Acute Infrapatellar Fat Pad Separation after Contusion in the Kneeling Position / 대한정형외과학회잡지

The infrapatellar fat pad (IPFP) is one of three fat pads located about the anterior knee. Injury in this region is relatively common. Damage to the IPFP is caused mostly by an iatrogenic injury from a surgical procedure or repeated small collision trauma. The authors experienced a case of an IPFP injury, that has not been reported in the domestic or international literature. In this case, acute IPFP separation followed by a contusion at the anterior aspect of knee in the kneeling position, confirmed using magnetic resonance imaging. The patient was fully recovered with conservative treatment.

Prevalence of Tarsal Coalition in the Korean Population: A Single Institution-Based Study / 대한정형외과학회잡지

Purpose@#Korean studies on the prevalence of a tarsal coalition are quite rare, and there are very few reports on the prevalence of multipletarsal coalitions among adults in the foreign literature. Therefore, this study examined the characteristics and prevalence of tarsal coalitionin the Korean population based on imaging tests. @*Materials and Methods@#The prevalence of tarsal coalition and its anatomical location and histological classification were reviewedretrospectively among 4,711 patients (4,454 males and 257 females) with an ankle sprain or ankle fracture who underwent foot and anklecomputed tomography and magnetic resonance imaging between March 2009 and February 2019 at the authors’ institution. @*Results@#Over a period of 10 years, 78 patients (1.7%) had a tarsal coalition, among whom 53 patients (67.9%) had an isolated tarsalcoalition and 25 patients (32.1%) had multiple tarsal coalitions. Regarding the anatomical location, a talocalcaneal coalition was the mostcommon type in both isolated (31 patients, 37 cases [62.7%]) and multiple (22 patients, 23 cases [45.1%]) tarsal coalitions. In the isolatedcoalition group, the second-most common type was calcaneonavicular coalition (10 patients, 16.9%), followed by naviculocuneiform (ninepatients, 15.3%) and cuboidonavicular coalitions (three patients, 5.1%). In the multiple coalition group, the second-most common coalitiontype was calcaneonavicular coalition (14 patients, 14 cases [27.5%]), followed by talonavicular coalition (six patients, six cases [11.8%]).From a total of 60 cases of talocalcaneal coalition, 24 cases (40.0%) were in the posterior facet, 18 cases (30.0%) in the middle facet, andfour cases (6.7%) in the anterior facet. Regarding the histological classification, cartilaginous coalition was the most common in both single(32 patients, 35 cases [59.3%]) and multiple (20 patients, 37 cases [72.5%]) coalition groups. @*Conclusion@#The present study found that talocalcaneal coalition was the most common type of tarsal coalition. In contrast to previousreports that a talocalcaneal coalition generally occurs in the middle facet, it was usually observed in the posterior facet in the presentstudy. In addition, although multiple tarsal coalitions have been reported to be quite rare, this study confirmed that they are not rare andcan occur in a range of patterns.

Total Hip Arthroplasty in Patients with Avascular Necrosis of the Entire Femur / 대한정형외과학회잡지

Avascular necrosis (AVN) is defined as the cellular death of bone and bone marrow components due to the loss of blood supply, and associated with post-traumatic or non-traumatic events. AVN usually involves the epiphysis of a long bone, such as the femoral and humeral heads, which are susceptible to osteonecrosis. Many studies have been conducted but they were restricted to investigations of femoral head avascular necrosis. The presence of osteonecrosis in the proximal femur may impair biological fixation after total hip arthroplasty. We report a 56-year-old male patient with avascular necrosis located not only at the femoral head, but also in the entire femur, including the medullary cavity, who underwent total hip arthroplasty 2 years earlier along with a review of the relevant literature.

