Diffuse Idiopathic Skeletal Hyperostosis and Thoracic Myelopathy in Spondyloepiphyseal Dysplasia Congenita: A Case Report / 대한정형외과학회잡지

Diffuse Idiopathic Skeletal Hyperostosis (DISH) had been regarded as a radiologic entity with an innocuous clinical course, but recent years it has been reported as potentially devastating, such as dysphagia, fracture following minor trauma and myelopathy. Spondyloepiphyseal dysplasia congenita is a rare condition with spinal involvement such as flat vertebrae and spinal deformities. We experienced a case of DISH with thoracic myelopathy in spondyloepiphyseal dysplasia congenita patient, and this report can elicit further concern to these disease entities.

Survival Analysis of Posterior Short Fusion in Thoracolumbar Fracture: Significance of Load-Sharing Score and Bone Mineral Density-Changseop / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the fixation survival rate and the radiologic prognostic factors of posterior short fusion in thoracolumbar fracture. SUMMARY OF BACKGROUND DATA: Posterior short fusion has the advantage of saving motion segments in spite of high fixation failure rate. The high load-sharing score is well known as a cause of fixation failure, but the effect of osteopenia is not evaluated. MATERIALS AND METHODS: Authors evaluated 27 patients treated surgically with posterior short fusion using pedicle screws as thoracolumbar fractures from 1995 to 1999. The median follow-up was 20.5 months (6-54). The survivorship using Kaplan-Meier method and the radiologic prognostic factors were evaluated. RESULTS: The sagittal index was preoperatively 16.7 dgree (+/-7.9 SD), immediate postoperatively 6.9 dgree (+/-4.6), and at last follow-up 10.6 dgree (+/-6.9). The fixation failures were detected in 4 patients, and the failure time was ranged from 6 months to 11(median 7.5). The overall survival rate was 82.3% at the last follow-up. The significant prognostic variables were load-sharing score, Jikei grade, compression percent and age in uni-variate analysis, but the load-sharing score and Jikei grade were significant prog-nostic factors in multivariate analysis. CONCLUSIONS: In decision to perform posterior short fusion, the load-sharing score and evidence of osteopenia should be consid-ered as a prognostic factors to avoid fixation failure in thoracolumbar fracture.

Chevron Osteotomy as the Treatment of Moderate to Severe Hallux Valgus Deformity / 대한정형외과학회잡지

Chevron osteotomy is one of the most widely used distal metatarsal osteotomies in the treatment of hallux valgus in adults. We performed chevron osteotomy on 11 feet (7 patients), and the combination of proximal metatarsal osteotomy and distal soft tissue procedure on 6 feet (4 patients) for painful hallux valgus associated with an increased hallux valgus angle (>35 degrees) and 1/2 intermetatarsal angle (>13 degrees). The results were as follows: 1. In the chevron osteotomy, the average correction of hallux valgus angle was 28.8 (19-36) degrees and the average loss of correction was 7.6 (3-18) degrees. The average correction of 1/2 intermetatarsal angle was 7.8 (6-13) degrees and the average loss of correction was 4.3 (1-10) degrees. 2. In the combination of proximal metatarsal osteotomy and distal soft tissue procedure, the aver age correction of hallux valgus angle was 34.3 (26-42) degrees and the average loss of correction was 4 (1-7) degrees. The average correction of 1/2 intermetatarsal angle was 9.8 (4-14) degrees and the average loss of correction was 2 (0-5) degrees. 3. The radiographic result of the combination method was significantly better statistically than that of the chevron osteotomy alone. 4. In the chevron osteotomy, the metatarsalgia of the great toe was subsided in 10 of 11 feet (91%) and the patients were satisfied with the cosmetic and functional result of their operation. Recurrence of hallux valgus deformity and superficial wound infection were seen in each case (9.1%). 5. In the combination of proximal metatarsal osteotomy and distal soft tissue procedure, the metatarsalgia of the great toe was subsided in all feet and postoperative complication was not found. In our studies, the chevron osteotomy applied to moderate to severe hallux valgus deformity was found as a relatively good radiographic result, but a recurrence of hallux valgus deformity was checked, compared with the combination of proximal metatarsal osteotomy and distal soft tissue procedure. Therefore, the chevron osteotomy can be applied to moderate to severe hallux valgus deformity but for the best result, the other procedure in addition will be necessary.

