Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoidsplitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures

BACKGROUND: This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures. METHODS: From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >5° loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated. RESULTS: In all cases, complete union was achieved. The ASES and VAS scores were improved to 85.4 ± 2.1 and 3.2 ± 1.3, respectively. Twelve patients (75.0%) had greater than a 5° change in NSA; the average NSA change was 3.8°. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a < 100° active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit. CONCLUSIONS: Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.

Association between social economic status and asthma in Korean children: An analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010–2012)

PURPOSE: Asthma is one of the most common chronic conditions, and its prevalence has been increasing in recent decades. Social economic status is a well-known risk factor for asthma. This study was performed to investigate the relationship between social economic status and asthma in Korean children. METHODS: Data were acquired from 4,397 children, aged under 18 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 to 2012. The presence of asthma was based on self-reported, physician-diagnosed asthma in the Health Interview Surveys. RESULTS: The prevalence of pediatric asthma was 5.3%, while the prevalence of atopic dermatitis in children was 14.0%. In univariate analysis, asthmatic children tended to be male, to be older, to have asthmatic mothers, to suffer from atopic dermatitis and to live in urban areas (P < 0.05). The parents' marital status, employment status, education level, and the number of household members were not associated with pediatric asthma. In logistic regression analysis, older age, male sex, maternal asthma, pediatric atopic dermatitis, and urban residence were associated with a higher prevalence of childhood asthma (P < 0.01). CONCLUSION: Socioeconomic status was not an important risk factor for asthma in Korean children in our study. It is conceivable that socioeconomic factor could affect the asthma prevalence in a different manner in each country. Further studies are warranted to explore mechanisms responsible for the association between socioeconomic status and asthma in children.

Superior Labrum Anterior to Posterior (SLAP) Lesion with Glenohumeral Instability / 대한정형외과학회잡지

Role of the superior labrum-biceps complex for the glenohumeral stability is still unclear. Nevertheless, isolated superior labrum anterior to posterior (SLAP) lesion can cause glenohumeral instability in young patient (especially in throwing athletes) and SLAP lesion are a well-known pathology entity in acute or chronic glenohumeral dislocation. Ten types of SLAP lesion have been classified by arthroscopic examination, among them type II and type IV through X SLAP can disturb glenohumeral stability by disrupting the anchoring of biceps. Arthroscopic repair of labrum is the most preferred method for SLAP lesion with glenohumeral instability in younger patient. Surgical treatment, if necessary, should address all aspects of the labral anatomy so that all the roles of the labrum in shoulder stability must be restored. In terms of restoration for glenohumeral instability, the good clinical results have been reported after arthroscopic repair of a SLAP with Bankart lesion. But, it is still a work in progress for long term clinical follow-up and understanding about relationship between SLAP lesion and glenohumeral instability.

Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

A Case of Ankyloblepharon-Ectodermal Defect-Cleft Lip and/or Palate (AEC) Syndrome with Missense Mutation in TP63 1657(th)

Ankyloblepharon-ectodermal defects-cleft lip and/or palate (AEC) syndrome, also known as Hay-Wells syndrome, is a rare autosomal dominant disorder characterized by congenital ectodermal dysplasia. It is caused by mutations in p63 gene. Six isoforms are generated from the TP63 gene mutation and the main isoform expressed in postnatal skin is Np63a, which functions as a key regulator of epidermal integrity. We have experienced a 1-day-old female baby with skin erosions, ankyloblepharosis, and cleft palate that require treatment for skin care and feeding difficulties. Missense mutation in TP63 1657(th) T → A transition was found in the genetic test performed in the patient, and this genotype has not been reported in a previously variant. The patient was found dead at 91days of birth and the cause of death was estimated by aspiration.

Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

Demographic and Clinical Characteristics of Primary Frozen Shoulder in a Korean Population: A Retrospective Analysis of 1,373 Cases

