of dynamic instability of lumbar spine and to suggest indication of dynamic X-ray to find out the causes of low back pain. A retrospective analsysis was perfomed on 30 patients who had dynamic instability of lumbar spine without spondylolithesis between January 1996 and March 1997. They were reviewed in sex, age, symptom duration and instability level, etiologic factor etc. And then their plain films and flexion and extension lateral views were reviewed. Following results were obtained. Dynamic instability was more frequent in women than in man and occured younger age in women. The mean symptom duration was 5 years and 10 months and simple degenerative change was the most common etiologic factor. In plain films, traction spur and dome shaped end plate were common findings and the L4-5 intervertebral disc space was most frequently involved(23/30 cases). Translation was occured more frequently in flexion position(23/30 cases). The mean dynamic translation distance was 4.7mm, the mean sagittal rotational angle was 16.2degreesand the mean angular displacement was 3.2degrees. Conclusively, among the diagnostic criteria af instability of lumbar spine, translational distance was the most common finding. Flexion and extension lateral views have diagnostic value in patients who complaint back pain from unknown origin, in old age, for prolonged symptom duration, or those who have findings associated with instability in plain films.