Fracture in a Young Male Patient Leading to the Diagnosis of Wilson's Disease: A Case Report

Wilson's disease is a rare genetic disorder that has abnormal copper metabolism. Although the disease's main problems are found in liver and brain, some studies revealed manifestation of various musculoskeletal problems in the patients. In this report, we encountered a young patient who had fracture in the forearm bone. Initially, exception to a previous history of fracture from a motorcycle accident, the patient did not have any medical or drug use history, and laboratory work-ups were insignificant. However, with suspicion on his bone's integrity, bone densitometry was recommended and revealed osteopenic change. To disclose a cause for the change, questions were made to recall any particular history or event, and his complaint of recent vision loss led to ophthalmologic consultation where under slit-lamp test found Kayser-Fleischer ring. Further laboratory work-up found low levels of serum copper and ceruloplasmin and high copper level in 24-hr urine sample that led to the diagnosis of Wilson's disease. Although Wilson's disease has been frequently noticed with considerable musculoskeletal manifestation, it rarity makes the diagnosis illusive to a physician. Hence, despite of its rarity, it is imperative to remember the disease's bony manifestation, and it should be suspected in young patients with demineralized bone when the reason for brittle bone cannot be answered with other better known conditions.

The Efficacy of Ultrasound-Guided Brachial Plexus Block in Trauma Patients

PURPOSE: We evaluated the efficacy of brachial plexus block under the guide of ultrasonography for immediate management of open wound in patients with multiple trauma. METHODS: From July 2012 to April 2013, 34 patients with multiple trauma had brachial plexus block for immediate management of open wound in the upper extremity. We evaluated the patient satisfaction of the anesthesia and any complications related to the block. RESULTS: During the brachial plexus block, intravascular injection of lidocaine occurred in one patient. Except this, all patients who received brachial plexus replied they would choose brachial plexus block if they had to undergo the same surgery. CONCLUSION: Brachial plexus block is an effective anesthesia technique in the immediate management of open wound in upper extremities.

Schwannoma of the Ulnar Nerve in the Elbow: A Case Report

Schwannomas are soft tissue sarcomas arising from neurilemma of Schwann cells in peripheral nerves, and is the most frequent type of benign tumor found in these nerves. We report a case of a Schwannoma of the ulnar nerve in the elbow joint, and along this report, give a review of the literature. A 46-year-old male patient was hospitalized with complaints of swelling and pain in the left elbow and a tingling sensation and hypoesthesia of the fourth and fifth fingers. Physical examination of the patient showed he was positive for Tinel's sign, and magnetic resonance imaging results demonstrated the presence of a Schwannoma. Subsequent biopsy and excision of the Schwannoma was carried out. The suspected mass, which had a clear margin separating it from the healthy nerve of the medial left elbow, was removed along with its 2 x 2 x 3 cm capsule after a histological diagnosis of a Schwannoma was made. Pathophysiological results confirmed the excised mass as a Schwannoma. Schwannoma of the ulnar nerve within the elbow joint is rare and differential diagnosis is difficult. Therefore, treatment can only proceed after the presence of Schwannoma has been confirmed by physical and radiological examinations.

Schwannoma of the Ulnar Nerve in the Elbow: A Case Report

Schwannomas are soft tissue sarcomas arising from neurilemma of Schwann cells in peripheral nerves, and is the most frequent type of benign tumor found in these nerves. We report a case of a Schwannoma of the ulnar nerve in the elbow joint, and along this report, give a review of the literature. A 46-year-old male patient was hospitalized with complaints of swelling and pain in the left elbow and a tingling sensation and hypoesthesia of the fourth and fifth fingers. Physical examination of the patient showed he was positive for Tinel's sign, and magnetic resonance imaging results demonstrated the presence of a Schwannoma. Subsequent biopsy and excision of the Schwannoma was carried out. The suspected mass, which had a clear margin separating it from the healthy nerve of the medial left elbow, was removed along with its 2 x 2 x 3 cm capsule after a histological diagnosis of a Schwannoma was made. Pathophysiological results confirmed the excised mass as a Schwannoma. Schwannoma of the ulnar nerve within the elbow joint is rare and differential diagnosis is difficult. Therefore, treatment can only proceed after the presence of Schwannoma has been confirmed by physical and radiological examinations.

Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture

PURPOSE: Authors compare clinical and radiological results of internal fixation group and hemiarthroplasty group for comminuted proximal humerus fracture to find out which the treatment method have to be chose for comminuted proximal humerus fractures. MATERIALS AND METHODS: Patients who were treated from March 2005 to March 2007 and available for 2 years follow-up were targets of this study. The internal fixation group had 38 cases, and hemiarthroplasty group included 26 cases. The results were analyzed both clinically and radiologically. RESULTS: On average, Bone union took 15.6 weeks in the internal fixation group. Constant score between the internal fixation and hemiarthroplasty groups were on average 75+/-6.5 points and 70+/-7.4 points (p=0.034). In 3-part fracture, Constant score between both groups were 78+/-5.4 points from the former and 71+/-2 points, respectively (p=0.028). In 4-part fracture group, Constant score were 72+/-8 points for the internal fixation group and 69+/-9.2 points for the hemiarthroplasty group (p=0.041). CONCLUSION: Internal plate fixation can gain better outcome than hemiarthroplasty in 4-part fracture as well as 3-part fracture of proximal humerus by careful dissection for preservation of blood supply for humeral head and optimal reduction.

Comparison of Results Between Immediate Fixation Group and Delayed Reconstruction Group in Displaced Mid-shaft Fractures of the Clavicle

PURPOSE: Several authors have reported excellent results of delayed reconstruction of non-union & malunion in displaced mid-shaft fractures of the clavicle and these results were equal to that of immediate fixation. But direct comparison between these treatments is rare. We evaluated the results between the immediate fixation group and delayed reconstruction group for treating displaced mid-shaft fractures of the clavicle. MATERIALS AND METHODS: We studied the results of 18 cases with immediate fixation of displaced mid-shaft fractures of the clavicle and 15 cases with delayed reconstruction of non-union & malunion after conservative management, and these cases were seen from March 2000 to February, 2006. The final postoperative outcome was analyzed according to the clinical outcomes with using the Constant score and the radiological findings of bony union. RESULTS: The constant score was low in the delayed reconstruction group compare to that of the immediate fixation group (p value=0.045). For the pain score & the activities of daily living score, a statistically significant difference was seen between the two groups (p0.05). Radiological findings of bony union were seen for both groups at an average of 8.8 weeks for the immediate fixation group and at an average of 9.8 weeks for the delayed reconstruction group. CONCLUSION: Though the delayed reconstruction group was shown good clinical and radiological results, the immediate fixation group had a significantly better pain score, a better activities of daily living score and a better Constant score. It is important to choose the initial treatment option for displaced mid-shaft fractures of the clavicle after sufficient explanation to patients about the merits and demerits between these two treatment options

The Clinical Results of ACL Reconstruction with the Bio-Transfix(R) Technique

PURPOSE: We wanted to evaluate the clinical results of ACL reconstructions with using four strands of an auto-hamstring tendon graft and a bioresorbable-Transfix device (Arthrex, Naples, FL) for femoral fixation. MATERIALS AND METHODS: From May 2005 to May 2007, a total of 108 cases that underwent arthroscopic ACL reconstruction with using hamstring tendons and a bioresorbable-Transfix device were followed-up for more than 1 year (Range: 12~32 months) postoperatively. The clinical results were evaluated by the preoperative and postoperative Lysholm knee scores, the International Knee Documentation Committee (IKDC) scoring system and a KT-1000 arthrometer. The radiological results were evaluated by the measurement method described by L'Insalata. RESULTS: Preoperatively, the mean Lysholm knee score was 70.8+/-6.8 (Range: 52.0~81.0) which improved to 94.2+/-4.8 (Range: 76.0~98.0) at the last follow up (p<0.05). According to the IKDC scoring system, 104 cases (96%) were categorized as normal or nearly normal and no case was categorized as severely abnormal at the last follow up (p<0.05). KT-1000 arthrometer instability was statistically improved from 8.8 mm (Range: 3~17 mm) to 2.1 mm (Range: 1~7 mm) (p<0.05). The femoral and tibial tunnels were statistically widened 22.7% and 12.7% on the AP view, respectively, and 17.4% and 8.4% on the lateral view, respectively, at the last follow up (p<0.05). CONCLUSION: ACL reconstruction using auto-hamstring tendons with a bioresorbable-Transfix device showed satisfactory results on the physical examination and functional evaluation.