BACKGROUND: The aim of this study was to investigate the demographic and clinical characteristics of patients with primary frozen shoulder in a Korean population. METHODS: A total of 1,373 patients whose shoulders were diagnosed with primary frozen shoulder across 11 resident-training hospitals were reviewed retrospectively. Various demographic characteristics and clinical characteristics according to gender and presence of diabetes were evaluated. RESULTS: The average age of patients was 55.4 years. Gender proportion was 58.3% females and 41.7% males. The frozen shoulder involved the non-dominant arm in 60.7% of patients and the bilateral arms in 17.6% of patients. The average duration of symptoms was 8.9 months, and 51.3% of patients had experienced nocturnal pain. Comorbidities associated with frozen shoulder in our sample of patients included diabetes (18.7%), cardiovascular diseases (17.7%), thyroid diseases (5.4%), and cerebrovascular diseases (3.6%). The diabetic group was correlated with the following demographic and clinical characteristics: old age, involvement of the dominant arm, nocturnal pain, long duration of symptoms, and no history of trauma. Further, we found that, in males, having a frozen shoulder was significantly correlated with a history of trauma; in females, having a frozen shoulder was significantly correlated with having thyroid diseases. CONCLUSIONS: These demographic data of primary frozen shoulder in the Korean population were consistent with those of previously reported epidemiologic studies. Primary frozen shoulder with diabetes was correlated with old age, bilateral involvement, long duration of symptoms, and nocturnal pain.

Demographic and Clinical Characteristics of Primary Frozen Shoulder in a Korean Population: A Retrospective Analysis of 1,373 Cases

BACKGROUND: The aim of this study was to investigate the demographic and clinical characteristics of patients with primary frozen shoulder in a Korean population. METHODS: A total of 1,373 patients whose shoulders were diagnosed with primary frozen shoulder across 11 resident-training hospitals were reviewed retrospectively. Various demographic characteristics and clinical characteristics according to gender and presence of diabetes were evaluated. RESULTS: The average age of patients was 55.4 years. Gender proportion was 58.3% females and 41.7% males. The frozen shoulder involved the non-dominant arm in 60.7% of patients and the bilateral arms in 17.6% of patients. The average duration of symptoms was 8.9 months, and 51.3% of patients had experienced nocturnal pain. Comorbidities associated with frozen shoulder in our sample of patients included diabetes (18.7%), cardiovascular diseases (17.7%), thyroid diseases (5.4%), and cerebrovascular diseases (3.6%). The diabetic group was correlated with the following demographic and clinical characteristics: old age, involvement of the dominant arm, nocturnal pain, long duration of symptoms, and no history of trauma. Further, we found that, in males, having a frozen shoulder was significantly correlated with a history of trauma; in females, having a frozen shoulder was significantly correlated with having thyroid diseases. CONCLUSIONS: These demographic data of primary frozen shoulder in the Korean population were consistent with those of previously reported epidemiologic studies. Primary frozen shoulder with diabetes was correlated with old age, bilateral involvement, long duration of symptoms, and nocturnal pain.

Treatment of Periprosthetic Femoral Fractures Following Total Knee Arthroplasty

PURPOSE: The purpose of this study is to compare the treatment results of fracture fixations by using two minimal invasive techniques for patients with periprosthetic femoral fractures following total knee arthroplasty. MATERIALS AND METHODS: We reviewed 36 patients (5 males, 31 females) of periprosthetic femoral fractures whom were treated surgically between January 2005 and January 2011. Mean patient age was 68.9 years (range, 43 to 81 years) old and the follow-up period averaged 41 months (range, 18 to 72 months). Nineteen patients were treated with minimal invasive locking plate fixations (group I) and 17 patients with retrograde intramedullary nailing (group II). Clinical and radiological outcomes in each group were comparatively analyzed. RESULTS: Successful bone unions occurred in all patients and the mean time to bone union was 3.7 months in group I and 4.2 months in group II. There were no statistical differences between the two groups according to mean operative time and mean intraoperative blood loss. There were also no statistical differences between two groups according to clinical outcomes but the valgus deformity was apparent in group II and radiological outcomes revealed significant differences between the two groups. CONCLUSION: For the treatment of periprosthetic femoral fractures after total knee arthroplasty, two minimal invasive techniques have shown good clinical results. However, the minimal invasive plate fixation showed better results in the radiological alignments.

Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur / 대한고관절학회지

PURPOSE: The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail. MATERIALS AND METHODS: From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed. RESULTS: In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw. CONCLUSION: Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.

Corelation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot / 대한족부족관절학회지

PURPOSE: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. MATERIALS AND METHODS: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. RESULTS: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. CONCLUSION: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old / 대한고관절학회지