Effect of Sarcopenia on Postoperative Mortality in Osteoporotic Hip Fracture Patients

BACKGROUND: Few studies have investigated the effects of sarcopenia on postoperative outcomes including mortality rates following surgery for osteoporotic hip fractures. The purpose of the present study was to determine the prevalence of sarcopenia and the relationship between sarcopenia and 1- and 5-year mortality rates in a consecutive series of patients with osteoporotic hip fractures. METHODS: Among patients who underwent hip surgery for osteoporotic hip fractures, this study included 91 patients subjected to abdominal computed tomography within 1 year of hip surgery. We defined sarcopenia using sex-specific cut-off points for the skeletal muscle index at the level of the third lumbar vertebra. All patients were divided into 2 groups according to the presence or absence of sarcopenia and the 1- and 5-year mortality rates were compared. To confirm factors affecting mortality in addition to sarcopenia, we examined patient age, sex, American Society of Anesthesiologists grade, location of fracture, type of surgery, and bone mineral density. RESULTS: The 1- and 5-year mortality rates were 20.9% and 67.2%, respectively. Among the 45 patients with sarcopenia, the 1- and 5-year mortality rates were 22.2% and 82.7%, respectively. Of the 46 patients without sarcopenia, the 1- and 5-year mortality rates were 19.6% and 52.7%, respectively. Results of the Kaplan-Meier analysis showed that sarcopenia did not affect the 1-year mortality rate (P=0.793), but had a significant effect on the 5-year mortality rate (P=0.028). Both perioperative sarcopenia (P=0.018) and osteoporosis (P=0.000) affected the 5-year mortality rate. CONCLUSIONS: Sarcopenia increases the risk of 5-year mortality in patients with osteoporotic hip fractures.

Acute Isolated Tear of Gluteus Medius in Young Male / 대한고관절학회지

The hip rotator cuff tear usually develops in the middle-aged through gradual degenerative changes, similar to rotator cuff tears in the shoulder. An acute tear in the hip abductor by a traumatic event in young ages is very uncommon. The authors experienced an unusual case of an acute traumatic tear isolated to the gluteus medius in a young male; thus, we report the treatment results in this rare case with a review of the literature.

Early Clinical Outcomes after Subacromial Injection of Ketorolac in Patients with Shoulder Impingement Syndrome: A Comparison with Steroid Injection / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical results between the subacromial injection of the ketorolac and that of the corticosteroid in patients with subacromial shoulder impingement syndrome. MATERIALS AND METHODS: Twenty patients with shoulder impingement syndrome received an injection of 60 mg ketorolac and were evaluated in terms of visual analogue scale (VAS), range of motion (ROM) and Constant-Murley score. The outcomes are compared with the data of patients treated by 40 mg triamcinolone injection, retrospectively. RESULTS: There was no significant difference in the demographics, VAS, ROM, and Constan-Murley score between the two groups before the injection. At the 4 weeks follow-up, pain improvement was significantly greater in the corticosteroid group (2.7±1.53) than in the ketorolac group (4.9±2.08; p=0.001). However 12 weeks after the injection, there was no significant difference in pain improvement between the two groups (ketorolac: 2.9±2.32, corticosteroid: 2.6±1.82; p=0.707). The Constant-Murley score at the final follow-up improved from 33.5 to 52.1 in the corticosteroid group, and from 39.0 to 56.6 in the ketorolac group (p=0.677). ROM was increased in both groups, and external rotation was significantly greater in the ketorolac group than in the corticosteroid group at the final follow-up (ketorolac: 29.3°±9.90°, corticosteroid: 20.8°±7.99°; p=0.005). CONCLUSION: In this study, ketolorac provided an effect equivalent to triamcinolone in the treatment of subacromial shoulder impingement syndrome at 12 weeks after the injection. This result could offer better opportunities to manage patients with diabetes or local and systemic side effects of repetitive use of corticosteroids.

