Acute Longus Colli Tendinitis without Calcification / 대한정형외과학회잡지

Calcific tendinitis of the longus colli is an inflammatory disease caused by calcium hydroxyapatite crystal deposition in the longus colli tendon of the prevertebral space. It is also known as retropharyngeal calcific tendinitis or prevertebral tendinitis. The typical imaging characteristics of this entity are calcifications on the superior insertion of the longus colli tendons at the C1-2 level and fluid collection in the retropharyngeal space. However, we introduce a case of acute longus colli tendinitis without definite calcification deposition on image findings.

Associated Factors of Nonunion Following Conservative Management of Distal Clavicle Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate radiological and clinical outcomes and to analyze factors associated with nonunion after conservative management in patients with distal clavicle fracture. MATERIALS AND METHODS: We analyzed 29 cases. Neer type, coracoclavicular distance (CCD), initial displacement, comminution, union, and presence of bony union were evaluated by plain radiographs. Clinical outcomes according to University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), and subjective shoulder value (SSV) scores were assessed. RESULTS: Six cases (20.7%) had developed nonunion. Three cases had asymptomatic nonunion. Mean UCLA, ASES, and SSV scores were 30.9, 88.3, and 87.0 in the union group and 26.7, 76.2, and 70.8 in the nonunion group. Although the nonunion group had inferior clinical outcome compared to the union group, there was no significant difference between the two groups. Older age and more CCD showed correlation with nonunion (p=0.047, p=0.007). CONCLUSION: Conservative management of distal clavicle fractures provided satisfactory clinical outcomes. The rate of symptomatic nonunion was 10.4%. Occurrence of nonunion showed correlation with older age and more CCD.

Brain Tumor Mimicking Cervical Spinal Disease: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of cerebellar tumor mimicking cervical spinal disease with neck pain for one year. SUMMARY OF LITERATURE REVIEW: Neck pain is one of the most common symptoms of cervical spinal disease. Neck pain in the cervical spine is usually accompanied by radiculopathic or myelopathic symptoms. Pain aggravated with neck motion is another point of differentiation. However, the differential diagnosis of neck pain is not always easy. MATERIALS AND METHODS: A 47-year-old woman presented with neck pain, without other symptoms of radiculopathy or myelopathy. The neck pain was not position-dependent and had exacerbated 1 week previously. Cervical magnetic resonance imaging (MRI) revealed a brain tumor in the cerebellum. RESULTS: The patient underwent surgical craniotomy and tumor resection. The neck pain improved after surgery. CONCLUSIONS: If neck pain cannot be explained by cervical pathological conditions, the possibility of other causes, including brain pathology, should be considered.

Transscaphoidal Dorsal Perilunar Dislocation Associated with Dislocation of Distal Radioulnar Joint: A Case Report

Dorsal perilunar dislocations are rare traumatic entities. Associated fractures such as carpal bones and radial styloid processes can occur. However, the dorsal perilunar dislocation associated with dislocation of distal radioulnar joint is extremely rare. The authors herein report the case of a 34-year-old man who was presented with transscaphoidal perilunar dislocation which is associated with dislocation of distal radioulnar joint.

Fourth and Fifth Metacarpal Base Arthrodesis for Posttraumatic Arthritis of Fifth Carpometacarpal Joint

Posttraumatic arthritis of the fifth carpometacarpal joint occurs as a sequelae of intraarticular comminuted fracture or missed and untreated fracture. If it is inappropriately managed, persistent pain and functional disability of the hand can occur. Arthrodesis, resection arthroplasty, or interposition arthroplasty has been reported as the treatment for the arthritis. However, outcome studies for operative treatment of the fifth carpometacarpal arthritis have been rarely reported. We report a case of the fifth carpometacarpal arthritis occurred after missed fracture, which was successfully treated with fourth, fifth metacarpal base arthrodesis.

Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature

The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.

Rupture of the Extensor Tendon Secondary to Advanced Kienbock's Disease / 대한정형외과학회잡지

Rupture of the extensor tendon caused by a posteriorly displaced lunate fragment is an uncommon complication of Kienbock's disease. Thirteen cases have been reported in the English literatures, but it has never been reported in the Korean literatures. We report a case of rupture of the third and fourth extensor tendons secondary to advanced Kienbock's disease that was successfully treated by excision of the lunate and a tendon transfer.

