Anatomic Reconstruction of the Distal Radioulnar Ligament for Posttraumatic Distal Radioulnar Joint Instability

BACKGROUND: To analyze clinical outcomes after anatomical reconstruction of distal radioulnar ligaments in patients with chronic post-traumatic instability of the distal radioulnar joint. METHODS: Anatomical reconstruction was performed in 16 patients with subluxation or dynamic instability of distal radioulnar joint following trauma. Osteotomy was performed simultaneously in 10 patients with radial malunion. The average follow-up period was 18.9 months. For clinical outcome assessment, we performed the anteroposterior stress test, measured the range of motion and grip strength, and performed radiological examination. For assessment of the pain and function, we used the Patient Rated Wrist Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the Modified Mayo Wrist Score. RESULTS: Anteroposterior stress test performed at the last follow-up showed normal in 12 patients, mild laxity in 3, and residual subluxation in one. The average Patient Rated Wrist Evaluation was 9.1 for pain and 11.2 for function. The average Disabilities of the Arm, Shoulder and Hand score was 10.5. The average Modified Mayo Wrist Score was 92.8; there were 10 excellent, 5 good, and 1 poor case. The average grip strength improved from 69.7 1b to 80.9 1b. A revision osteotomy was performed on the patient with residual subluxation in order to obtain normal alignment of the joint. CONCLUSIONS: Anatomical reconstruction of the distal radioulnar ligaments is recommended to restore distal radioulnar joint stability. In addition to ligament reconstruction, realignment of the distal radioulnar joint seems critical when the instability is combined with malunion of the radius.

Comparison of Arthroscopy and Routine MRI About Cartilage Lesion in Knee Joint

PURPOSE: The cartilage lesions of routine MRI (no cartilage-specific image sequences) compared with those of arthroscopy for detecting how much we can predict. MATERIALS AND METHODS: We made a retrospective study of 53 patients with cartilage lesions of medial femoral condyle in the knee arthroscopy from Nov. 2003 to Jan. 2006. We analyzed the extent of agreement in cartilage lesions between arthroscopy and routine MRI using modified Outerbridge classification. RESULTS: All patients were categorized by modified Outerbridge Grade I~IV. In arthroscopy, 3, 4, 24, 22 cases were reported in each category: on routine MRI, 3, 10, 12, 23 cases were reported in each category and there were 5 normal cases. The sensitivity of cartilage lesions on MRI was high (90.6%), however, the agreement of those was low (K=0.24). We found 24 cases (45.2%) that MRI levels and arthroscopy levels were matched. We found 29 cases (54.7%) that those two levels were not matched. CONCLUSION: It is important to make a close inspection of chondral surfaces even in routine MRI. And cartilage lesions in routine MRI should be considered as those of higher grade in arthroscopy.

Multiple Spine Fractures of Young Adult (Over 3 Vertebrae) / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the mode of injury, associated lesions, time of injury, and the checking times of MRI/CT and Bone scans in multiple spine fractures SUMMARY OF LITERATURE REVIEW: CT was predominantly used to discover and identify the fracture levels of the spine. However, fracture level identification in the entire spine was limited. CT, MRI and Bone scans were used for diagnosing multiple spine fractures. MATERIALS AND METHODS: Between 1999 and 2004, 12 patients who had more than level 3 spine fractures were studied. The mode of injury, associated lesions, time of injury, and checking times of MRI/CT and Bone scans were analyzed. RESULTS: The causes of the spinal injuries were from a fall from height, from traffic accidents and from multi-complex forced trauma in 7, 4 and 1 cases, respectively. Most cases had no severe associated lesions. The accuracy of the plain roentgenograms was 26% and that of CT was 35.3%, and the average checking time was 1.5 days. The accuracy of MRI was 100% and the average checking time was 4.3 days. The accuracy of the bone scans was 100%, and the average checking time was 11.7 days. The fracture patterns consisted of 37, 7, 3 and 3 non-compression (74%), compression (14%), burst (6%) and fracture-dislocation types (6%), respectively. The major treatment methods used with these patients were conservative. The treatment methods in 4 cases were with the use posterior instrumentation. CONCLUSIONS: MRI produced more accurate and faster results than the other methods of detection. The accuracy of the plain roentgenograms was 26%, which was relatively inaccurate. Therefore, if the patient complains of multiple back pains, the surgeon must check other diagnostic tools.

Early course and Long term follow-up after Automated Percutaneous Lumbar Discectomy and Short term follow-up after Nucleoplasty / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to compare the early course of APLD with the long term follow-up after APLD and also the long term follow up after APLD with the short term follow-up after nucleoplasty. SUMMARY OF LITERATURE REVIEW: We evaluated the postoperative clinical course of both APLD and nucleoplasty. The evaluation of the postoperative clinical course was performed by using the Oswestry Disability Index (ODI). MATERIALS AND METHODS: We studied 59 patients who underwent APLD and nucleoplasty from 1989 to 2004. We defined the 26 cases with less than 5 years follow up as the early course follow-up after APLD, the 20 cases with over 5 years follow up as the long term after APLD, and 13 cases with less than 5 years follow up as the short term follow up after nucleoplasty. We then compared three groups. We inspected the condition of the discs on MRI and the level of the operated disc. RESULTS: The most common type of disc was a protruded disc (69.4%). Its ODI was lower than that of the extruded type. 5 cases out of the total group underwent open discectomy after APLD. In our study, the extruded type patients underwent a worse clinical course than protruded type patients. The patients who under went procedures at two affected disc levels had higher ODI scores compared to patients who underwent procedures at one level. The ODI score of the early course follow-up after APLD was 12.4%, the ODI of the long term follow up was 6.9% and that of the short term follow-up after nucleoplasty was 4.6%. CONCLUSIONS: On the long term follow-up, the patients who underwent APLD had significant improvement for any of the clinical parameters, as compared with their preoperative status. The patients who underwent nucleoplasty had a better prognosis than those patient who underwent APLD with less than 5 years follow up.