Long Level (T4-L1) Spinal Epidural Abscess in a Diabetic Patient: A Case Report

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.

3.5 mm T-shaped LCP (Locking Compression Plate) Fixation for Unstable Distal Clavicular Fractures

PURPOSE: To review the clinical and radiological results after an open reduction and internal fixation with a T-shaped LCP for unstable distal clavicle fractures. MATERIALS AND METHODS: From February 2005 to June 2006, ten patients with distal clavicle Neer type II fractures were treated with an open reduction and internal fixation with a T-shaped LCP. Bony union was identified by plain radiography. The clinical results were analyzed according to the UCLA scoring system. RESULTS: The mean time to fracture union was 9weeks and union was achieved in all cases. The mean UCLA score was 33.4 (30-35); excellent in 8 cases and good in 2 cases. In one case, loosening of one distal screw was occured and mild AC joint subluxation was observed in another case. CONCLUSION: 3.5 mm T-shaped LCP fixation is a useful technique for treating unstable distal clavicle fractures. This procedure provide stable fixation with no further AC joint injury.

The Effect of Patellar Position on the Flexion Gap in Total Knee Arthroplasty

PURPOSE: The aim of this study was to investigate the relationship between eversion or reduction of patella and the heights of the extension or flexion gaps. MATERIALS AND METHODS: Measurements of the heights of the extension and flexion gaps were obtained during 32 primary posterior-stabilized total knee arthroplasties in 25 osteoarthritic patients. A tensor device was introduced after femoral and tibial bony resections while putting the knees flat on the operating table to measure the extension gaps in the medial and lateral compartments, respectively. The knee was flexed 95 degrees, and the tensor was introduced to measure the flexion gaps in the same manner. A calibrated torque wrench permitted the application of the force of about 113.4N.cm both in extension and in flexion in right knee, and of about 152.4N.cm both in extension and in flexion in left knee. RESULTS: The average height of the extension gap with everted patella was 20.9+/-2.6mm medially and 23.6+/-2.5 mm laterally, respectively. The average height of the extension gap with reduced patella was 21.0+/-2.6mm medially and 23.7+/-2.4mm laterally, respectively. The average height of the flexion gap with everted patella was 20.7+/-2.5mm medially and 23.2+/-2.8mm laterally, respectively. The average height of the flexion gap with reduced patella was 22.1+/-2.3mm medially and 24.2+/-2.8mm laterally, respectively. After reducing the patella, the flexion gap height increased an average 1.4+/-1.1(range: 0~4)mm and 1.0+/-1.2(range: -1~3)mm in the medial and lateral compartments, respectively. CONCLUSION: The height of flexion gap would be increased by reducing the patella from everted position in posterior- stabilized total knee arthroplasty for the patient with good preoperative flexion. The flexion gap must be observed not with everted patella but with reduced patella to determine whether it appears symmetric and balanced.

The Effect of Lateral Retinacular Peeling in Total Knee Arthroplasty

PURPOSE: The aim of the present study was to investigate if a lateral retinacular peeling helped decrease the amount of lateral patellar tilt in total knee arthroplasty (TKA). MATERIALS AND METHODS: The lateral tilt angles were measured in tangential radiographs made preoperatively and postoperatively, with the knee in 100 degrees of flexion, in an earlier series of 38 TKAs(Group 1) and a series of 53 TKAs (Group 2) that included lateral retinacular peel and partial facetectomy. RESULTS: The mean preoperative patellar tilt angle was 9.1+/-4.5 degrees in the group 1 and 9.5+/-5.2 degrees in the group 2. The mean postoperative patellar tilt angle was 12.8 +/-6.2 and 11.0+/-7.1 degrees, respectively. The implant tilt angle was 6.3+/-7.3 and 5.5+/-6.1 degrees, respectively. The differences between two groups were not statistically significant. CONCLUSION: The patella would tilt laterally following total knee arthroplasty. A lateral retinacular peeling had no discernible effect on the postoperative lateral tilt of the resurfaced patella.

Total Hip Arthroplasty in Patients who had Previous Infection of the Hip with LegLength Discrepancy / 대한정형외과학회잡지

PURPOSE: To analyze the results of a minimum of three-year follow-up in patients with a severely deformed sequelae pyogenic hip, who had undergone total hip arthroplasty with a simultaneous limb length correction. MATERIALS AND METHODS: The postoperative complication, clinical and the radiographic results were analyzed in 74 out of 102 patients, who were followed for a minimum of three years between December 1987 and May 2003. The average age was 42.8 years. The average follow-up duration was 4 years and 11 months. There were 50 tuberculosis infections, 24 pyogenic infections, and 23 fused hip cases. The average leg length shortening was 4.1 cm (range, 1.0-10.0 cm). RESULTS: Preoperative Harris hip score improved to 90.2 postoperatively from 65.0 (range, 25-92.5) preoperatively. Leg length shortening was corrected by 0.4 cm (0.0-3.0 cm). Radiographically, excluding the 3 revisions, no case met the criteria of definite loosening. The postoperative complications included the recurrence of tuberculosis (2 cases), and variable nerve palsies, including femoral nerve (3 cases), and a sciatic nerve (3 cases). These patients completely recovered from nerve palsy. B-K amputation, after the postoperative exacerbation of circulation to the affected limb, was needed in one case with a preoperatively undetected femoral artery occlusion. CONCLUSION: Although, restoring the normal limb length in the severely deformed pyogenic hip sequelae patients requires highly demanding surgical techniques, with a relatively higher incidence of postoperative complications, it is possible to achieve a higher level of patient satisfaction and definite gait improvement.

Evaluation of Rotational Displacement of the Posterior Facet on the Sagittal Plane in Computed Tomographic Images of Calcaneal Fractures

PURPOSE: To find out whether or not the computed tomographic (CT) classification systems of the calcaneal fracture are efficient in illuminating displaced posterior facet fragment and the degree of displacement can be evaluated by analyzing serial CT images. MATERIALS AND METHODS: Seventy-seven hundred calcaneal fractures were classified by CT classification systems including Sanders classification, and the sagittal rotation angle of the posteior facet fragment was measured on the plain lateral radiograph. Among the serial axial CT images, a number of images with the cortical bone embedded in the cancellous portion were recorded and any significant relationship between each data were evaluated. RESULTS: The conventional CT classification systems are rather insufficient in illuminating the extent of sagittal rotatory displacement. However, the number of CT images in which the cortical radiodensity was observed showed a significantly related with the degree of displacement. CONCLUSION: The conventional CT classification of the calcaneal fractures is unsatisfactory in expressing the degree of sagittal rotatory displacement of the posterior facet fragment; this problem may be alleviated by observing the number of axial CT images in which cortical radiodensity was revealed within the calcaneal body.

New Wiring Method for Lesser Trochanter Fixation in Unstable Intertrochanteric Fractures: Technical Note

In unstable femoral trochanteric fracture, we usually used transversing K-wires through the lesser trochanter to achieve an anatomical reduction, and using sliding hip screws. However, in patients with comminuted lesser trochanter or osteoporosis, an intrusion of the wire into the lesser trochanter and/or iatrogenic intertrochanteric fractures were often resulted. Those who were not familiar with a technique of puncturing two holes through the lesser trochanter might have had to face some difficulties. In order to overcome aforementioned drawbacks, the authors had quite satisfactory results by employing the method of passing each of two wires above and below the iliopsoas muscle, and they were twisted posteriorly and then anteriorly; and finally they were pulled together posteriorly. Through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.