Humeral Shaft Fracture Sustained during Arm Wrestling in Young Males / 대한스포츠의학회지

Humeral shaft fracture sustaining arm wrestling is rare, but occurs intermittently. We treated 15 cases of humeral shaft spiral fractures occurred during arm wrestling for fun since 2007. Average age was 22.47±2.69 years, average body mass index was 22.67±2.06 kg/m2. There was no prominent tendency for the fractures to occur at a certain phase of the match. Fractured level and length of each case were measured in the plain radiographs and compared with those of previous reports. Eight cases (53.3%) had an associating medial butterfly fragment, and the time taken until the fracture occurred was longer than that of simple spiral fracture (15.62±9.03 seconds vs. 7.85±2.67 seconds, p=0.048). Fractures were distributed mid to distal one third of humerus, the length of fracture was 7.93±2.69 cm and involved 25.43%±8.24% of humeral length. All cases except one treated surgically using plate and screws and returned their full activities within postoperative 3 months. Although arm wrestling is a simple and joyful sport, participants should be aware of the risks of injury during arm wrestling, especially for the amateur players.

Locating Femoral Insertion of Superficial Medial Collateral Ligament and Posterior Oblique Ligament Using Adjacent Structures: Magnetic Resonance Imaging Study / 대한정형외과학회잡지

PURPOSE: Anatomical medial knee reconstruction is crucial to the recovery of the knee joint. Our purpose is to determine the location of femoral insertion of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) from the attachment site of the adductor magnus and medial gastrocnemius tendon with MRI results. MATERIALS AND METHODS: A total of 200 knee magnetic resonance imaging results were retrospectively measured. The boundary of femoral insertion of sMCL and POL was marked and measured on the sagittal image. The attachment site of the adductor magnus tendon and medial gastrocnemius tendon was identified. The lineal, anterior-posterior and proximal-distal distances were measured from the attachment site to the center of the femoral insertion of sMCL and POL. RESULTS: The average size of sMCL and POL was as follows—sMCL: length of 13.5±1.7 mm, width of 10.9±0.3 mm and POL: length of 9.4±1.3 mm, width of 6.1±0.5 mm. The lineal distances from the insertion of the adductor magnus tendon and medial gastrocnemius tendon to the center of the sMCL and POL were measured—distances to the sMCL: 17.1±3.8 mm, 15.9±3.2 mm; distances to the POL: 11.9±2.9 mm, 8.2±2.7 mm. CONCLUSION: This study will help determine the location of the femoral attachment site of sMCL and POL by identifying the attachment section of the adductor magnus tendon and medial gastrocnemius tendon. Moreover, this study will guide the reconstruction of sMCL and POL when palpation of the bony structures become difficult.

Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the treatment outcomes of conservative treatment, early vertebroplasty (EVP), and delayed VP (DVP) of patients with osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: VP is regarded as an effective treatment for osteoporotic compression fractures. Few studies have compared the outcomes of each of the following treatments: conservative treatment, EVP, and DVP. MATERIALS AND METHODS: A total of 202 patients who presented with thoracolumbar osteoporotic vertebral compression fractures between January 2008 and December 2013 were divided into three groups: group 1 (conservative treatment), group 2 (VP within three weeks), and group 3 (VP after three weeks). We compared the collapse rate and the visual analog scale (VAS) score immediately after the trauma and at the 1-week, 3-week, 6-week, and 1-year follow-ups. RESULTS: The three abovementioned groups consisted of 89 patients, 60 patients, and 53 patients, respectively. The bone mass density (BMD) score of group 1 was statistically significantly higher than that of the others (p<0.05). In group 2, the average VAS score was high immediately after the trauma and low at the 1-year follow-up. Only group 2 showed a significantly high vertebral compression rate immediately after the trauma (p<0.05). Although there were no statistically significant differences in the incidence between the adjacent and the non-adjacent vertebral compression fractures, more patients underwent additional VP in groups 2 and 3 (p=0.980). CONCLUSION: The treatment method of performing EVP seems to yield the best clinical outcomes for patients with osteoporotic compression fractures who exhibit a relatively low BMD, high collapse rate, and high VAS score. Conservative management is the treatment of choice for osteoporotic compression fracture patients with a relatively high BMD, low collapse rate, and low VAS score.

Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training / 대한고관절학회지

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.

Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip / 대한고관절학회지

PURPOSE: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. MATERIALS AND METHODS: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1+/-0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0+/-19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. RESULTS: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). CONCLUSION: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.

