“Free Hand” or Wire Guide: In Reply

No abstract available.

Remaining Loose Bodies after Arthroscopic Surgery Including Extensive Capsulectomy for Synovial Chondromatosis of the Hip

BACKGROUND: The purpose of our study was to evaluate the usefulness of hip arthroscopy including extensive capsulectomy for synovial chondromatosis of the hip. METHODS: From 2008 to 2016, 13 patients with synovial chondromatosis of the hip were treated with arthroscopic removal of loose bodies and synovectomy using three arthroscopic portals. An extensive capsulectomy was performed to allow the remaining loose bodies to be out of the extracapsular space, and the excised capsule was not repaired. All patients were assessed by clinical scores and the radiographs were reviewed to determine whether the remaining loose bodies disappeared at the last follow-up. RESULTS: Eight men and two women were followed up for a minimum of 1 year (mean, 3.8 years; range, 1 to 6.8 years) after hip arthroscopy. Clinical outcomes such as modified Harris hip score, University of California Los Angeles score, and Western Ontario and McMaster Universities Osteoarthritis Index score improved at the last follow-up. Although seven hips had remaining loose bodies after arthroscopic surgery, the remaining loose bodies disappeared in five hips (71.4%) at the last follow-up. CONCLUSIONS: Arthroscopic surgery was useful to treat synovial chondromatosis of the hip. In spite of limited removal of loose bodies, arthroscopic procedures including extensive capsulectomy could be effective for the treatment of synovial chondromatosis of the hip.

Learning Curve of Internal Fixation for Nondisplaced Femoral Neck Fractures: A Cumulative Sum Analysis

BACKGROUND: The purpose of this study was to determine whether there is a learning curve for internal fixation for nondisplaced femoral neck fractures using the cumulative sum (CUSUM) technique. We applied the CUSUM technique in monitoring performance of a single surgeon in internal fixation for nondisplaced femoral neck fractures. METHODS: Fifty consecutive patients who underwent internal fixation for nondisplaced femoral neck fractures were evaluated retrospectively. Loss of fixation within 6 months postoperatively was considered as failure of treatment. Patients were stratified into the early experience group (cases 1 to 25) and the late experience group (cases 26 to 50). The CUSUM method was used to analyze the learning curve. RESULTS: There was no failure of treatment during study period. The operation time became shorter with experience. Using the CUSUM analysis to plot the learning curve, there was no significant learning curve observed for multiple pinning for nondisplaced femoral neck fractures. CONCLUSIONS: The CUSUM analysis revealed there was no obvious learning curve to become proficient at internal fixation for nondisplaced femoral neck fractures, if technical principles were followed during the procedure.

Trend in the Age-Adjusted Incidence of Hip Fractures in South Korea: Systematic Review

BACKGROUND: The incidence of hip fractures has been reported to vary geographically, and its trend has also varied widely. However, the trend in the age-adjusted incidence of hip fractures has not been well studied in Korea. After we identified eligible studies presenting multiple age-adjusted incidences of hip fractures in the Korean population in PubMed, we evaluated changes in the absolute number of occurrence and calculated the annual percentage change (APC) of age-adjusted incidences of hip fractures. METHODS: We have searched PubMed for the original and English-language literature on the incidence of hip fractures in the Korean population published since 2000. The studies presenting multiple age-adjusted incidences of hip fractures were selected. We evaluated the change in the absolute number of hip fractures and calculated the APC of age-adjusted incidences of hip fractures for each study. RESULTS: Three eligible articles were identified. The absolute number of hip fractures for both genders increased over time in all three studies although the operational definition of hip fracture differed from one another. The APC of the age-adjusted incidence of hip fractures was positive for women and negative for men. However, the change was not statistically significant in both genders during each study period (2001–2004, 2005–2008, and 2006–2010, respectively). CONCLUSIONS: The age-adjusted incidence of hip fractures was stable among men and women, while the absolute number of hip fractures increased for both genders in Korea. Further studies with longer study periods on age-adjusted incidences are required to better determine the trend in the incidence of hip fractures in Korea.

