Undetected Incomplete Stress Fracture in the Proximal Femur of a Patient with Paget's Disease: A Case Report

Paget disease is a well-documented skeletal disease and it has an increased rate of tissue breakdown due to the excessive turnover of osteoblasts and osteclasts. Stress fracture is one of the most common complications in the late phase of Paget disease, but the clinical presentation of incomplete pathologic fracture is rare and this is an important clue to plan the treatment. We experienced a case of Paget's disease in a 74 year old woman with a periprosthetic fracture from the undetected, imcomplete stress fracture in the proximal femur.

Arthroscopic Treatment of Septic Arthritis of Acromioclavicular Joint

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.

Arthroscopic Transosseous Suture Repair for Bankart Lesion with a Flexible Drill Device: An Experimental and Preliminary Clinical Report

PURPOSE: Too develop a flexible drill device that can be inserted into the shoulder joint so that arthroscopic transosseous suture repair for Bankart lesion is possible. MATERIALS AND METHODS: We created a device composed of a flexible drill unit and a guide pipe unit. The flexible drill unit was made of flexible multifilament wires (1.2 mm in diameter) that was twisted into one cord so that it can flex in any direction and a drill bit (1.2 mm in diameter) that is attached onto one end of the flexible wire. The guide pipe unit was a 150 mm long metal pipe (2.0 mm in inner diameter and 3.0 mm in outer diameter), with one end bent to 30 degrees. The flexible drill set was inserted into the shoulder joint through the posterior portal of the joint. The guide pipe component was placed onto the medial wall of the glenoid so that the pipe was placed 5 mm posterior to the margin of the anterior glenoid rim. The flexible drill was driven through the glenoid by the power drill so that holes were made in the glenoid. A non-absorbable suture was passed through the hole. Tying of a sliding knot tying was accomplished over the capsule and labrum after making a stitch through the capsule and labrum with a suture hook loaded with suture passer. The same procedures were done at the 2 and 4 O'Clock positions of the glenoid. RESULTS: Five cases with Bankart lesion received arthroscopic transosseous repair with our flexible drill device. There were no intraoperative problems. Neither redislocation nor subluxation was reported at final follow-up. CONCLUSION: Arthroscopic transosseous suture repair without suture anchors and easy tying of a sliding knot are possible with a flexible drill set.

Interposition Arthroplasty with Pectoralis Major Muscle Transfer for the Shoulder Arthropathy: 2 Cases Report

Interpostion arthroplasty with allograft has been known as a useful option for the shoulder arthropathy, but it has a limitation to immune response. We performed the pectoralis major muscle transfer for shoulder arthropathy. From January 2007 to December 2007, we performed the pectoralis major muscle transfer in 2 patients. They were 1 man and 1 woman, and the mean age of the patients was 70 years (range, 65 to 75). The average follow-up after surgery was 13 months (range, 12 to 14). We analyzed the clinical results by the American Shoulder and Elbow Surgeons (ASES) Score, and evaluated the pain by Visual Analogue Scale. The level of pain reduced from a preoperative average of 10 to a postoperative average of 1. The ASES scores increased from a preoperative mean of 9 to a postoperative mean of 58. These results indicated that interposition arthroplasty with the pectoralis major muscle transfer is a reliable treatment method for the shoulder arthropathy improving shoulder pain, and patient satisfaction.

Operative Treatment of Bilateral Tibial Tuberosity Fractures in Adolescent: A Case Report

Bilateral avulsion fractures of the tibial tubercles are extremely rare. There is no case report about this in Korean literature. We present simultaneous bilateral tibial tuberosity fractures in 14-year-old adolescent male fell on the ground during running. These fractures were managed by open reduction and screw fixation. We gained complete union and removed metal after 6 months. Functional results were excellent 6 month after surgical treatment.

Surgical Treatment of Brucellar Spondylodiscitis with Epidural Abscess: A Case Report / 대한척추외과학회지

Brucellosis is a well known systemic, zoonotic disease that can affect many organs. We report a rare case of spondylodiscitis with an epidural abscess caused by brucellosis. The patient was treated surgically for severe pain and concomitant devastating neurological deficit. A diagnosis of spondylodiscitis or an epidural abscess due to brucellosis must be considered when acute back pain, radiating pain and febrile episodes occur, particularly in people in a high risk group.