Bilateral Bone Marrow Edema Syndrome of the Femoral Head with a Unique Onset: A Case Report / 대한고관절학회지

Bone marrow edema syndrome (BMES) is a rare condition which mainly affects the hip area. The etiology and pathogenesis of BMES is still unclear. Pain near the affected area, regional osteoporosis, bone marrow edema (identified using magnetic resonance imaging) and spontaneous regression within 6-12 months are the main characteristics of BMES. In this case, a 52-year-old male was diagnosed with BMES of the right hip followed by spontaneous subsiding of symptoms. After 3 years, and under nearly the same social and physical conditions, he was admitted again with newly developed left hip pain and again diagnosed with BMES. We report this rare case since a similar one has not been previously reported in the domestic literature and may be considered valuable for basic research relating to the pathogenesis of BMES.

An Intratendinous Tophaceous Gout Mistaken for Cellulitis in the Patellar Tendon / 대한정형외과학회잡지

Gout is characterized by recurrent attacks of arthralgia, and deposition of monosodium urate crystals in and around the joints of the extremities and soft tissues. Monosodium urate crystals are observed most frequently at the 1st metatarsophalangeal joint and usually presented in the ankle and wrist joint. However, no case of an intratendinous tophus in the patellar tendon has been reported in Korean literature. In this report, we found monosodium urate crystals in the patellar tendon on magnetic resonance imaging images and intratendinous tophus were visible to the naked eye by excision. We reported on the case of a patient who experienced an unusual intratendinous tophus in the patellar tendon.

Motor Weakness of Right Ankle Dorsiflexion Caused by Increasing Size of Sacroiliac Joint Cyst after Posterior Lumbar Interbody Fusion in a Patient with Spinal Stenosis: A Case Report

STUDY DESIGN: Case report OBJECTIVES: To report a case of motor weakness caused by the increasing size of a sacroiliac joint cyst after spinal fusion. SUMMARY OF LITERATURE REVIEW: There have been no reports on the increased size of a sacroiliac joint cyst and motor weakness after spinal fusion. MATERIALS AND METHODS: A 63-year-old female was admitted with low back pain and right sciatica. Magnetic resonance imaging (MRI) findings showed the spinal canal narrowing at L4-5 and a cystic lesion on the right sacroiliac joint. After surgery, the symptoms were relieved. RESULTS: One month after the operation, motor function had worsened to grade 4. Follow-up MRI revealed an increase in the size of the cystic lesion. Selective nerve root blocks were performed. There was gradual improvement, and the motor grade reached grade 5 seven months after the operation. CONCLUSIONS: We recommend that surgeons evaluate the adjacent segmental lesion by MRI before performing spinal fusion.

Diagnostic Utility of Magnetic Resonance Imaging for the Patients with Problems Confined to Cross-Legged Posture / 대한스포츠의학회지

This study was conducted to evaluate the diagnostic utility of magnetic resonance imaging (MRI) for the patients having problems confined to cross-legged posture. The study subjects were 128 cases (male 87.5%) and 120 patients from October 2008 to June 2013. Average age of male patients was 50 years old (range, 21-72 years old), and female 45 years old (range, 18-76 years old). The rate of positive MRI findings was compared according to abnormal physical findings. The average duration of symptoms was 11.7 months. The most frequent complains was on the back (41.9% at rest, 57% when taking the posture). Patrick test was positive for 33.6% of cases, simple radiography was abnormal only for 20% of cases. Bone scan was normal for all 98 cases. Only 21.9% of 128 cases showed abnormal MRI findings which were managed with conservative treatment. Limitation in the range of hip joint motion was not statistically associated with abnormal findings of MRI (p=0.148). Normal Patrick test was associated with normal MRI finding (p=0.001). Among normal cases on both physical and simple bone X-ray film, 88.6% were normal at MRI. In conclusion, for patients with physical complaints from the cross-legged posture, diagnostic utility of MRI is relatively low when they show normal on both physical examination and simple radiography.