Endogenous Cushing's Syndrome in a Patient with Systemic Lupus Erythematosus

Systemic lupus erythematosus is an autoimmune disease for which glucocorticoids are the mainstay of treatment. Cushing's syndrome is caused by glucocorticoid excess, which can be either exogenous or endogenous. Although iatrogenic Cushing's syndrome is the most common form, especially in patients undergoing glucocorticoid treatment, endogenous glucocorticoid excess should be considered because it has a different treatment strategy. We describe a 51-year old woman with a longstanding history of SLE. She was treated with steroid and cytoxan pulse therapy and plasmapheresis. Her lupus activity had been stable for 7 years with low-dose glucocorticoid treatment. She showed excessive weight gain, easy bruising, moon facies, truncal obesity, acne, and menstrual disorder. Given her history of long-term steroid therapy, iatrogenic Cushing's syndrome was considered the most likely diagnosis; however, worsening features of Cushing's syndrome with a minimal dose of glucocorticoid led us to diagnose endogenous Cushing's syndrome due to a left adrenal adenoma. The patient underwent laparoscopic left adrenalectomy. Her SLE was controlled with transient low-dose glucocorticoid treatment, and her lupus activity remained stable without glucocorticoid treatment. This is the first reported case of concomitant endogenous Cushing's syndrome in a patient with preexisting SLE in Korea. This case shows the importance of differential diagnosis including exogenous Cushing's syndrome and endogenous Cushing's syndrome in autoimmune disease patients with glucocorticoid therapy.

Coracoclavicular Screw Fixation and Tension Band Wiring in Treatment of Distal Clavicle Fracture

PURPOSE: The purpose of this study was to analyze the effectiveness of coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures. MATERIALS AND METHODS: From October 2006 to December 2010, 18 patients with Neer type 2 displaced distal clavicle fracture were surgically treated. Fixation was performed, using coracoclavicular screw with tension band wiring. Radiographic and clinical evaluation was performed and the University of California at Los Angeles (UCLA) shoulder rating scale was employed for the assessment of shoulder joint function. RESULTS: Osseous union was achieved approximately 9.5 weeks (8-11 weeks) in all patients. After the union, the screw and wire were removed under local anesthesia. All patients returned to the normal shoulder range of motion. Loosening of the screw was seen in two patients and breakage was seen in one patient. However, we could not observe the delayed union and complications, such as infection and refracture. All but one patient showed excellent results according to the UCLA shoulder score at one year after the operation. CONCLUSION: Coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures is a clinically useful technique with good result and less complication.

Osteochondral Autograft Using Head of Proximal Phalanx of Toe for Partial Osteochondral Defect of Proximal Interphalangeal Joint: A Case Report

Osteochondral injury due to the trauma of the hand is relatively common. If the size of the osteochondral fracture fragment is large, open reduction and internal fixation are often feasible in treating these problems. However, arthroplasty using osteochondral graft is more preferred when the particle is small and articular surface is comminuted or fully defected. There are many reports of osteochondral graft using the costal osteochondral graft but the osteochondral graft using the interphalangeal joint of the toe is rarely reported. Thoroughly reviewed with relevant articles, this report presents a case of a 33 year old male who was successfully treated with osteochondral autograft using the proximal interphalangeal joint of the toe due to the traumatic osteochondral defect in the head of the second proximal phalanx.