Three Years Follow-up Results of High-flex Total Knee Arthroplasty

PURPOSE: To evaluate the Three years clinical results of a total knee arthroplasty using the NexGen LPS-Flex fixed bearing system. MATERIALS AND METHODS: One hundred knees(65 patients) which used the LPS-Flex system for primary TKA and were followed up for a minimum Three years were evaluated. Evaluations included preoperative and postoperative range of motion(ROM), factors affecting the postoperative ROM that included age of the patient, the body mass index, the flexion contracture, degree of varus deformity, and Hospital for Special Surgery score. RESULTS: Knee ROM increased from preoperative 122.8 degrees to postoperative 130.5 degrees. The mean HSS score improved from preoperative 58.4 to postoperative 91.3. The femoral-tibial angle was changed from preoperative 6.4 degrees varus to a pos- toperative 5.5 degrees valgus. The most important factor that influenced the range of motion after an arthroplasty was the preoperative range of motion. One deep infection developed, but was cured with synovectomy and administration of antibiotics. CONCLUSION: Primary TKR with NexGen LPS-Flex system showed satisfactory early results including excellent ROM. We found that preoperative ROM had a significant effect on postoperative ROM.

Comparative Analysis between Patellar Resurfacing and Retention in Total Knee Arthroplasty: 5-year Follow-up Result / 대한정형외과학회잡지

PURPOSE: To compare the clinical and radiological results between patellar resurfacing, group and patellar retention group in total knee arthroplasty. MATERIALS AND METHODS: Of the 74 patients who underwent total knee arthroplasty on due to knee osteoarthritis since March 1996, and followed-up for at least for 5 years, there were 42 and 32 cases in the patellar retention and patellar resurfacing groups respectively. These subjects were evaluated preoperatively and at 1 and 5 years postoperatively using the pain score, Hospital for Special Surgery (HSS) knee score, walking and stair-climbing in knee function score and radiological analysis. The radiological evaluation was achieved by measuring the patellar tilt angle and displacement with a 45degreesmerchant view. The results were analyzed using the student's t-test. RESULTS: There were no significantly differences between the patellar resurfacing and patellar retention groups in the pain score, HSS knee score, walking in knee function score and radiological analysis (p>0.05), but the patellar retention group achieved superior results in stair-climbing (p<0.05). CONCLUSION: The clinical and radiological results were similar in the patellar retention and patellar resurfacing groups. The use of selective indications of patellar resurfacing is required in order to achieve better results for total knee arthroplasty.

Method for Positioning the Tibial Tunnel in Anterior Cruciate Ligament Reconstructions

PURPOSE: This study determined that knee extension and its relationship to the slope of the intercondylar roof for positioning the tibial tunnel in ACL reconstructions. MATERIALS AND METHODS: Fifty subjects (25 men and 25 women) between the age of 25 and 40 were recruited for the study. We obtain a lateral roentgenogram of their knees in maximum extension. We measured knee extension angle, roof angle and the location of central axis of the tibial tunnel. We also used statview IV program for statistics. RESULTS: Regression analysis of the measurements from the two authors revealed knee extension (r2=0.846, p<0.0001), roof angle were reliably measured(r2=0.630, p<0.0001). There was a strong relationship between the two authors in their selection of the position for the center of the tibial tunnel(r2=0.702, p<0.0001). There was considerable variety in the degree of knee extension, roof angle and the position of the tibial tunnel. We failed to detect a difference between men and women since the population was insufficient. A correlation between knee extension and roof angle was week (r2=0.207, p<0.008). CONCLUSION: There is variety of extension angle and roof angle of knees among persons. It is required to customize the position of tibial tunnel in ACL reconstructions because of differences in anatomy.

The effect of early therapeutic electrical stimulation on bone mineral density in the paralyzed limbs of the rabbit

The purpose of this animal experiment was to evaluate the changes of bone mineral density in paralyzed limbs, and to assess the effects of electrically stimulating muscle contraction upon bone mineral density (BMD) in paralyzed limbs during the four week period immediately following spinal cord injury (SCI). Ten rabbits were used for the study, spinal cords were totally transected at the T11 spine level. The paralyzed quadriceps femoris of one limb was contracted by electrical stimulation for 60-minutes daily, while the other side was not stimulated as a control. The BMD of each lower limb was measured by Dual Photon Absorptiometry before and four weeks after acute SCI. BMD of both limbs decreased in all rabbits four weeks after SCI. The decrease in BMD for stimulated and non-stimulated limbs was 6.130 +/- 3.212% and 9.098 +/- 3.831%, respectively during the four-week period after SCI. The BMD of stimulated limbs decreased significantly less than that of the non-stimulated limbs. Electrically induced muscular contraction reduced bone mineral loss in the paralyzed limb during the early stage of SCI in the rabbit.

