Preoperative Magnetic Resonance Imaging Evaluation in Patients with Adolescent Idiopathic Scoliosis

STUDY DESIGN: Retrospective case series. PURPOSE: The purpose of this study was to examine the incidence of neural axis abnormalities and the relevant risk factors in patients with adolescent idiopathic scoliosis (AIS). OVERVIEW OF LITERATURE: The use of preoperative magnetic resonance imaging (MRI) to assess the whole spine in patients with idiopathic scoliosis is controversial, and indications for such MRI evaluations have not been definitively established. However, we routinely use whole-spine MRI in patients with scoliosis who are scheduled to undergo surgical correction. METHODS: A total of 378 consecutive patients with presumed AIS who were admitted for spinal surgery were examined for neural axis abnormalities using MRI. To differentiate patients with normal and abnormal MRI findings, the following clinical parameters were evaluated: age, sex, menarcheal status, rotation angle (using a scoliometer), coronal balance, shoulder height difference, and low back pain. We radiographically evaluated curve type, thoracic or thoracolumbar curve direction, curve magnitude and flexibility, apical vertebral rotation, curve length, coronal balance, sagittal balance, shoulder height difference, thoracic kyphosis, and the Risser sign. RESULTS: Neural axis abnormalities were detected in 24 patients (6.3%). Abnormal MRI findings were significantly more common in males than in females and were associated with increased thoracic kyphosis. However, there were no significant differences in terms of the other measured parameters. CONCLUSIONS: Among the patients with presumed AIS who received preoperative whole-spine MRI, 6.3% had neural axis abnormalities. Males and patients with increased thoracic kyphosis were at a higher risk.

Treatment of Scaphoid Nonunions with Autogenous Cancellous Bone Grafting Combined with Threaded K-wire Fixation

PURPOSE: To evaluate the results of surgical treatment of autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunions. MATERIALS AND METHODS: We retrospectively reviewed the 13 patients with scaphoid nonunion, which was follow up at least 12 months from March 1999 to June 2003. According to the Mayo classification, two cases were type P (proximal third), eight cases were type W (waist) and three cases were type D (distal third). According to the Russe classification, eight cases showed horizontal oblique type, another two cases were transverse, and last three belonged to vertical oblique type. We assessed the radiologic bony union, correction of humpback deformity and lateral intrascaphoid angle and degenerative change of radioscaphoid joint, clinical results were evaluated using assessment of Maudsley. RESULTS: Radiologic union was obtained in all cases, mean time of union was 15.4 weeks (13~17.4 weeks), and there was no radiological evidence of postoperative humpback deformity, intercarpal instability, proximal osteonecrosis and degenerative changes. According to assessment of Maudsley, there were 7 excellent cases, 4 good cases, 1 fair case and 1 poor case among these 13 cases. The final clinical results were 11 excellent cases, 2 good case in the aspect of wrist pain and tenderness. All range of motion was satisfactory to patients except 4 cases (3 fair, 1 poor) and every patients could return to work except 1 poor case. CONCLUSION: The surgical treatment using a autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunion was a relatively straightforward technique, which provides simplicity, and high union rate.

Treatment of Failed Internal Fixation of Intertrochanteric Fractures of Femur

PURPOSE: To compare the result of failed internal fixation of intertrochanteric fractures treated with arthroplasty and 95degrees angled blade plate. MATERIALS AND METHODS: From June 2000 to may 2003, there were 12 cases with failed internal fixation of intertrochanteric fractures among 185 cases treated with dynamic hip screw and followed up for more than 1 year. The 4 cases were treated with bipolar hemiarthroplasty, 1 case with total hip arthroplasty, and other 7 cases were treated with 95degrees angled blade plate with allograft, evaluated clinically the operation times, blood loss, walking ability and complication. RESULTS: In the 7 cases, which treated with 95degrees angled blade plate, the average operation time was 109 minutes, the average blood loss was 431 ml. The result of keeping abreast of 1 year, no aid ambulation was 4 cases, the cane ambulation was 2 cases, the walker ambulation was 1 case, and there was no pain in 3 cases, mild pain in 4 cases, and no moderate pain. In the 5 cases, which treated with arthroplasty, the average operation time was 157 minutes, the average blood loss was 618 ml. During 1 year, no aid ambulation was 3 cases, the cane ambulation was 1 case, the walker ambulation was 1 case, and no pain in 2 cases, mild pain in 1 case, moderate pain in 1 case. CONCLUSION: Both 95degrees angled blade plate and arthroplasty can be useful for failed internal fixation of intertrochanteric fractures, and the choice of implant must be determined with caution, considering the surgical conditions of patient, as well as benefits of each devices

A Case of Mitral Regurgitation due to Isolated Cleft Mitral Valve

A cleft in the anterior mitral valve leaflet is commonly associated with an atrioventricular septal defect, but an isolated cleft mitral valve is a rare condition. We report a case of a 27-year-old woman with severe mitral regurgitation due to an isolated cleft mitral valve. The echocardiography showed an anterior cleft on the mitral valve, but a normal sized and positioned left ventricular papillary muscle without septal defect. Under the diagnosis of mitral regurgitation due to the isolated cleft mitral valve the patient underwent mitral cleft repair. After surgery, the further echocardiography showed no mitral regurgitation.