Posterior Lumbar Interbody Fusion and Unilateral Posterolateral Fusion with Local Bone and Single Cage: Comparison with Posterolateral Lumbar Fusion and Autologous Iliac Bone / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of posterior lumbar interbody fusion (PLIF) using a single cage and unilateral posterolateral fusion (PLF) with local bone, and to compare the clinical and radiological results with those of posterolateral lumbar fusion (PLF) with autologous iliac bone. MATERIALS AND METHODS: Fifty patients with single segment degenerative lumbar disease were treated with spinal fusion. Twenty six patients, who underwent PLIF with single cage and local bone without autologous iliac bone, were classfied as the "cage group". The other 24 patients, who underwent PLF using autologous iliac bone, were classified as the "PLF group". The fusion rate, lumbar lordortic angle, segmental angle, and intervertebral disc height were compared in the radiograph between the two groups. The clinical outcomes were evaluated by the Oswestry Disability Index. Statistical analysis was performed using a T-test and Chi-Square test. RESULTS: The bony fusion rate was 80.8% in the cage group and 83.3% in the PLF group. The intervertebral disc height was restored better in the cage group, but there was no statistical difference between the two groups (p=0.10). Average intraoperative blood loss was similar in the two groups (565 ml in the cage group vs 567 ml in the PLF group). The average operation time was longer in the cage group but the difference was not significant (146.7 min vs 134 min). In the PLF group, 22 patients experienced pain at the iliac graft donor site in the early postoperative period that persisted for more than 6 months in 5 patients. CONCLUSION: PLIF using a single cage and local bone for single segment degenerative lumbar disease produced satisfactory bony fusion with none of the donor site morbidity at the iliac bone.

Fixaton of Lesser Trochanteric Fragments on an Unstable Intertrochanteric Fracture of the Femur

PURPOSE: We evaluated the effect of cable fixation of the lesser trochanter for treating unstable intertrochanter fractures. MATERIALS AND METHODS: In this retrospective study, we assessed the availability of cable fixation of the lesser trochanter and the cause of complications in a series of 47 unstable intertrochanteric femoral fractures that were seen between February 2001 to May 2008 at our hospital. The fractures were classified using the Evans-Jensen classification system. The lesser trochanters were fixed in 21 cases. The correlations between the lag screw position, comminution of the fracture site and the radiological results were studied. Nonunion was diagnosed if patients experienced pain and the radiographs revealed a persistent, radiolucent defect at the fracture site 6 months after fracture fixation. RESULTS: Union was observed in 43 cases (91.5%). The average union time was 3.75 months. Nonunion was observed in 4 cases (8.5%) 1 in group l and 3 in group ll. The average sliding distance of the lag screw was 8.76 mm. In groups l and ll, the distance was 4.92 mm and 12.45 mm, respectively. Excessive sliding, which was defined as more than 15mm, developed in 9 cases, and 7 of these 9 cases were in group ll. The average neck-shaft angle change was 1.28degrees and 5.81degrees, respectively. CONCLUSION: Additional cable fixation of the lesser trochanter for treating intertrochanter fractures, including large posteromedial fragments, is recommended for preventing the excessive sliding of lag screws and varus deformity.

Progression of Preoperative Degeneration of the Adjacent Segmentafter Instrumented Lumbar Arthrodesis / 대한정형외과학회잡지

PURPOSE: Preoperative degeneration has not been clearly defined as a risk factor of adjacent segment disease (ASD). The aim of this study was to analyze the progression of preoperative degeneration at the adjacent segment after instrumented lumbar fusion. MATERIALS AND METHODS: Forty-eight patients (mean age: 63.9, range: 39-77) who underwent posterolateral fusion for a degenerative lumbar spine were reviewed. All the patients showed preoperative degenerative changes at the adjacent segment. The preoperative degeneration included disc degeneration (n=42), degenerative lumbar scoliosis (n=7), posterior translation (n=7), lateral translation (n=9), and spondylolisthesis (n=1). The patients were divided into the following three groups according to the progression of degeneration: Group I, No progression; Group II, asymptomatic radiographic progression; and Group III, symptomatic progression. RESULTS: There were 22, 15, and 11 patients in Groups I, II and III, respectively. The incidence of symptomatic progression of degeneration was 22.9%. Of the 42 patients showing disc degeneration, 9 patients (21.4%) developed symptomatic progression. On the other hand, 3 out of 7 (42.9%) patients with posterior translation and 5 out of 7 (71.4%) patients with degenerative scoliosis developed symptomatic progression. The age and number of fused segments were not predisposing factors to progression. CONCLUSION: The incidence of symptomatic adjacent segment disease in patients with preoperative degeneration was 22.9%. Preoperative coronal malalignment and posterior translation might be risk factors for adjacent segment disease. Correct selection of the fusion level is important for reducing the incidence of adjacent segment disease.