Results of Total Knee Arthroplasty with NexGen LPS-flex Implant Using Navigation System (Brain Lab): Results with a 5-year Follow-up

PURPOSE: To evaluate the clinical and radiological results of patients that underwent total knee arthroplasty (TKA) with a NexGen LPS-Flex implant using a Navigation system (Brain Lab). MATERIALS AND METHODS: Between January 2001 and December 2005, 55 knees in 46 patients which used the NexGen LPS-Flex implant with a Navigation system (Brain Lab) for primary TKA were clinically and radiologically evaluated after a minimum follow-up of 5 years. Evaluation included preoperative and postoperative range of motion (ROM), Knee Society Score (KSS), tibio-femoral angle and postoperative complications. RESULTS: Knee ROM was increased from 118.9degrees preoperatively to 126.9degrees at the last follow up. In addition, the preoperative flexion contracture improved from 6.5degrees to 1.8degrees postoperatively. The mean KSS and functional score were improved from 59.8 and 51.2 to postoperative scores of 86.4 and 85.2 respectively. The rate of appearance of radiolucency in X-ray was 21.8%. One case of superficial skin infection and one case of aseptic loosening were noted as complications but, did not require a revision surgery. CONCLUSIONS: TKA with NexGen LPS-Flex implant using Navigation system (Brain Lab) showed satisfactory improvement in pain and function, but more long term follow up will be needed to complete verification.

Ulnar Nerve Palsy Following Closed Fracture of the Distal Radius: A Report of 2 Cases

Ulnar nerve palsy subsequent to a fracture of the distal radius is extremely rare compared to a median nerve injury. The lesion tends to occur in younger patents with a high-energy mechanism of injury and a severe injury pattern consisting of wide displacement, comminution, combined distal ulnar fracture and open fracture. The mechanism of injury can contribute to a direct contusion and traction, compression secondary to prolonged edema and tissue fibrosis, intraneural fibrosis and laceration. We report 2 cases of progressive ulnar nerve palsy subsequent to closed fractures of the distal radius. The neurological symptoms recovered in all cases who underwent nerve decompression and neurolysis at 2 or 3 months after the trauma. It is recommended that cases with high-energy, widely displaced or comminuted fractures of the distal radius be evaluated carefully for ulnar nerve as well as median nerve injury.

Clavicle Midshaft Fracture with Acromioclavicular Joint Dislocation: A Case Report

Clavicle fracture or acromioclavicular joint dislocation is common injury in the upper extremity. But ipsilateral clavicle midshaft fracture with acromioclavicular joint dislocation is a extremely rare. Seven cases has been reported in the English literature, but it has never been reported in Korea. We report a case of clavicle midshaft fracture with acromioclavicular joint dislocation caused by motor vehicle accident and describe its presumed mechanism, diagnosis, treatment with a review of literature.

Kimura's Disease of the Elbow : A Case Report

PURPOSE: Kimura's disease is an uncommon benign lymphoproliferative inflammatory disorder with an unknown etiology. The recurrence rate after surgical excision is relatively high and renal involvement is its only systemic manifestation. The condition mainly involves the head and neck, and peripheral involvement is extremely rare. MATERIALS AND METHODS: We encountered the case of a 28-year-old man who had a non-tender mass with mild brownish skin color changes and pruritus around the medial side of the distal arm and elbow. RESULTS: The peripheral blood investigation revealed peripheral eosinophilia and elevated serum IgE levels. Magnetic resonance imaging showed an isointensity signal relative to the muscle on the T1-weighted images and hyperintensity signal relative to the muscle on the T2-weighted images. CONCLUSION: A marginal resection of the lesion was performed and there was no recurrence at 2 years postoperatively.

Indirect Reduction of Posterior Column through Ilioinguinal Approach in Case of Both Column Fractures

PURPOSE: To evaluate the efficacy and results of indirect reduction of the posterior column through the ilioinguinal approach in cases of both column fractures. MATERIALS AND METHODS: Between February 2000 and January 2008, 18 patients, who underwent indirect reduction of the posterior column through the ilioinguinal approach, were evaluated clinically and radiographically after a minimum follow-up of one year. The mean follow-up duration was 52.7 months. The reduction quality, clinical results, and radiographic results were analyzed according to the criteria reported by Matta. The complications were also recorded. RESULTS: There were 13 cases (72.2%) of an anatomical reduction, 2 cases (11.1%) of an imperfect reduction, and 3 cases (16.7%) of a poor reduction. Out of 13 anatomically reduced fractures, excellent results were graded in 12 cases clinically and 9 cases radiographically. Poor clinical and radiographic results were graded in 2 of the 3 poorly reduced fractures. Complications included 3 cases with transient lateral femoral cutaneous nerve injury, which resolved during the follow-up period and 1 case with an injury to the superior gluteal artery. CONCLUSION: Indirect reduction of the posterior column through the ilioinguinal approach is effective for both column fractures. During surgery, care should be taken to reduce the risk of iatrogenic lateral femoral cutaneous nerve injury.