Arthroscopic Assisted Management of Displaced Intraartieular Calcaneal Fractures / 대한정형외과학회잡지

Although the management of fractures of the calcaneus still remains controversial, open reduction and internal fixation is gaining in popularity as the method of choice for the treatment of displaced intraarticular calcaneal fractures. However, open methods can make several complications such as neurovascular injury and infection. Thus we have performed the new technique of arthroscopic reduction and minimal internal fixation for displaced intraarticular calcaneal fractures in 5 cases. The results were evaluated between 12 and 16 months after surgery. A Bohler angle was restored to 25degrees-40degrees in all cases. Anatomical reduction of articular surface were obtained from 4 cases out of 5. No complications were found except 1 peroneal tendinitis. The clinical results by Creighton-Nebraska health foundation assessment for fractures of the calcaneus were 3 excellent, 1 good and 1 fair. Even though this was a few case and a short term follow-up study, the arthroscopic assisted management of displaced intraarticular calcaneal fracture induced a little complications and satisfactory results.

Tuberculous Spondylitis Complicated with Descending Aortic Pseudoaneurysm: Report of 1 Case / 대한척추외과학회지

Tuberculous spondylitis is not rare disease. Today the posterior instrumentation and posterior or posterolateral fusion concomitant with the anterior decompression and anterior interbody fusion have been used for the treatment of spinal tuberculosis. The authors experienced a case of tuberculous spondylitis complicated with descending aortic pseudoaneurysm. An aneurysm is defined as a localized dilatation of an artery that is at least one-half the size greater than is expected for that artery. Pseudoaneurysm occurring after previous operation, trauma, and infection. Erosion of the thoracic aorta with the development of an fistula in the presence of infection is an unusual and difficult problem to manage. We report a case and review related articles briefly.

Relationship between Traumatic Spinal Canal Stenosis and Neurologic Deficits in Thoracolumbar Burst Fractures / 대한정형외과학회잡지

In the assessment of thoracolumbar burst fractures, computed tomography(CT) is superior to other imaging modalities, especially when a more definitive assessment of the posterior elements of the spine or the nueral canal is desired. A few authors have reported the relationship between traumatic spinal canal stenosis and neurologic deficits. Authors analysed 64 patients with thoracolumbar burst fractures about the relationship between traumatic spinal canal stenosis and neurologic deficits using plane x-ray findings and CT scans. The results were as follows; 1. There was no difference of kyphotic angle and anterior vertebral height loss between neurologic deficit group on lateral plane x-ray findings. 2. The incidence of injury of the superior endplate was 100%(64/64); of the inferior endplate 53%(36/64); of the posterior element 45.3%(29/64). 3. Twenty(69.0%) of 29 patients with disruption of posterior element had neurologic deficits, while fourteen(40.0%) of 35 patients without disruption had neurologic deficits. 4. Spinal canal ratio of 35.3% or more at the epiconus level, 56.0% or more at the conus medullaris level, and 65.3% or more at the cauda equine level were significant factors for neurologic deficits in thoracolumbar burst fractures. Spinal canal ratio of 22.0% or less at the epiconus level, 34.5% or less at the conus medullaris level, and 43.1% or less at the cauda equine level were not accompanied with neurologic dieficit in thoracolumbar burst fractures. 5. Fifteen(68%) of 22 patients with neurologic deficit in epiconus and conus medullarsis level had the horsehoe or crescent shape of patient spinal canal, eight (66.7%) of 12 patients with neurologic deficit in cauda equine level had the horsehoe or crescent shape of spinal canal.

Radiologic Analysis of Primary Hip Replacements on the Porous: Coated Acetabular Component / 대한정형외과학회잡지

Component fixation on the acetabular side is not as much of a problem because of the simpler geometry and loading configuration. It is generally accepted that hemispheric component design is preferable and immediate implant stability can be achieved by using screws or spikes in the porous coated implants. The authors reviewed 130 primary noncemented porouscoated, press fit acetabular component in 110 patients; 84 were AML (Anatomical Medullary Locking) and 46 were HarrisGalante acetabular component. Radiologic analysis at a minimum of 3 years(average 4.5 years) was done with special regards to the vertical and medial migration, screw size and numbers, change of the radiolucent line and its zone with its fate and acetabular cup angles on the acetabular component by the 2 observers. Progressive radiolucent line at the component-bone intersurface were found in 14 cases(11%), frequently located in zone I and zone I & II. No significant vertical, medial migration and change of the acetabular cup angle were found. No screw and spike failure had occurred. No component had to be revised because of loosening. As a whole, in our 3-years experience we report excellent results with porous coated acetabular component although it dose not ensure long-term sucess.