PURPOSE: This study examined therelationship between the clinical outcome and risk factors of intertrochanteric femoral fractures in patients over 65 years old. MATERIALS AND METHODS: From January 2000 to March 2012, three hundred and twenty one patients older than 65 years, who underwent surgeryfor intertrochanteric femoral fractures, were evaluated. The following parameters wereanalyzed: the patient risk factors, such as age, sex, smoking, drinking history, cardiovascular disease, cerebrovascular disease and delayed days to surgery; admission day of the week; anesthetic method; operation time by perioperative care related to clinical outcome including postoperative mortality; and complications. RESULTS: An analysis of the risk factors revealedfemale patients to have a 13% higher mortality (P=0.043). Aduration of surgerylonger than 3 hours was associated with a 29.1% and 20.8% higher mortality and complication rate, respectively (P<0.001, P=0.027). Asurgical delay of four days or more after admission wasassociated with a 20.1% and 18.8% higher mortality risk and complication rate, respectively (P<0.001, P<0.001). Smoking, drinking history, underlying disease, anesthetic method, and operation time had no significant effect on the outcome. CONCLUSION: In addition to recognizing the importance of patient-related risk factors, modifying the operative factors, such as reducing surgical delays and method of anesthesia, can reduce the mortality and postoperative complications of intertrochanteric femoral fractures.

Prognostic value of serum CA-125 in patients with advanced epithelial ovarian cancer followed by complete remission after adjuvant chemotherapy

OBJECTIVE: The aim of this study was to evaluate the prognostic value of serum CA-125 in advanced epithelial ovarian cancer with complete remission after primary adjuvant chemotherapy. METHODS: We reviewed the records of 120 patients with advanced epithelial ovarian cancer who underwent primary surgery followed by adjuvant therapy at our institution between January 1998 and December 2005. RESULTS: The median progression free survival was 21.6 months and 12.5 months in patients with nadir CA-125 levels 35 U/mL, respectively, after first cycle of adjuvant chemotherapy. CONCLUSION: Serum CA-125 level after the first cycle of adjuvant chemotherapy is a strong independent prognostic factor for advanced epithelial ovarian cancer with complete response.

Sciatic Nerve Compression Secondary Due to Ischial Tuberosity Osteochondroma

Ostehochondroma is a common primary benign bone tumor, and is mostly asymptomatic. Symptoms are related complications due to compression on the adjacent nerve. The sciatic nerve compression secondary to osteochondroma has rarely been reported. A 21 year-old man had right hip pain radiated to the right lower extremity. In a radiological evaluation, bone mass was detected at the right ischial tuberosity. After dynamic ultrasonography, we excised the bone mass and decompressed the sciatic nerve. The bone mass was diagnosed as osteochondroma by pathologic evaluation. We report the case with a review of the literature.

A Case of Aggressive Digital Papillary Adenoma of the Fifth Finger / 대한정형외과학회잡지

Aggressive digital papillary adenoma is a rare neoplasm of eccrine sweat gland origin. We report a case of aggressive digital papillary adenoma of the fifth finger, together with a literature review.

Radiologic Changes after Shelf Acetabuloplasty on Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To evaluate the radiologic changes in the acetabulum after shelf acetabuloplasty in Legg-Calve-Perthes (LCP) disease. MATERIALS AND METHODS: From January 2003 to March 2006, 13 patients with unilateral LCP disease were treated by shelf acetabuloplasty. The mean follow-up period was 51 months. Pre-operative, post-operative, and annual follow-up radiographs were obtained to assess the changes in lateral subluxation ratio (LSR), acetabular head quotient (AHQ), acetabular depth index (ADI), acetabular height index (AHI), total depth index (TDI) and width of bone graft. RESULTS: The mean LSR decreased from 1.78+/-0.32 pre-operatively to 1.48+/-0.15 post-operatively, and remained 1.33+/-0.21 at last follow-up (p=0.011). The mean AHQ increased from 81.0+/-7.5% pre-operatively to 120.0+/-15.1% post-operatively, and remained 109.7+/-13.8% at final follow-up (p=0.001); the post-operative TDI that included the width of bone graft, decreased at follow-up. Furthermore, the mean ADI and AHI changed from 0.97+/-0.12, 1.13+/-0.07 pre-operatively to 1.04+/-0.02, 1.15+/-0.09 post-operatively; last follow-up results were 1.03+/-0.05 and 1.16+/-0.07, respectively. Between the 2 indices, post-operative ADI for 2 years was statistically significant (p<0.05). Also, the width of bone graft decreased from 24.4+/-3.6 mm post-operatively to 15.0+/-4.1 mm at final follow up (p<0.05). CONCLUSION: The indices LSR and AHQ confirmed that the shelf acetabuloplasty could preserve the femoral head containment. The growth of the acetabulum after shelf acetabuloplasty was stimulated by increasing the depth of acetabulum in comparison with height for postoperative 2 years. Further follow-up is needed until skeletal maturity.

