Outcomes of Wedge Wing in the Lag Screw for Unstable Intertrochanteric Fractures in Elderly Patients / 대한고관절학회지

Purpose@#To evaluate clinical-functional and radiologic outcomes of elderly patients with an unstable intertrochanteric femur fracture treated with a wedge wing in the lag screw. @*Materials and Methods@#Forty-eight patients treated with the Dyna Locking Trochanteric nail (DLT nail) to resolve an unstable intertrochanteric femur fracture were reviewed retrospectively. Based on AO/OTA classification, Fracture 31-A2 (34 cases) and 31-A3 (14 cases) were included in the analysis. We measured the femoral neck-shaft angle, tip-apex distance (TAD), Cleveland index, sliding distance of the lag screw, and time to the fracture union. The Harris Hip Score and Paker and Palmer’s mobility score for clinical evaluation were used. @*Results@#The mean follow-up period was 21.4 months (range, 12-34 months). The postoperative state of reduction was good in 28 cases and acceptable in 20 cases. The mean TAD was 20.5 mm. The position of the lag screw was center-center in 30 cases and center-inferior in 18 cases. The mean sliding distance of the lag screw was 3.4 mm at the last follow-up. The mean union time was 4.5 months. Two cases had complications which included a cut-out (1 case) and non-union (1 case). The mean Harris Hip Score was 86.5±8.3 (range, 76-90).Walking ability in 34 of the cases (70.8%) at last follow-up was similar to that prior to fracture. @*Conclusion@#Functional and radiological outcomes are satisfactory using the DLT nail in the treatment of elderly patients with unstable intertrochanteric fractures; however, wedge wing in the lag screw does not prevent implant-related complications.

Predictive Factors for the Short-Term Efficacy of Epidural Injections in Lumbar Disc Herniation Treatment

Objectives@#The purpose of this study was to analyze several factors affecting the efficacy of epidural steroid injections as a nonoperative treatment modality in lumbar disc herniation patients.Summary of Literature Review: Despite several studies, the normal course of intervertebral disc herniation is not fully understood, and the optimal timing of surgery is unclear. @*Methods@#From January 2017 to April 2019, among outpatients in our hospital, 64 patients diagnosed with 3-4 or 4-5 single-level lumbar disc herniation and followed up for at least 6 weeks were included. Epidural steroid injection was performed in all patients during their 1-week admission. Symptoms improved in 36 patients (group 1) and persisted or recurred in 28 patients (group 2), who were finally treated surgically. Demographic factors, magnetic resonance imaging findings, and clinical assessments were analyzed. @*Results@#The only demographic factor with a significant difference between groups was symptom duration. In magnetic resonance imaging, significant differences were found in disc sequestration and the degree of the herniated disc. At 6 weeks after the injection, significant differences were found between the 2 groups in visual analog scale scores and the Korean version of the Oswestry Disability Index. @*Conclusions@#Several factors must be considered when treating patients with lumbar disc herniation. Of note, longer symptom duration was found to be associated with a lower effectiveness of conservative treatment. The effects of treatment could also be influenced by the disc form and the degree of disc herniation.

Predictive Factors for the Short-Term Efficacy of Epidural Injections in Lumbar Disc Herniation Treatment

Objectives@#The purpose of this study was to analyze several factors affecting the efficacy of epidural steroid injections as a nonoperative treatment modality in lumbar disc herniation patients.Summary of Literature Review: Despite several studies, the normal course of intervertebral disc herniation is not fully understood, and the optimal timing of surgery is unclear. @*Methods@#From January 2017 to April 2019, among outpatients in our hospital, 64 patients diagnosed with 3-4 or 4-5 single-level lumbar disc herniation and followed up for at least 6 weeks were included. Epidural steroid injection was performed in all patients during their 1-week admission. Symptoms improved in 36 patients (group 1) and persisted or recurred in 28 patients (group 2), who were finally treated surgically. Demographic factors, magnetic resonance imaging findings, and clinical assessments were analyzed. @*Results@#The only demographic factor with a significant difference between groups was symptom duration. In magnetic resonance imaging, significant differences were found in disc sequestration and the degree of the herniated disc. At 6 weeks after the injection, significant differences were found between the 2 groups in visual analog scale scores and the Korean version of the Oswestry Disability Index. @*Conclusions@#Several factors must be considered when treating patients with lumbar disc herniation. Of note, longer symptom duration was found to be associated with a lower effectiveness of conservative treatment. The effects of treatment could also be influenced by the disc form and the degree of disc herniation.