Factors affecting Reduction of Slippage in Posterolateral Fusion for Spondylolytic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: The purpose of this study was to analyze the reduction of spondylolisthesis after postural reduction and pedicle screw instrumentation for low-grade spondylolytic spondylolisthesis, and to determine the factors affecting reduction. MATERIALS AND METHODS: Twenty patients (mean age 52.5 years old; range, 30-71 years old), who underwent pedicle screw instrumentation and posterolateral fusion after wide laminectomy and facetectomy, were reviewed. The minimum follow-up period was 2 years. The percentage of slippage was measured on lateral radiographs by the Taillard method. We measured the slip angle, sacral inclination, lumbar lordosis, disc height, and angulation and translation on flexion-extension stress views. These radiological parameters were analyzed statistically for correlation with the reduction of slippage. RESULTS: In these passive reduction surgeries, no forceful reduction was attempted. The average percentage of slippage was 20.6% preoperatively, 13.0% after instrumentation, and 19.5% at the last visit. The reduction of slippage had a correlation with hypermobile angulation on flexion-extension radiographs (p=0.02). There were no significant correlations between the amount of reduction and translation on flexion-extension radiographs (P=0.99), slip angle (P=0.79), disc space height (P=0.6), lumbar lordosis (P=0.68), and sacral inclination (P=0.35). CONCLUSION: Loss of reduction that was achieved by postural reduction with pedicle screw instrumentation for spondylolytic spondylolisthesis occurred at the final follow-up. There was a negative correlation between the reduction of slippage and hypermobile angulation on flexion-extension dynamic radiographs.

Changes of Clinical Outcomes after Decompression and Fusion for Spinal Stenosis during 2-Year Follow-up Periods / 대한척추외과학회지

STUDY DESIGN: A prospective study OBJECTIVE: To assess the clinical outcomes after the surgical treatment of spinal stenosis, using patient-centered measurements at the serial follow-up times. SUMMARY OF LITERATURE REVIEW: Patient-centered measurements are appropriate to assess the clinical outcomes of surgery for spinal stenosis. MATERIALS AND METHODS: Thirty-seven patients underwent posterior decompression and posterolateral fusion, with an iliac autograft using pedicle screw instrumentation. They were assessed for their pain using a visual analog scale, and the Oswestry disability index for the preoperative functional disability, at 6 weeks, 3 and 6 months, and at 1 and 2 years, postoperatively. RESULTS: The pain, as measured by the visual analog scale, was 7.42 points before the operation, and 4.12 and 2.76 six weeks and 1 year after the operation, respectively. Compared with the pre-operation scores, 44% has improved after 6 weeks, and 73% after a year. The functional disability, as measured by the Oswestry disability index, was 56.5% before the operation, and 32.13 and 20.1% three months and 1 year after the operation. Compared with the pre-operation, 43% recovered after 3 months, and 65% after a year. The state of recovery state in the functional disability continued for 2 years after the operation. The disability recovered more slowly than the pain. CONCLUSIONS: Patient-centered measurements were found to be appropriate for assessing the clinical outcomes to surgery for spinal stenosis. After decompression and fusion for spinal stenosis, the pain and functional disability both improved for 1 year after the operation, with no worsening in the postoperative improvements at 2 years.