Coracoclavicular Ligament Augmentation Using TightRope(R) for Acute Acromioclavicular Joint Dislocation : Surgical Technique and Preliminary Results

PURPOSE: The purpose of this study was to introduce a new surgical technique and to evaluate the preliminary results after operative treatment with using TightRope(R) for treating acute acromioclavicular joint dislocation. MATERIAL AND METHODS: We studies 10 patients who were followed up for more than 6 months after operative treatment with using an TightRope(R). A longitudinal incision approximately 4cm in length was made from 1cm medial to the acromioclavicular joint to the coracoid process, and then coracocalvicular ligament augmentation using TightRope(R) was done after splitting the deltoid. For postoperative stability, two 1.6 mm Kirschner wires were inserted temporarily across the acromioclavicular joint in all cases. The radiologic results on the serial plain radiographs and the clinical results according to the UCLA score were analyzed. RESULTS: Radiologically, 7 cases showed anatomical reduction, 2 cases showed a slightly loss of reduction and 1 case showed partial loss of reduction. Clinically, 6 cases were excellent, 3 cases were good and 1 case was fair. CONCLUSION: Coracoclavicular ligament augmentation using TightRope(R) for treating acute acromioclavicular joint dislocation is a minimally invasive, safe procedure that provides satisfactory radiologic and clinical preliminary results. Yet the long-term results have to be analyzed to determine the final results of this procedure.

An Analysis of the Outcome of Transforaminal Epidural Steroid Injections in Patients with Spinal Stenosis or Herniated Intervertebral Discs / 대한통증학회지

BACKGROUND: Spinal stenosis and herniated intervertebral discs are the principal causes of lumbosacral radiculopathy. This study was conducted to compare the therapeutic value and duration of pain relief of fluoroscopic guided transforaminal epidural steroid injections (TFESIs) in patients with refractory radicular leg pain. METHODS: Between August 2006 and March 2007, 87 patients (H group: patients with herniated intervertebral disc, S group: patients with spinal stenosis) who met the inclusion criteria were treated with fluoroscopic guided TFESIs. Prior to treatment, the VAS and ODI scores were determine to evaluate the degree of pain and level of disability. The degree of pain relief was then assessed 1 month after treatment with the TFESIs and graded as excellent (no residual pain), good (improvement of pain symptoms by more than 50%), fair (improvement of pain symptoms by less than 50%) and Poor (no improvement of pain). In addition, the duration of pain relief was evaluated by regular outpatient visits for 6 months, and by telephone interviews after 6 months. RESULTS: The H and S group both had excellet results at 1 month after treatment with TFESIs showing improvements of 44.1% and 20.8% respectively. However this difference was not significant between groups. In addition, a duration of pain relief greater than 6 months was achieved in 32.4% of the patients in the H group and 37.7% of those in the S group. CONCLUSIONS: TFESIs had a similar degree of therapeutic effectiveness and duration of pain relief in patients with spinal stenosis and herniated intervertebral discs.

Comparison of Outcomes for Unstable Distal Radius Intraarticular Fractures: T-locking Compression Plate versus External Fixator

PURPOSE: To compare the outcomes between T-locking compression plate (T-LCP) and external fixator (EF) for unstable distal radius intraarticular fractures. MATERIALS AND METHODS: We retrospectively analysed the results in 22 cases with T-LCP, 20 cases with EF. We evaluated the clinical results according to the Mayo Wrist Scoring System, radiographic results. RESULTS: The mean score was 84.6 in the T-LCP group and 80.5 in the EF group respectively. Final radiographic measurements for the T-LCP group averaged 10.5 mm radial length, 21.7degrees radial inclination, 9.8degrees volar tilt and 0.25 mm intraarticular step-off. The EF group averaged 10.1 mm radial length, 20.3 degrees radial inclination, 6.3 degrees volar tilt and 0.73 mm intraarticular step-off. CONCLUSION: Both groups showed satisfactory final clinical outcomes. But T-LCP group allowed return to daily living, resulting in early postsurgical wrist motion. By the anatomical reduction, final volar tilt, intraarticular step-off were statistically better in the T-LCP group.