Bilateral Traumatic Anterior Dislocation of the Hip with an Unstable Lumbar Burst Fracture

Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.

The Results of Proximal Femoral Nail Antirotation: A Comparative Study with Proximal Femoral Nail

PURPOSE: This study was performed to compare the results between PFNA (Proximal Femoral Nail Antirotation) and PFN (Proximal Femoral Nail) in the treatment of peritrochanteric fracture. MATERIALS AND METHODS: The patient group with PFNA (n=24, group I) was taken from operations between February, 2007, and March, 2008, whereas the PFN patient group (n=24, group II) were taken from January, 2005, to January, 2007. Both groups were carefully compared with regard to operation time, estimated blood loss, amount of transfusion, ICU care, amount of drainage, average duration of admission, intra- and postoperative complications, radiologic union, Tip Apex Distance (TAD), the change of neck shaft angle, the sliding length of lag screw, Jensen's functional score, and Paker and Palmer's mobility score. RESULTS: The results of our study showed statistical (P0.05). CONCLUSION: PFNA appears to be more effective than PFN for the treatment of peritrochanteric fractures of the proximal femur.

Ligament Reconstruction for the Posttraumatic Instability of the Carpometacarpal Joint of the Thumb: A Report of Three Cases / 대한정형외과학회잡지

Eaton and Littler's ligament reconstruction is used to treat carpometacarpal instability of the thumb using the flexor carpi radialis tendon. This procedure involves a reconstruction of the deep anterior oblique ligament in patients with post-traumatic prearthritic unstable joints. According to a recent paper, the dorsoradial ligament as well as the deep anterior oblique ligament plays an important role in stabilizing the trapeziometacarpal joint. We report three cases of post-traumatic instability in a prearthritic thumb that was treated with Eaton and Littler's reconstruction using the flexor carpi radialis tendon.

Treatment for the Supracondylar Fractures of the Distal Humerus with Cannulated Screw

PURPOSE: To evaluate the results of the treatment of the supracondylar fractures of the humerus according to the fixation methods with cannulated screw. MATERIALS AND METHODS: Eight patients, aged 49 to 82 years (average, 65 years), were reviewed after a mean follow-up of 16 months (range, 12~24 months). According to AO classification all fractures were classified as type A2 (simple transverse supracondylar fracture). All patients underwent closed reduction. Percutaneous fixation with cannulated screws was performed in 8 patients. Three of 8 patients had associated medical problems and one patient had distal radius fracture. The functional results were assessed by the Mayo Elbow Performance Score. RESULTS: Mean operation time was 59 minutes (45~75) and all the patients with cannulated screw fixation had bony union and were able to early ROM exercise. Mean ranges of motion was 5~120 degrees with excellent functional results. Functional evaluation of elbow joint by Mayo method showed mean value of 88 (75~95). CONCLUSION: The cannulated screw fixation of supracondylar fracture of humerus, especially in the elderly aged group with medical disease had excellent functional results (rigid fixation & early ROM exercise) due to shortening of surgery time and anesthesic time, combined with decreased technical difficulties of the surgical procedure

Diagnosis of Herniated Tibialis Anterior Muscle by Dynamic Ultrasonography: A Case Report / 대한정형외과학회잡지

Muscle herniation is a relatively common disorder in the extremities, particularly in the lower extremity where the tibialis anteior muscle is the most commonly affected. Usually muscle herniation is asymptomatic or mild but a few patients complain of cramping or severe pain. We report a case of a bilateral hernia of the tibialis anterior muscle that was confirmed by dynamic ultrasonography.

Sciatic Nerve Palsy Complicating Gluteal Compartment Syndrome due to Rhabdomyolysis: A Case Report / 대한정형외과학회잡지

Rhabdomyolysis is an acute disorder resulting from skeletal muscle injury in which intracellular contents are released into extracellular space and plasma. The condition may result from drug or alcohol abuse, infection, collagen disease or intensive excersice, trauma and longstanding comatous mentality. We report a case of sciatic nerve palsy complicating gluteal compartment syndrome due to rhabdomyolysis.