Posterolateral Decompression and Posterior Instrumentation in Lumbar and Thoracolumbar Burst Fracture with Neurologic Deficit / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the postoperative outcome of posterolateral decompression and posterior instrumentation in lumbar and thoracolumbar burst fracture with neurologic deficit. SUMMARY OF LITERATURE REVIEW: There are several methods to decompress the spinal canal following fracture. The use of posterolateral decompression had been limited due to several reasons including postoperative instability and further neurologic injury. The development of fixation system and new designed impactor solved the limitation of posterolateral decompression. MATERIALS AND METHODS: 11 posterolateral decompression and pedicle screw instrumentation in burst fractures were performed. We measured canal compromise, reduction of sagittal curve and recovery of neurologic condition before and after surgery and at final follow-up. RESULTS: Canal compromise was reduced from 60.4% to 12.8% postoperatively. The sagittal index was 24.5 .preoperatively, 2.3 . postoperatively and 7.4 .at final follow-up. The recovery of neurologic condition was 1.1 degree in Frankel grade. CONCLUSION: Single-stage posterolateral decompression and posterior instrumentation is an effective technique to obtain neurologic recovery and rigid stabilization in the management of a lumbar and thoracolumbar burst fracture with neurologic deficit.

A Case of Bilateral Knee Septic Artiritis Complicating Rheumatoid Arthritis / 대한류마티스학회지

Septic artiritis is a disease that causes a rapid joint destruction by various kinds of bacteria such as Staphylococcus aureus. It affects more frequently the patients with rheumatoid arthritis, diabetes, immunocompromised patients, and chronic steroid users. In patients with rheumatoid arthritis, 1 to 12% of patients are affected by septic arthritis. In these patients, it is very difficult to distinguish between an acute exacerbation of rheumatoid arthritis and a development of septic arthritis if the latter affects more than one joint. Septic arthritis usually affects single joint, especially the knee joint. If the diagnosis and treatment are delayed, it would cause sepsis resulting in high mortality and morbidity. Thus early diagnosis by arthrocentesis, prompt drainage, and antibiotics therapy are essential. We experienced a 46 years-old woman with rheumatoid arthritis who abused the steroids for 10 years and complaining recent aggravation of bilateral knee joint swelling, warmth, and tenderness. Large amount of pus from both knees showed Gram positive cocci. The immediate open surgical drainage of both knees was done. The patient recovered from septic arthritis after 6 weeks of antibiotics therapy. The synovial fluid microbiology study should be done in all joints of the patients with the risk factors of joint infection.

Diagnostic Usefulness of CT-guided Pe rcutaneous Biopsy of the Spine

PURPOSE: To evaluate the diagnostic value of CT-guided percutaneous biopsy of inflammatory and tumorous lesions of the spine and paraspinal soft tissue. MATERIALS AND METHODS: Twenty-three patients underwent CT-guided percutaneous biopsy of the spine and paraspinal soft tissue. Tentative clinical diagnoses determined before biopsy were tuberculous spondylitis (n=5), pyogenic spondylitis (n=4), butterfly vertebra (n=1), old compression fracture (n=3), discitis (n=1), hemangioma (n=1), metastasis (n=7) and multiple myeloma (n=1). Biopsy was performed at the following levels: cervical-(n=1), thoracic-(n=9), and lumbar-spine(n=13). The approach to biopsy of the spine and paraspinal soft tissue lesions was posterolateral (n=11), posterior (n=2), or transpedicular (n=10). RESULTS: Tissue considered adequate by the pathologist involved was obtained in 21 (91%) of the 23 cases. In 19 cases, pathologic findings supported the clinical diagnoses determined before biopsy. In two cases, pathologic and clinical diagnoses differed. Complications such as severe pain, bleeding, infection, neurologic deficit or damage to internal organs were detected neither during or after the procedure. CONCLUSION: CT-guided percutaneous biopsy is a safe and reliable method of obtaining a diagnosis in many cases involving different spinal and paraspinal lesions.