The Treatment for Hallux Valgus with Scarf Osteotomy in Elderly Patients with Osteoporosis / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the radiological and clinical outcomes of scarf osteotomy for hallux valgus (HV) deformity in elderly patient with osteoporosis. MATERIALS AND METHODS: A total of 58 elderly patients (mean age, 72.6 years) underwent scarf osteotomy for HV deformity between 2008 and 2015. The mean follow-up period was 24.4 months. Of the 58 patients, 42 were diagnosed with osteoporosis and 16 were diagnosed as normal. The radiological and clinical outcomes were assessed preoperatively, postoperatively, and at final follow-up, including HV angle, intermetatarsal (IM) angle, American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction, visual analogue scale (VAS), and complication. RESULTS: There was no significant difference in HV angle and IM angle between the osteoporosis group and normal bone mineral densitometry group at all time points, preoperative, postoperative, and final follow-up. Moreover, there was no statistically significant difference between the two groups with respect to the AOFAS score and VAS evaluations. In the osteoporosis group, the mean HV angle improved from 36.7° preoperatively to 11.3° at the time of final follow-up, and the mean IM angle improved from 13.2° to 5.7°. The mean AOFAS score improved from 52.6 preoperatively to 89.1 at the time of final follow-up. With respect to satisfaction, 83.4% of patients were very satisfied or satisfied. There were no serious complications, and all cases showed complete union at the osteotomy site. CONCLUSION: We believed that scarf osteotomy is a safe, effective procedure for the correction of elderly patients with osteoporosis.

Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

BACKGROUND: The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS: Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS: The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.

Knowledge on Osteoporosis of Prescriber According to Level of Medical Institute

PURPOSE: There are gaps between the treatment guideline and clinical practice of osteoporosis showing low compliance. Although attitude and knowledge of prescriber have been known to be associated with the low compliance in real clinical practice, no study has assessed the knowledge of prescriber regarding osteoporosis in accordance to the level of medical institution. We compared the knowledge on osteoporosis of general practitioners with that of practitioners in a tertiary referral hospital. MATERIALS AND METHODS: In May 2012, 40 general practitioners and 40 practitioners in a tertiary referral hospital were evaluated using a modified Facts on Osteoporosis Quiz. RESULTS: The level of knowledge of general practitioners was similar with that of practitioners in a tertiary referral hospital (p=0.386). And, both groups were lack of knowledge of effect of physical exercise. CONCLUSION: The level of knowledge on osteoporosis was not associated with the level of medical institute, and the effect of physical exercise should be stressed in an educational program on osteoporosis for practitioners.

Arthroscopic Treatment of Septic Arthritis of the Hip in a Child: A Case Report / 대한고관절학회지

Recommended treatment options for acute septic arthritis in children include repeated aspiration, open arthrotomy, and arthroscopic drainage. However, reports of arthroscopic treatment of septic arthritis of the hip in a child are rare. We experienced a case of arthroscopic management of acute septic arthritis of the right hip joint in a three-year-old child using a 30degrees, 2.7 mm arthroscope for the ankle joint through manual traction without use of a traction table. The patient had complete range of motion in the right hip joint two weeks after surgery and recurrent infection was not observed at the final follow-up two years postoperatively.

Poor Prognosis in Elderly Patients Who Refused Surgery Because of Economic Burden and Medical Problem After Hip Fracture

Although many studies have assessed mortality and morbidity of conservative treatment after hip fracture in elderly patients, the mortality of conservative treatment done because of economic burden is unclear. Among 451 patients diagnosed with displaced hip fracture during 3 yr, 28 patients (Group I) were enrolled as conservative treatment. Fifty-six patients matched in age, gender, ASA score, and diagnosis (Group II) who had undergone surgical treatment were used as the control group. The causal factors of non-operative treatment and mortality rate and functional recovery were evaluated according to the causal factors of patients with surgical procedure. Ten patients (36%) in Group I involved medical problems and 18 (64%) by economic burdens. The cumulative mortality rate over 3, 6, 12, and 24 months was 54%, 61%, 64%, and 82% in Group I and 9%, 11%, 14%, and 21% in Group II, respectively. At the latest follow-up, all five patients in Group I displayed a nonfunctional ambulatory state, whereas only seven of 44 patients in Group II were in a nonfunctional ambulatory state. Non-surgical treatment following hip fracture that is done because of the economic burden is associated with substantially high mortality and serious functional loss.

Is It a Simple Stress Fracture or Bisphosphonate-related Atypical Fracture?

A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ, USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.

Sequential Bilateral Insufficiency Fractures of the Femur Neck in Patients Treated with Prolonged Bisphosphonate Therapy: A Case Report

The relationship between long-term bisphosphonate usage and insufficiency fracture in osteoporotic elderly patients has been increased interest in recent years. Most reported insufficiency fractures are predominantly concentrated on proximal femoral shaft or pelvic bone. However, there was no report about insufficiency femoral neck fracture after long term use of bisphosphonate in domestic. We experienced a rare case of a 70-years-old woman who was diagnosed with bilateral insufficiency femoral neck fracture after 8 years use of alendronate. We performed an internal fixation using 6.5 mm diameter cannulated screws for the both insufficiency femoral neck fracture. Symptoms disappeared immediately after the surgery and there was no radiologic and clinical complication such as nonunion or delayed union up to the latest follow-up at 12 months postoperatively.

Successful Treatment of Gastric Hamartomatous Polyp with Hemorrhage by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Hamartomatous polyp is an uncommon lesion. Most of the gastric hamartomatous polyps occur in patients in their 40s because of polyposis coli. Gastric hamartomaotus polyps are usually asymptomatic, but they occasionally manifest with hematemesis or anemia. If they are congenital, then sessile polyps in children should be observed with some measurable frequency. However, many reports have revealed that if the polyp size is big and the risk of rebleeding is high, then ESD or surgical resection can be used to completely remove them. An inverted gastric hamartomatous polyp may have an early gastric cancer component. We report here on an unusual polyp in a 14-years male who presented with hematemesis. Those were about two 3 cm sized large polyps at the proximal antrum and mid body of the stomach, respectively. The polyps were successfully removed by an endoscopic mucosal resection and the lesions were diagnosed as gastric harmatomas.