Anatomical Reduction with Brick-Work Technique in Comminuted Intraarticular Distal Radius Fractures

PURPOSE: This study examined the clinical outcomes of comminuted intraarticular distal radius fractures treated by an anatomical reduction using a brick-work technique. MATERIALS AND METHODS: Seventeen patients with AO/OTA type 23-C3 distal radius fractures were enrolled in this study. An anatomical reduction of the articular surface was achieved using a brick-work technique through the dorsal approach and dorsal plates were used for fixation. The postoperative functional results were assessed with the range of motion of the wrist and the modified Mayo wrist score (MMWS). In addition, the radial length, radial inclination, volar tilt, and Lidstrom score were evaluated from the radiology results. The mean postoperative follow-up period was 13.6 months. RESULTS: All patients showed bony union and the mean range of motion of the injured wrists was 94% (92% to 95%) of the uninjured side. The mean MMWS was 85.3, and the functional results were excellent in 12 patients, good in 4, and fair in one at the final follow-up. Based on the final radiographic measurements, the radial length, volar tilt, and radial inclination were 11.4 mm (10.0 to 13.5 mm), 6.6° (−1.8° to 9.2°), and 21.3° (20.1° to 25.7°), respectively. The radiologic results according to the Lidstrom score were excellent in 14 patients and good in three. CONCLUSION: An anatomical reduction with the brick-work technique is relatively easy, results in a reproducible clinical outcome, and could be a safe and effective treatment option for severe comminuted intraarticular distal radius fractures that are not amenable to volar plate fixation.

Synovial Osteochondromatosis of the Subtalar Joint in an Adolescent Baseball Player / 대한스포츠의학회지

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation within the synovial membrane of the articular joint. Smaller joints are rarely affected and it may be progressed to osteochondromatosis after ossification or calcification of metaplastic cartilage. It is commonly presented in the third to fourth decade of life, but rarely presented in adolescence. We report a unique case of synovial osteochondromatosis of the subtalar joint in 14-year-old baseball player. Arthroscopic removal of loose body and complete excision of the osteochondral mass with concomitant synovectomy resulted in satisfactory outcome without recurrence at final follow-up.

Free Vascularized Fibular Graft for Femoral Head Collapse Combined with Ununited Pathologic Intertrochanteric Fracture / 대한정형외과학회잡지

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.

Cervical Myelopathy Secondary to Atlas Hypoplasia: Reports of 3 Adult Cases

There have been paucity of reports on atlas hypoplasia, and as a result this condition is not clearly defined, nor well understood. The authors reported three cases of atlas hypoplasia that were found in adults who presented with myelopathic symptoms. On radiographic examination, it was found that the anterior-posterior diameter of the atlas was remarkably narrower in all three cases in comparison with normal persons. The MRI in all three cases also revealed intramedullary high signal lesions at the levels where severe spinal cord compression was present. This led to our diagnosis of atlas hypoplasia causing myelopathy.

Dens Fracture-Nonunion in Ankylosing Spondylitis: A Case Report / 대한척추외과학회지

Patients with ankylosing spondylitis are susceptible to fractures, which usually occur in the cervical spine. However, upper spinal fractures, particularly dens fracture-nonunion complicating ankylosing spondylitis, are quite rare. We encountered one such case. The patient was treated with posterior fusion followed by a halovest, which resulted in good conditions.

Mono-segment Cervical Spondylotic Myelopathy / 대한척추외과학회지

STUDY DESIGN: A retrospective follow-up study comparing soft disc cervical myelopathy (Group A) and spondylotic bar cervical myelopathy (Group B). OBJECTIVES: To analyze different factors by comparing preoperative radiological and clinical data of Group A with that of Group B. SUMMARY AND LITERATURE REVIEW: The different causes of cervcal myelopathy resulted in different symptoms and prognoses. MATERIALS AND METHOD: A clinical and radiological analysis of the data in 31 patients who underwent an anterior cervical decompression and fusion was performed to assess the different factors between two groups. The patients were classified into two groups; 20 in Group A and 11 in Group B. Comparisons between the two groups were made in regard to the physical findings, radiological and clinical evaluation. RESULTS: The duration of myelopathy was 3 months in Group A and 8.7months in Group B. Of all cases, 5 cases (25.0%) in group A and 4 cases (36.4%) in group B had myelopathy associated with radiculopathy. Of the 20 cases in group A with myelopathy, 7 cases had a median compression and 13 cases had a paramedian compression on MRI. Of the 11 cases in group B with meylopathy, 9 cases had a median compression and 2 cases had a paramedian compression on MRI. The follow-up MRI of the 14 cases (73.7%) in group A and 2 cases (20.0%) in group B showed spontaneous regression of the T2 WI high signal intensity. CONCLUSION: In degenerative disc disease, the different causes of cervcal myelopathy result in different symptoms and prognoses. However, the treatment of choice in both groups is a one level anterior decompression and fusion.