Gender differences in paclitaxel-induced neuropathic pain behavior and analgesic response in rats / 대한마취과학회지

BACKGROUND: Females show greater sensitivity than males to several modalities of experimental pain. However, the gender differences in paclitaxel-induced neuropathic pain have not been studied. The current study examined the gender differences in neuropathic pain behavior and the effect of analgesics in a paclitaxel-induced neuropathic pain model in rats. METHODS: Neuropathic pain was induced by intraperitoneal injection of paclitaxel (2 mg/kg) on 4 alternate days in Sprague-Dawley rats of both genders. Mechanical allodynia was measured using a von Frey filament. The gender differences in analgesic responses were determined after administration of morphine (2 or 5 mg/kg), ketamine (2 or 5 mg/kg), or combined morphine (2 mg/kg) and ketamine (2 mg/kg). RESULTS: Paclitaxel induced mechanical allodynia, which began to manifest on day 4, peaked within 10 days, and plateaued for at least 2 months after the first paclitaxel injection. No gender difference in the manifestation of mechanical allodynia was observed. A 2 mg/kg dose of ketamine increased the mechanical threshold only in males. The 5 mg/kg dose of ketamine significantly increased the mechanical threshold in both genders. Morphine (2 and 5 mg/kg) dose-dependently increased the mechanical thresholds in both genders. The 2 mg/kg dose of ketamine enhanced the antinociceptive effect of 2 mg/kg morphine only in females. CONCLUSIONS: No gender difference in paclitaxel-induced neuropathic pain or analgesic response to ketamine or morphine was observed in Sprague-Dawley rats. Low dose ketamine enhanced the analgesic effect of morphine on paclitaxel-induced mechanical allodynia but only in female rats.

Treatment of Enchondromas of the Hand with Curettage, Autoiliac Bone Graft and Contact Cryotherapy

PURPOSE: The purpose of this study was to evaluate the effectiveness of contact cryotherapy as an adjuvant therapy after intralesional curettage and autoiliac bone graft of enchondromas of the hand. MATERIALS AND METHODS: Thirty seven cases in 30 patients (17 males, 13 females) with enchondromas of the hand who underwent curettage, contact cryotherapy and autoiliac bone graft between July 2004 and March 2010 were reviewed with a minimum follow-up of 1 year. Radiologic evaluations were done periodically. Mean follow-up period was 26 months (range: 12-54 months). The radiologic results were evaluated according to the degree of new bone formation based on the Tordai's criteria. RESULTS: According to the Tordai's criteria, 33 cases (89%) were group I, and 4 cases (11%) were group II. There was no case of group III, which meant recurrence. Bone healing was achieved at average 4.8 months (range: 4-5.3 months) after the operation. There was no cryotherapy-related complication such as pathologic fracture, bone necrosis and skin necrosis during the follow-up periods. CONCLUSION: We suggest that the contact cryotherapy can be used as an effective adjuvant therapy for treatment of enchondroma of the hand without complications.

Results of the Kapandji Procedure in the AO Type C Distal Radius Fracture in Patients over Age 60

PURPOSE: To evaluate the clinical and radiologic results of the Kapandji procedure in AO classification type C distal radius fracture patients over 60 years old. MATERIALS AND METHODS: Twenty-one type C distal radius fracture patients over the age of 60 years who were treated with the Kapandji procedure from June 2004 to June 2009 in our hospital and had a post-operative follow-up period of more than 1 year were enrolled. The volar tilt, radial inclination, and radial length were measured for the radiographic analysis using the modified Lidstrom scoring system about post-operative reduction loss in every follow-up radiogram. The clinical result was assessed with a visual analogue scale (VAS) and Korean Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) score at the last follow-up. RESULTS: The mean radiologic loss of volar tilt was 1.1degrees and the mean loss of radial length was 2.6 mm and the mean radial inclination loss was 2.7degrees compared with the immediate post-operative period and last follow-up period. The average VAS and DASH scores were 1.4 and 15.9. CONCLUSION: The radiologic results of closed reduction and percutaneous pinning using the Kapandji technique for distal radius AO type C fracture patients over 60 years of age was not satisfactory. Nevertheless, the clinical results were satisfactory.

Recurrent Lipofibromatous Hamartoma of the Median Nerve / 대한정형외과학회잡지

Lipofibromatous hamartoma is a rare tumor of the peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue and very few cases have been described and reported in the literature. Surgical treatments of lipofibromatous hamartoma include partial excision, debulking operation, nerve decompression and so on. We report a case of recurrent lipofibromatous hamartoma of the median nerve that partial excision was done previously but causing secondary carpal tunnel syndrome and a review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma.