Do Cerclage Cables Delay the Time to Bone Union in Patients with an Unstable Humeral Shaft Fracture Treated with Intramedullary Nails?

PURPOSE: To evaluate the time to bone union after open reduction and internal fixation with cerclage cables followed by intramedullary nailing (IMN) for unstable humeral shaft fractures. MATERIALS AND METHODS: Patients with a humeral shaft fracture treated by IMN were enrolled. One group of patients was treated via open reduction and internal fixation with cables followed by IMN (cable group; n=32), while the other group was treated with a conventional closed IMN (non-cable group; n=64). The length of time to bone union and functional scores [Disabilities of the Arm, Shoulder and Hand (DASH) and University of California, Los Angeles (UCLA) scores] were measured for all patients. RESULTS: No significant differences were found in terms of age, gender, injury type, or smoking history between the two groups, except for the type of fracture. The cable group had significantly more complex types of fracture than the non-cable group (p0.05). No differences were identified in terms of DASH and UCLA scores (28.8 and 32.1 in the cable group and 26.4 and 32.6 in the non-cable group, respectively; p=0.335 and 0.264). CONCLUSION: In unstable humeral shaft fractures treated by IMN, open reduction and internal fixation with additional cerclage cables do not delay the length of time to bone union or increase the rate of other complications.

Intraneural Ganglion of the Digital Nerve of the Hand: A Case Report

Intraneural ganglia in the upper extremity are rare, and the involvement of the digital nerve of hand has not been reported. The following case report demonstrates a 57-year-old woman with a symptomatic nodular mass on the thenar area of the left hand. Magnetic resonance images showed a lobulated, homogeneous mass of high signal intensity on T2-weighted images and low signal intensity with peripheral enhancement on T1-weighted images. Excisional biopsy and histopathologic examination revealed an intraneural ganglion of the digital nerve of the thumb. Her symptom disappeared immediately after the surgery, and has remained free of abnormal sensation and parestheia for the 3-year follow-up period.

Complex Limb Trauma with Neuro-Vascular Injury

No abstract available.

A Comparison of Sugar Tong Splint and Radial Gutter Short Arm Splint after Closed Reduction of Distal Radius Fracture

PURPOSE: Various methods of immobilization exist in the nonsurgical treatment of the distal radius fracture, among which sugar tong splint is the most commonly used. In this study, we observed the results after treating the distal radius fracture with radial gutter short arm splint without elbow immobilization. MATERIALS AND METHODS: Among the fracture of distal radius who have been under conservative treatment after closed reduction, 48 patients (from January to December of 2005) were treated with sugar tong splint, and 57 patients (from January to December of 2007) were treated with radial gutter short arm splint. The loss of reduction after closed reduction of the two groups was compared. The types of fractures were determined as either stable or unstable based on the fracture segment. Follow up examination of the stability was performed 8 weeks later. RESULTS: There were 105 patients (male, 52; female, 53) with mean age of 50.2. Of the 57 patients with the sugar tong splint, loss of reduction was shown in 11 cases out of the 31 unstable fractures and none in 17 stable fractures. In the radial gutter short arm splint group, 12 cases out of 33 unstable fractures showed loss of reduction. Only one case in 24 stable fractures treated by the radial gutter splint has failed. There was no statistically significant difference in the reduction loss rate between the two immobilizing methods (p-value=0.37), as well as the type of reduction loss (p-value>0.05). CONCLUSION: Sugar tong splint and radial gutter short arm splint had no difference in maintaining reduction. Sugar tong splint has been considered as the most effective method of maintaining reduction by preventing rotation of the forearm and flexion-extension of the elbow. Furthermore, radial gutter short arm splint can minimize limitation of the elbow motion and daily life activity. Based on our results, radial gutter short arm splint, which only immobilize the wrist joint, had a good results as well.

Pseudoaneurysm of the Anterior Tibial Artery After Closed Intramedullary Nailing of a Tibial Shaft Fracture: A Case Report / 대한정형외과학회잡지

We would like to present a case of pseudoaneurysm of the anterior tibial artery after closed intramedullary nailing of a tibial shaft fracture. In an automobile accident, a 56-year-old man sustained a transverse diaphyseal fracture of the left tibia. 10 days after closed intramedullary nailing with laterally inserted proximal and distal locking screws, an enlarging tender, pulsating mass was found over the anterolateral aspect of his left leg. Ultrasonography and angiography revealed a pseudoaneurysm of the anterior tibial artery at the level of the distal locking screw. Surgical resection of the injured segment of the anterior tibial artery associated with a pseudoaneurysm and a vein graft was performed.