Surgical Treatment of Late Presented Displaced Lateral Condylar Fracture of the Humerus in Children / 대한정형외과학회잡지

PURPOSE: To determine whether late open reduction and internal fixation (ORIF) of a lateral condylar fracture (LCF) after 3 weeks is possible, and to determine the latest time for ORIF without a bone graft. MATERIALS AND METHODS: Eight children underwent late ORIF (>3 weeks) of a displaced LCF (>2.5 mm) of the humerus between 3 weeks and 5 weeks after injury. RESULTS: Clinically, results were excellent in 6 cases and good in 2 cases. There was no serious complication, including nonunion and avascular necrosis (AVN), though 2 cases had a slight fishtail deformity and mild carrying angle loss due to overgrowth of the lateral condyle fragment. CONCLUSION: We believe that 3 weeks is too short to deny open reduction and anatomic reduction for fear of AVN of a late presented lateral condyle fracture of the humerus. The latest time for ORIF in late presented LCF in children is around 5 weeks, and surgical treatment may even be possible after greater delays.

Beck Depression Inventory Score and Associated Factors in Korean Patients with Lumbar Spinal Stenosis / 대한통증학회지

BACKGROUND: Depression is a frequent comorbid disease of chronic pain patients. This study was conducted to evaluate the prevalence of depression and to correlate associated factors and depression in patients with lumbar spinal stenosis. METHODS: The data of this survey was collected from 97 patients that visited our pain clinic for the management of lumbar spinal stenosis. Depression was examined by a self-reported survey using the Korean version of the Beck Depression Inventory (BDI). The Oswestry Disability Index (ODI) and the life satisfaction scale score were also obtained. Demographic and clinical characteristics (including spouse status, employment status, smoking status, the number of patients with multiple painful areas, the number of patients with combined disease, pain duration, visual analogue scale, Roland 5-point scale and walking distance) were obtained from an interview with the patient. The patients were divided into group N (BDI 14, n = 54) according to the BDI scale. Of the 97 patients, 55.7% had a high BDI score. RESULTS: The patients in group N had a higher rate of employment (48.0%, P < 0.05) and had higher life satisfaction scale scores (9.4 +/- 2.5, P < 0.01) as compared to group D patients. The BDI score showed a close correlation with employment status and the life satisfaction scale. CONCLUSIONS: Many lumbar spinal stenosis patients had high BDI scores. Employment status and the life satisfaction scale were closely correlated with the BDI score.

Myelopathy due to Spinal Dural Arteriovenous Fistula: A Case Report / 대한척추외과학회지

Spinal dural arteriovenous fistulas are rare abnormal connections of arteries and veins on the surface of the dura. A male presenting with myelopathy, which had a slowly progressive course for about 28 months, was diagnosed by magnetic resonance imaging and selective angiography. After surgical coagulation and excision, his symptoms were mildly improved. We report here on a man who underwent a surgical procedure for his myelopathy that was due to spinal arteriovenous fistula. Although it is unusual, spinal arteriovenous fistula should be considered when making a differential diagnosis of myelopathy.

Late-onset Brachial Artery Occlusion caused by Subclavian Artery Stenosis after Clavicular Fracture: A Case Report

Although vascular injury after clavicular fracture is a extremely rare, it is a complication which is serious problem. Vascular injury associated with the fracture can be immediate or delayed. We report a case of late-onset brachial artery occlusion caused by subclavian artery stenosis with excessive scar tissue after open reduction and plate fixation for clavicular fracture and include a review of the literature.

The Extended Trochanteric Osteotomythrough the Lateral Approachin Revision Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To review the results and discuss the technique for an extended trochanteric osteotomy through the lateral approach in revision total hip arthroplasty. MATERIALS AND METHODS: Twenty patients were reviewed after an average follow-up of 30.4 months (range, 24-56 months) between 1999 and 2003. The indications for the extended trochanteric osteotomy included the removal of a well-fixed cemented or cementless stem in 12 hips, varus remodeling of the femur in 3 hips and trochanteric malposition in 5 hips. The length of the osteotomy, the proximal migration of the osteotomized fragment, the fixation status of the femoral stem, the union status of the osteotomy site and complications were evaluated at the last follow-up. RESULTS: The mean length of the osteotomy was 12 cm (range, 8-20 cm). Radiographic union of the osteotomy site was noted in all cases after an average of 3.8 months (range, 2.5-6.0 months). The mean migration of the osteotomized fragment was 2.4 mm (range, 0-8 mm). The complications included postoperative dislocation in 3 hips and fractures of the osteotomy fragment in 2 hips, which were treated at the last follow up. Fixation of the stem with bone ingrowth was noted in all patients. CONCLUSION: An extended trochanteric osteotomy through the lateral approach can be performed safely in complex revision total hip arthroplasty.