Clinical Results of Percutaneous Endoscopic Discectomy in Herniated Intervertebral disc of Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the clinical outcomes and roentgenographic changes after an percutaneous endoscopic discetomy of an intervertebral disc herniation of the lumbar spine. SUMMARY OF LITERATURE REVIEW: Percutaneous endoscopic discectomy can preserve normal posterior element in the treatment for herniated intervertebral disc of lumbar spine. MATERIALS AND METHODS: Fifty two patients (41 men, 11 women), who had been treated with percutaneous endoscopic discectomy due to a herniated intevertebral disc of the lubar spine and were followed at least 1 year, were enrolled in this study. The mean age was 26.5 years (21~45) and the mean follow-up period was 42 months (12~76). Fifteen, 28 and 9 herniated discs were extracted from L3-L4, L4-L5 and L5-S1, respectively. RESULTS: After the percutaneous endoscopic discectomy, excellent and good results were obtained in 71% (37 cases) of patients but 9% (5 cases) of patients reported poor results. A roentgenographic assessment at the final follow-up showed no instability and no degenerative spondylotic finding. However, the intervertebral disc space was decreased in only 1 case. CONCLUSION: An percutaneous endoscopic discectomy is an effective method for treating a herniated intervertebral disc of the lumbar spine. However, prudent patient selection is very important for achieving good results.

Immunoreactivity of Somatostatin Receptor Subtype 2 in Dorsal Root Ganglia in the Rat / 대한정형외과학회잡지

PURPOSE: Somatostatin has been suggested to play a role in the transmission of neurotransmitters and in the modulation of pain. Of the different subtypes of somatostatin receptors 2, sstr2A and sstr2B are important in the modulation and transmission of pain. The present study was carried out to investigate sstr2 immunoreactivity in rat. MATERIALS AND METHODS: Dorsal root ganglia (DRG) cells at the L4-L6 levels of the spinal cord of 10 rats (Sprague-Dawley, 200-250 g) were examined for sstr2 by immunohistochemistry. RESULTS: In the control group, sstr2A immunoreactivity was strongly positive in the dense network within laminae I and II of the dorsal horn at spinal levels (L4-L6). In contrast to sstr2A, sstr2B immunoreactivity was observed throughout laminae III-VI. In the DRG, sstr2A and sstr2B immunoreactivities were mainly found in medium-sized neurons. CONCLUSIONS: The distribution of sstr2A immunoreactive cells among sstr2 in the dorsal root ganglia (L4-6) resembles that of somatostatin. Incontrast to sstr2A, sstr2B immunoreactivity showed a different distribution. The presence of sstr2A at laminae I and II, and sstr2B at laminae III-VI of the dorsal horn may modulate sensory functions at these different regions of the spinal cord. Considering different actions according to the receptors of the neurotransmitter, the functions of the isoforms of sstr2 appear variable in terms of modulating and transmitting pain.

Differential Expression of Somatostatin Receptor Subtype 2 in Dorsal Root Ganglia after Ischemic Injury in the Rat / 대한정형외과학회잡지

PURPOSE: The somatostatin has been suggested to play a role in the transmission of neurotransmitters and the modulation of pain. Therefore, this study was carried out to investigate the spatial and temporal alterations of sstr2 (somatostatin receptors 2) immunoreactivity after an ischemic injury in rats. MATERIALS AND METHODS: Fifty-five rats (Sprague-Dawley, 200-250 g) were assigned to the experimental group, the other five to the control group. In the experimental group, an occlusion of the left common iliac artery was made using an aneurysm clip. Ten groups were classified according to the time after ischemiareperfusion. Dorsal root ganglia (DRG) cells in the L4, L5, L6 levels of the spinal cord, from the rats were examined the sstr2 using an immunohistochemistry technique. RESULTS: The sstr2A/B immunoreactivity (IR) appeared in the DRG after ischemia-reperfusion. The number of sstr2A- and sstr2B-IR neurons were markedly lower in the group of rats 12 hours after ischemia-reperfusion. In the group of rats one day after ischemia-reperfusion, the sstr2A- and sstr2B-IR neurons began to recover in both number and immunoreactivity. Furthermore, 3 days after ischemia-reperfusion, sstr2A/B immunoreactivity decreased in number and immunoreactivity, and 7 days after ischemia-reperfusion, very weak immunoreactivity was observed in the cytoplasm. CONCLUSION: The sstr2A/B immunoreactivity of the DRG exhibited different appearance according to the post-traumatic compartment syndrome or ischemic injury of the leg. In addition, the chronological alterations of sstr2A and sstr2B immunoreactivities may be important in controlling the pain after a transient ischemia-reperfusion event.