Epidural Arteriovenous Fistula in the Cervical Spine Associated with Unilateral Upper Extremity Pain: A Case Report / 대한척추외과학회지

We experienced a rare case of an epidural arteriovenous fistula, which presented with symptoms similar to those of cervical radiculopathy. An 18-years-old woman suffered from neck pain, which radiated to the left upper extremity for 4 months. On neurologic examination, there were sensory impairments of the left C4 to C8 dermatomes and intermittent weakness in both lower extremities after exercise. An MRI of the cervical spine demonstrated a mass, which produced a serpentine-like signal void within the spinal canal from C1 to C7. The feeding artery of the fistula and the arterialized epidural venous plexus within the spinal canal were found on vertebral angiography. One year after an endovascular embolization with platinum coils, the clinical symptoms resolved and complete resolution of the arteriovenous fistula was confirmed by angiogram and MRI scan.

The Evaluation of Bony Union after Posterior Occipitocervical Fusion / 대한척추외과학회지

STUDY DESIGN: The results of posterior occipitocervical fusions were analyzed retrospectively based on the results of post-operative radiographs. OBJECTIVES: To investigate subjective methods for the evaluation of occipitocervical stabilization by posterior fusion. SUMMARY OF LITERATURE REVIEW: Few studies have been performed that describe the methods utilized for the evaluation of the union of the instrumented segments. MATERIALS AND METHODS: Occipitocervical fusions were performed in 16 patients from 1995 to 2004. The patients underwent occipitocervical fusions with autogenous iliac bone grafting and wire fixation (5), loop and sublaminar wire fixation (3), C-D occipitocervical rod (2), and contoured reconstruction plate (6). The stability and failure of the instrumentation in the fusion sites were evaluated with flexion/extension lateral radiographs. The stability was evaluated by a change in the degrees and distances between the occiput and cervical vertebrae. RESULTS: Two of five patients who had undergone wire fixation with autogenous bone grafting were considered to have a nonunion because of persistent segmental instability: greater than 2 degrees and 2 mm three months postoperatively. In the other patients, we were unable to determine the presence of a solid fusion mass at the fusion site, because of overlapping of the instrumentation devices and graft bones. However, since there was no definite motion that indicated segmental instability and instrumentation breakage or loosening on flexion and extension radiographs, we considered these as stable fixations. CONCLUSION: It was difficult to evaluate whether or not the grafts were incorporated into the recipient sites, due to the complexity of the occipitocervical junction and the overlapping of the instrumentation. After removal of the external immobilization 3 months postoperatively, although flexion/extension radiographs taken 6 months postoperatively, demonstrated no motion at the fusion site, the occipitocervical fusions were judged to be stabilized rather than fused.

Spinal Stenosis Due to Hypertrophy of the Ligament Flavum with Monosodium Urate Deposits / 대한정형외과학회잡지

Deposition of monosodium urate crystal in joints and periarticular soft tissue is regarded as one of the characteristics of chronic gouty arthritis. In spine, however, only nineteen cases of tophaceous deposits have been reported to date suggesting the rarity of clinical symptoms secondary to involvement of spine. Authors report a case of spinal stenosis due to hypertrophy of ligament flavum with monosodium urate deposits. The patient was 65 years of age with chronic gouty arthritis who underwent a decompressive laminectomy at L4-5. At surgery, hypertrophied ligament flavum that was covered with chalky amorphous materials was noted without any evidence of radiologic features. Microscopically, a portion of ligament flavum had been focally destoryed by amorphous material deposits that were surrounded by a thin layer of mononuclear and giant cells along with occasional sprinkling of chronic inflammatory cells and negative birefringence on polarizing microscopy.