Treatment for Painful Bipartite Patella Using Vastus Lateralis Tendon Release / 대한정형외과학회잡지

Nine patients, who had ten painful bipartite patellae, were managed with a new operative tech nique in which the vastus lateralis insertion to the painful patellar fragment is detached subpe riosteally while the continuity of the tendon-periosteum complex to the main portion of the patella is preserved. A grossly mobile patellar fragment was removed in 3, fragment that showed minimum mobility was left in situ in 5 and fragment that had significant articular component was fixed with 4.0 mm cancellous screw in one. All of the patients had prompt relief of pain and returned to full sports activity within three months of the operation, 2 of 5 patellas that had not been removed united by bone to the main portion of the patella within 2 years post-operatively. Overall, 10 knees had excellent results at an average of four years post-operatively.

Mechanism of Hypercallus Formation in Patients with Concomitant Fracture and Head injury / 대한정형외과연구학회지

We built the hypothesis that the hypertrophic callus formation is mediated by beta-endorphin that stimulates secretion of GH and increase circulation growth factor activity in head injury patient. We classified 4 groups such as 5 normal person(control), group I;5 patients with only fracture, group II;5 patients with fracture and head injury, group III; 5 patients with only head injury, group IV. We obtained the samples of serum from each group at 0, 2, 4, 6, 8 weeks after trauma and assessed the serum level of GH, GHRH, somatostatin. The serum level of GH was statisticallyu higher in group III, IV than group I, II. There was not significant difference in serum level of GHRH. The serum level of somatostatin was higher in group II, III, IV than group I, but there was no statistical significance in each group. GH has a important role in hypertrophic callus formation in severe head injury patients, but there was no evidence that the mechanism is mediated by beta-EndorphinGHRH & somatostatin-GH-GF-1, beta-FGF axis. There may be a another mechanism in increasing GH that was stimulated by beta-endorphin in thalamus and lateral ventricle, and it should be necessary for further evaluation of it.

Entry Point of Pedicle Screw in the Lower Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: We analysed retrospectively the entry point of pedicle screw in the lower lumbar spine using computed tomoscan. OBJECTIVES: The purpose of this study is to find the ideal entry point of pedicle screw in the lower lumbar spine. MATERIALS AND METHODS: We evaluated 98 patients with each second, third, fourth, fifth lumbar spine, and divide three group into normal group(NP), osteoarthritis group(OA), degenerative spondylolisthesis group(DS). We collected the two axial images of lower lumbar spine from CT at the same level. One image is parallel to upper end plate and again, the facet joint is well visuable, another image is the pedicle which cross the center, and the size of the both sides of pedicle is same and largest. And then we were superimposed mathematically above two images with computer. With the use of these three images, facet joint and pedicle axis orientation, pedicle isthmus width, distance between facet joint and pedicle axis, distance between lateral surface of facet and pedicle axis are measured. RESULT: The ideal entry point of pedicle screw is 3mm lateral from lateral end of facet joint in NP group, in OA 0.5~1mm medial and in DS 0.3mm medial from lateral end of facet joint. CONCLUSION: The selected anatomical landmark using the pedicle screw insertion is not advisable because of the variations of pedicle width and orientation depend on pathologic state of the lower lumbar spine, especially facet joint. We suggest that the sugeon should selected well the ideal entry point of the pedicle screw, knowing the shape and any anatomical variations of the pedicle in details before screw insertion with peroperative computed tomoscan.

Micronuclei in Peripheral Blood Lymphocytes of Chromate Workers / 대한산업의학회지

No abstract available.

Evoked EMG Monitoring during Ttanspedicular Screw Fixation / 대한척추외과학회지

STUDY DESIGN: In a prospective study of 38 patients undergoing lumbar pedicle screw instrumentation 200 pedicle hole were tested intraoperatively using electrical stimulation. OBJECTIVES: To evaluate the searching stimulus intensity at pedicle in Korean and to identify the most vulnerable root in transpedicular screw fixation of lumbosacral spine. MATERIALS AND METHOD: Electromyelogram(EMG) was monitored from eight lower extremity muscles bilaterally. Constant current stimulation pulses(0.2msec duration) were delivered through a ball-tipped nasopharyngeal probe used to evaluate each pedicle hole, and evaluated for searching stimulus intensity, the current necessary to evoked EMG RESULTS: The searching stimulus intensity above 5 mA were 194 cases(97.0%), above 7mA 151cases(75.5%), above 10 mA 107 cases(53.5%) and below 5 mA were 6 cases(3.0%). The vastus medialis muscle is most sensitive in L2(100%), L3(83.3%), tibialis anterior is in L4(68.4%), peroneus longus is in L5(44.2%) and gastrocnemious is in S1(64.5%). CONCLUSIONS: Stimulus-evoked EMG monitoring is a valuable and efficacious adjunct to lumbar pedicle screw instrumentation. A stimulation threshold greater than 5 mA reliably indicates adequate screw position and the root located at infero-medial side of pedicle is most vulnerab18 in transpedicular screw fixation.