Transforming Growth Factor-beta1 and Bone Morphogenetic Protein-2 Upregulates Matrix Synthesis and Chondrogenic Phenotype in Intervertebral Disc Cells / 대한척추외과학회지

OBJECTIVES: To determine effect of transforming growth factor-beta1 and bone morphogenetic protein-2 in matrix synthesis and expression of chondrogenic phenotype in human intervertebral disc cells. MATERIALS AND METHODS: The intervertebral disc cells were harvested and cultured from the surgical patients for the degenerative disc disease. TGF-beta1 was purchased from R&D and BMP-2 was produced by transfection of pcDNA3.1/Hygro/BMP-2 to CHO cell using Lipofectamine 2000. rhBMP-2 was separated by Heparin-Sepharose A chromatography. TGF-bata1 and BMP-2 were administered to culture. Proteoglycan synthesis was assessed by 35S incorporation and expression of matrix mRNA was analyzed by RT-PCR for collagen I, collagen II, aggrecan, and osteocalcin. RESULTS: TGF-bata1 and BMP-2 showed increased proteoglycan synthesis and expression of collagen I, collagen II and aggrecan mRNA in dose dependent manner respectively. There was no recognizable synergistic effect in matrix synthesis and matrix mRNA expression. Throughout dosage, expression of osteogenic phenotype (osteocalcin mRNA) was not noted. CONCLUSION: TGF-beta1 and BMP-2 proved to be effective anabolic agent for maximizing matrix synthesis without evidence of osteogenesis.

Cervical and Thoracic Intervertebral Disc Calaification in 6 an Year Old Girl: A Case Report / 대한정형외과학회잡지

Intervertebral disc calcification is rare in children, and known as a spine disease of unknown cause. Since the original description by Baron in 1924, about 200 cases have been reported worldwide. This disease is usually self-limited and responds to a conservative management unless there is an evidence of disc herniation into the spinal canal with associated neural symptoms. We experienced a case of intervertebral disc calcification in a 6-year-old girl and report the clinical and radiographic findings in detail.

Intraosseous Epidermoid Cyst of Distal Phalanx: A case report / 대한정형외과학회잡지

Epidermoid cyst is a common skin lesion. However, in areas where the skin is tightly adherent to the bone, a portion of the epidermis may be implanted into the bone traumatically or a subcutaneous epidermoid cyst may penetrate the bone cortex. Intraosseous epidermoid cyst is rare, and arises almost exclusively in the skull and phalanges of the hand. In the hands, terminal phalanx is involved in almost all cases. Differential diagnosis includes glomus tumor with bone erosion, enchondroma, osteomyelitis, aneurysmal bone cyst and metastatic tumors. We experienced a case of intraosseous epidermoid cyst in the distal phalanx of a 28-year-old woman, who had injured her finger about 20 years ago. We report the clinical, radiographic and pathological findings in detail.

Midcarpal Fusion with Excision of Scaphoid for Scapholunate Advanced Collapse ( SLAC ) / 대한정형외과학회잡지

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.

Double Incision Technique for Carpal Tunnel Release / 대한정형외과학회잡지

A preliminary study was conducted to evaluate the immediate postoperative recovery and socioeconomic efficacy with the surgical release of Carpal tunnel syndrome by double incision technique. Sixty cases of carpal tunnel syndrome were operated by one surgeon between 1993 and 1995 and 44 cases in 39 patients were available for this study. Surgery was done under axillary block and patients were evaiuated preoperatively, 3 weeks and 6 weeks each postoperatively. The evaluation was focused on the immediate recovery in terms of subjective symptoms of pain and paresthesia, local tenderness, strength of grip power and pinch power and postoperative disability. 1l was noted that surgical release of carpal tunnel syndrome utilizing double incision technique was as effective as seen in the endoscopic release in terms of quicker recovery of pain, local tenderness and strength. It was also noted that this double incision technique was as safe and economically beneficial as observed in the conventional open procedure.

MRI Staging of Legg - Calve - Perthes ( LCP ) Disease / 대한정형외과학회잡지

One of the most important prognostic factors in LCP disease is the extent of epiphyseal involvement. Magnetic resonance imaging is considered to be the technique of choice for early diagnosis of Legg-Calve-Perthes disease. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced Tl-weighted(spin-echo) and T2-weighted(gradient-echo) images. Four different areas were identified in the femoral epiphysis(necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LCP is well described by Catterall and others. Comparing their description with our MRI finding, we suggest classification of LCP into three phases: (I) necrosis, (II) regeneration(IIa-early and IIb-late) and (III) reossification and sequale. T2 weighted image was useful in the early stage and Tl weighted image was useful in the later stage for evaluation of involved extent of the disease. With MRI, we think that we can find out the stage of LCP more early and rationally, pathological factors more easily and appropriate time for operation exactly. we believe that MRI is more adequate method to decide the stage of LCP disease.

Buschke-Ollendorff Syndrome: A Case Report / 대한정형외과학회잡지

The osteopoikilosis is commonly known as harmatoma in which metaphyseal and epiphyseal area of long bones and the bone of pelvis, hands, feet and et al, contain islands of dense cortical bone with normal Harversian system without any symptoms. The radiologic findings of the osteopoikilosis is multitude of oval or well-circumscribed areas of increased density, 2 to 10 mm in size, in symmetrical distribution and normal uptake in bone scan. Buschke-Ollendorff syndrome, which is transmitted by autosomal dominant, is characterized by the association of osteopoikilosis and connective tissue nevi which are popular and symmetrically distributed lesions on chest, back, buttock, thigh or arm. Authors report three Buschke-Ollendorff syndrome, studied by CT scan, MRI, bone scan and bone and skin biopsy, among five patients associated with osteopoikilosis found by simple radiologic study from ten members in one family with their pedigree.