The Distribution of CGRP Containing Cells Innervating the Calcaneal Tendon in Rat Dorsal Root Ganglia / 대한해부학회지

This study was performed to investigate origins of the dorsal root ganglion cells containing calcitonin gene -related peptide (CGRP) which innervate the calcaneal tendon in the rat. We used the horseradish peroxidase (HRP) or fluoro -gold (FG) to trace retrogradely somatic afferents in dorsal root ganglion cells after unilateral injections into the rat calcaneal tendon. HRP or fluoro -gold labeled DRG cells for the calcaneal tendon were seen generaaly in lumbosacral (L1 to S1) DRGs ipsilaterally. In lumbosacral DRGs, the largest number of labeled cells were found in the L6 DRG. Many DRG cell bodies contained the CGRP throughout the L1~S1. A plenty of HRP -or FG -labeled cells innervating the calcaneal tendon were also identified to contain the CGRP in L1~S1 DRGs. These FG +/- CGRP DRG cells innervating the calcaneal tendon were primarily found in the L6 DRG. These results suggest that the main sensory DRG for the calcaneal tendon is the L6. This fact may be available in diagnosis and treatment of neurogenic pain in the calcaneal tendon.

The Effect of Extracellular Collagen on Synthesis of Extracellular Matrix in a 3-Dimensional Culture of Intervertebral Disc Cells / 대한척추외과학회지

STUDY DESIGN: In-vitro experimental study. OBJECTIVES: To determine the proteoglycan synthesis of the rabbit nucleus pulposus cells in various concentration of extracellular collagen type I and II under the stimulation of TGF-beta1. SUMMARY OF LITERATURE REVIEW: Therapeutic effect of growth factor and gene therapy can be altered by composition of extracellular matrix. However, the effect of extracellular collagen types I and II on synthetic activity of intervertebral disc cells is not thoroughly studied before. MATERIALS AND METHODS: The nucleus pulposus cells were isolated and cultured from 10 skeletally mature rabbits. Cultures were trypsinized and incorporated into alginate beads with different concentration of extracellular collagen type I and II (0.5%, 1.0% and 1.5%). Those cultures with TGF-beta1 (10 ng/ml) served stimulated condition of matrix synthesis. Newly synthesized proteoglycans were assessed by 35 S-sulfate incorporation using chromatography on Sephadex G-25 in PD-10 columns. Scintillation count was normalized with DNA content by Hoechst dye method. RESULTS: In basal condition, difference in proteoglycan synthesis in given concentration of extracellular collagen type I and II were statistically insignificant. In stimulated condition with TGF-beta1, difference in proteoglycan synthesis in given concentration of extracellular collagen type I and II was also statistically insignificant. However, cultures in stimulated condition with TGF-beta1 showed increased amount of newly synthesized proteoglycans compared to those of basal condition regardless of the concentration of extracellular collagen type I and II (p < 0.05). CONCLUSION: Anabolic response of rabbit nucleus pulposus cells is relatively insensitive to extracellular matrix composition, which facilitates application of gene therapy in various conditions of disc degeneration.