Operative Treatment of Thoracolumbar Spine Fractures with AO Internal Fixator / 대한정형외과학회잡지

A retrospective analysis of eighty-six consecutive patients who underwent stabilization with AO internal fixator for thoracolumbar spine fractures was performed at Wonju Christian hospital between 1988 and 1994. The purpose of this study was to determine the quality of reduction and stabilization with the fixateur interne(F-I) and the effects of limited posterior segmental fixation on neurologic recovery and rehabilitation. The mean wedge angle of the fractured vertebra was changed from 19.2° preoperatively to 8.4° preoperatively, and remained almost unchanged at last follow up(10.2°). Also, the wedge index showed nearly no bony loss of correction within the reduced fracture vertebra(corrected from 0.63 to 0.83 and 0.81 at follow up). The mean kyphosis angle was corrected from 22.3° to 8.3° and 16.9° at last follow up. Most of the change of kyphosis was due to the disc space collapse above the fractured vertebra. Transpedicular cancellous bone grafting for the vertebral body fractures effected a significant improvement in results of fixation. All cases of translational displacement were anatomically reduced. No neurologic or vascular complication occurred. Fixateur interne is capable of achieving three-demensional reduction in unstable thoracolumbar spinal fractures and maintaining sufficient stability until bony healing is achieved.

Anterior Cervical Fusion with Cervical Spine Locking Plate System / 대한정형외과학회잡지

The anterior approach to arthrodesis of the cervical spine has become a widely accepted. However, anterior interbody fusion in the presence of the posterior instability may be complicated by the bone graft dislodgement, kyphotic deformity or nonunion. As an attempt to prevent this complications, anterior cervical plate after graft placement was introduced. Although, anterior cervical plates provide excellent fixation for the anterior column, potential risk for injury to the spinal cord, soft tissues or screw loosening leading to dysphagia has been reported. Morscher, of Switzerland, has developed an anterior cervical spine locking plate(CLSP) system that attempts to prevent the migration and looseing of screw by using a cross-split screw head that can be locked into the plate. The secondary advantage of this system is the limination of the required posterior cortex purchase. The authors reviewed 42 patients in whom the CLSP system was applied for the treatment of degenerative disease or trauma. With a mean followup of 18 months, all 42 patients went on to fusion. One patient had screws placed in the discal space, hardware failure occurred in two patients. There was no iatrogenic injury to the spinal cord or esophagus. In conclusion, the CLSP system provides a reliable fusion with minimal complications. It should be considered in multilevel anterior cervical arthrosis and cervical fractures.

Cementless Total Hip Arthroplasty Using Hydroxyapatite-Coated Femoral stem / 대한정형외과학회잡지

PURPOSE: Evaluation of clinical and radiologic results of THR using HA-coated femoral stem. MATERIALS AND METHODS: From Jan. 1991 to Dec. 1992, we carried out 177 cases of Total Hip Arthroplasty using hydroxyapatite-coated implants of 167 patients, and among thses, 153 cases in 144 patients were followed up more than 24 months. The implants used were 74 cases of Mallory-Head Hip system, 41 cases of Omnifit system and 38 cases of Profile system. RESULTS: The average Harris Hip Score was 48.3 points preoperatively, 94.7 points at POD 1 year and 95.7 at POD 2 years. Seven patients(5.2%) complained thigh pain at POD 2 years. On the radiologic findings, cancellous condensation was noted around the hydroxyapatite coating region of femoral stem in 84 cases(54.2%), and radiolucent lines were noted at the non-coating region of distal stem in 102 cases(67.7%), but were less than 2mm and not progressive. There was no statistically significant differences among the groups of these three implants(P < 0.05). Comments : This early result of femoral stems with hydroxyapatite-coating was quite satisfactory, however, long-term follow-up studies will be necessary.

Treatment of Recurrent Anterior Instability of Shoulder using Modified Bristow Procedure / 대한정형외과학회잡지

We performed 15 cases of modified Bristow procedures for recurrent anterior instability of shoulder from january, 1987 to december, 1992 and the following results were obtained. 1. The patient's age at initial dislocation varied from 15 years to 29 years of age. 2. The most common cause of the recurrent anterior instability of shoulder was sport injury(6 cases) and next were traffic accident, hanging with one hand. 3. The average loss of external rotation of shoulder after operation were 10 degrees and internal rotation were 7 degrees. 4. The post-operative complication and recurrence were not observed. 5. End results were excellent in 7 and good in 5 by Rowe's grading system. 6. Strict attention to bone block placement was mandatory and decreased the risk of screw malpo-sition.