The Usefulness of Selective Nerve Block in Lumbar Spinal Stenosis in Cases with Inconsistent MRI Findings and Clinical Presentations

Objectives@#This study analyzed the diagnostic and therapeutic usefulness of selective nerve root block (SNRB) in patients with spinal stenosis who show inconsistencies between magnetic resonance imaging (MRI) and clinical findings (e.g., dermatomes).Summary of Literature Review: MRI is known to be highly accurate for diagnosing spinal stenosis, but few studies have investigated the diagnostic accuracy of MRI for spinal canal stenosis. In addition, the most suitable treatment of patients with inconsistent clinical and MRI findings has not been established. @*Methods@#This single-center, retrospective cohort study was conducted among 93 patients treated between January 2013 and December 2018, who underwent at least two SNRBs for single-level spinal stenosis on MRI with clinical discrepancies. Seventeen patients who were diagnosed with other causes of pain (e.g., spondylolisthesis, sacroiliac joint dysfunction, lower leg arterial occlusion) were excluded. The first SNRB targeted the lesion found on MRI. One week later, patients were assessed using a visual analog scale (VAS) and a second procedure was performed on the dermatome-indicated level if there was no improvement. VAS scores were also obtained 3 months after the procedure. @*Results@#In total, 45 patients had central stenosis and 31 patients had foraminal stenosis. The average VAS score before the SNRB was 7.4±1.4. After the first procedure, the average VAS score was 5.2±2.6. After the second procedure, the average VAS score was 2.4±1.3, and after 3 months, it was 3.6±1.9. Of the patients with foraminal stenosis, 77.4% did not respond to the first block (based on MRI), but responded well to the second procedure (based on clinical symptoms) (p<0.05). @*Conclusions@#SNRB targeting the level corresponding to clinical symptoms may be useful for locating the symptomatic nerve root and providing pain relief in patients with foraminal stenosis on MRI with discordant clinical findings.

Multiple Flexor Tendon Ruptures with Compression Neuropathy at Neglected Volar Lunate Dislocation / 대한정형외과학회잡지

Perilunate dislocation represents approximately 3% of all carpal injuries and is diagnosed late in 25% of cases. Neglected perilunate dislocation accompanies many complications. Multiple flexor tendon rupture is a very rare complication of neglected perilunate dislocation. Three cases have been reported in the English literatures. No case has been reported in Korean literature. We report on a case of multiple flexor tendon ruptures with compressive neuropathy of median and ulnar nerve caused by neglected volar perilunate dislocation.

Comparison The Safety and The Efficacy between the Group of using Pelubiprofen Tab. and the Group of using Aceclofenac Tab. on Back Pain Patients: Multi Institution, Double Blind, Random Sample

STUDY DESIGN: Multi institution, double blind, random sample. OBJECTIVES: We conducted a comparative study with Aceclofenac Tab, which is widely used in the clinical field in order to observe the Pelubiprofen Tab's clinical efficiency in patients with back pain. SUMMARY OF LITERATURE REVIEW: Among the numerous literatures regarding the chronic back pain, there is are few studies with Pelubiprofen Tab's clinical efficiency. MATERIALS AND METHODS: We computed an experimental model through a case control study, practiced from January, 2010 to January, 2011, and thereby, 298 back pain patients were selected. This study was conducted through a multi institution, double blind, and random sample. We compared the experimental and control groups' clinical efficiency that was estimated by VAS after 28 days of medication. Also, we compared the treatment efficiency of both drugs by using a variation of Oswestry Disability Index (ODI) and Physician's Global assessment, with a total usage of relief medicine. Also, the side effect and clinical pathologic result were tested. Statistical analysis was done with three different methods, Safety method, ITT (Intent-To-Treat), and PP (Per Protocol). Logistic regression model was used, and this result was compared by a Chi-square or Fisher's Exact test. RESULTS: Comparing the VAS of both groups, VAS decreased with statistical significance. Both groups didn't show a significant difference in VAS (p=0.6764). As the decrement of the total dosage of relief medicine, the decrease in the control group was rather higher, but the difference didn't show any statistical significance (p=0.9955). The experimental group was not inferior than that of the control group in ODI and PGA variation. Analyzing the side effect, both groups didn't show any significant difference (p=0.9843). CONCLUSIONS: As a result of the clinical trial, Pelubiprofen Tab. applied to back pain patients was not inferior to that of aceclofenac Tab., in terms of efficiency, and didn't show any significant difference in safety.