Origins of Dorsal Root Ganglion Cells with CGRP innervating Quadriceps Femoris Tendon of Rat / 대한정형외과학회잡지

PURPOSE: This study was undertaken to determine the origins of dorsal root ganglion (DRG) cells containing calcitonin gene-related peptide (CGRP) which innervate the quadriceps femoris tendon in the rat. MATERIALS AND METHODS: DRG cells containing CGRP, which innervate the quadriceps femoris tendon, from 25 rats (Sprague-Dawley, 200-250 g) were examined using the retrograde tracing technique (neural tracers: horseradish peroxidase and fluorogold) combined with immunohistochemistry. RESULTS: Injection of horseradish peroxidase (HRP) or fluoro-gold (FG) into the quadriceps femoris tendon resulted in the ipsilaterally labelling of cells between L1 and L6 DRGs. However, a large number of the labelled cells innervating the quadriceps femoris tendon were found in the L3 and L4 DRGs. Many DRG cells were immunostained with CGRP antibody in the L1-6 DRGs. The number of CGRP immunoreactive cells in the lumbar DRGs was larger than in the sacral DRG. FG labelled cells containing CGRP immunoreactivity (FG+CGRP cells) were found in the lumbosacral DRGs. Many FG+CGRP cells innervating the quadriceps femoris tendon were located in the L3 and L4 DRGs. CONCLUSION: These results show that the main DRG origin for the sensory innervation of the quadriceps femoris tendon is L3 or L4. The neurogenic pain of the quadriceps femoris tendon may originate from this region, and suggests that this may be important for the release of neurogenic pain.

Comparison of Results obtained from the Modified Brostrom and the Chrisman-Snook Procedures for Chronic Lateral Ankle Instability / 대한정형외과학회잡지

PURPOSE: To compare results of the modified Brostrom procedure and the Chrisman-Snook procedure for chronic lateral ankle instability. MATERIALS AND METHODS: Twenty-eight patients (30 ankles) who underwent 20 modified Brostrom procedures or 10 Chrisman-Snook procedures were available. Follow-up averaged 3.2 years (1.3-5.4 years). Clinical results were graded according to the AOFAS clinical rating system. The talar tilting angle was also measured. RESULTS: Clinical results were rated as excellent in 15, good in 4, and fair in 1 ankle after the modified Brostrom procedure, and excellent in 7, and good in 3 ankles after the Chrisman-Snook procedure. Three complications occurred after the Chrisman-Snook procedure; delayed wound healing in 1 ankle, and transient neuralgia in 2. Mean talar tilting angle was improved from 17.4+/-6.6degrees to 6.6+/-1.2degrees by the modified Brostrom procedure, and from 15.6+/-5.9degrees to 3.0+/-1.1degrees by the Chrisman-Snook procedure. CONCLUSION: Significant differences were found in the clinical results obtained using the two procedures, and good function was obtained in a high percentage of patients. The procedure of choice should be decided upon based on the patient's condition and the doctor's preference.

MR Assessment of Distribution and Amount of Joint Effusion in Patients with Traumatic Knee Joint Disorders

PURPOSE: To clarify the distribution of joint effusion, and the relationship between type of injury andamount of joint effusion seen in traumatic knee joint magnetic resonance imaging (MRI). MATERIALS AND METHODS: Weretrospectively reviewed the MR images of 400 patients with traumatic knee joint effusion. The knee joint spacewas divided into four compartments: central portion (para-ACL, para-PCL), suprapatellar pouch, posterior femoralrecess, and subpopliteal recess, and we then compared the amount and distribution of effusion. For statisticalanalysis, the chi-square test was used. RESULTS: Among 400 MRI examinations of joint effusion, 383 knees (96%)showed homogeneous low intensity on T1-weighted images, and - except for ten cases of fluid-fluid levels-homogeneous high intensity on T2-weighted images. Knee joint effusion was clearly shown to be distributed mainlyin the suprapatellar pouch (345, 86%), followed by the central posterior femoral recess, and the subpoplitealrecess (p<0.001). Extensive joint effusion was less frequently found in the normal group, but was occasionallyfound in the combined injury group (p<0.001). The relationship between amount of joint effusion and type ofinjury was statistically significant (p<0.001), except in the case of medial and lateral collateral ligamentinjury. CONCLUSIONS: The distribution of joint effusion in patients with traumatic knee disorders is a reflectionof anatomic communication, and whether the amount of joint effusion was small or large depended on the anatomicallocation and type of injury.