Cement Leakage after Vertebroplasty; Correlation with Patterns of Compression Fractures and Bone Mineral Density (BMD)

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the influence of fracture patterns and the result of bone mineral density on cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: Leakage of bone cement after vertebroplasty has known to be related with the direction of cortical disruption of fractured vertebral body and low bone mineral density (BMD). MATERIALS AND METHODS: One hundred eighty-two patients with osteoporotic vertebral compressions were studied from January 2009 to August 2013. The patients' fracture levels and patterns were compared. Among them, the cement leakage patterns were analyzed in 105 patients who had undergone vertebroplasty. The findings were compared with fracture patterns including cortical disruption and BMD. RESULTS: Seventy-five cases of cement leakage were observed. Among them, intradiscal leakage was the most common type of leakage. In the patient group with low BMD, there was a high incidence of lower and posterior cortical disruption in the fractures. Patients with posterior cortical disruption demonstrated a higher incidence of leakage into the spinal canal and anterior cortex. No significant correlation was observed between fracture patterns and leakage. CONCLUSIONS: A surgeon should use caution in performing vertebroplasty in patients with low BMD and posterior disruption of the vertebral cortex.

Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report / 대한고관절학회지

As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

Atraumatic Spinal Interdural Hamatoma: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To investigate the outcomes of recapping laminoplasty for the treatment of atraumatic spinal interdural hematoma. SUMMARY OF LITERATURE REVIEW: There are several causes for a spinal hematoma. The occurrence of spinal hematoma is rare; in particular, the ones arising atraumaticaly are considered extremely rare. MATERIALS AND METHODS: We studied a 33 year old male patient without any known risk factor. Magnetic resonance image has revealed an intraspinal epidural cyst compressing on the spinal nerve. After performing recapping laminoplasty, followed by partial excision of dura mater and resection of hematoma, we were able to observe another layer of dura mater, confirming the location of hematoma within two epidural layers, i.e., an interdural hematoma. RESULTS: Performing recapping laminoplasty is a more effective and less invasive procedure for removing cyst than conventionally used laminectomy. Patients were found to have synostosis after three months post-op, and they have exhibited neither lumbosacral pain nor lower limb motor weakness after six months follow-up. There were no recurrences or complications reported on our study. CONCLUSION: There are a few reported cases of atraumatic spinal interdural hematoma. Our study shows that performing pars osteotomy with recapping laminoplasty yield good clinical outcome for the treatment of atraumatic spinal interdural hematoma.

Multiple Giant Tumoral Calcinosis in Pelvic Region / 대한정형외과학회잡지

Tumoral calcinosis is a very rare disease in which calcium deposit is accumulated on soft tissue around joints without specific metabolic disorder of calcium or predisposing illnesses. Its causes have not been revealed clearly, and the disease has been known to occur rarely among Asian patients. We report a case of a multiple giant tumoral calcinosis patient who complained of painful masses in the groin region as well as in both buttocks and sacral area. The patient was evaluated to differentiate with other causes and have been treated with surgical excision. We present this case with a review of literature.

The Short Term Results of Selective Nerve Root Block in Spinal Stenosis by Contrast Pattern

STUDY DESIGN: Retrospective study. OBJECTIVES: To observe the short term effect of selective nerve root block (sNRB) depending on the contrast pattern and spinal canal size. SUMMARY OF LITERATURE REVIEW: A number of studies have demonstrated that sNRB is quite effective not only for patients with herniated intervertebral discs but also for those with spinal stenosis. MATERIALS AND METHODS: The Visual Analog Scale(VAS) score was collected before and after the procedure from 217 subjects with lumbar spinal stenosis and underwent sNRB. Two types were classified after observing the contrast's spreading pattern, Type I contrast reaching the spinal canal and Type II not reaching the spinal canal. Efficacy of the treatment for each type was also compared. In addition, the spinal canal size was classified into three categories. Treatment efficacy depending on the contrast pattern was also compared in each category. RESULTS: When divided into two types based on the contrast pattern, type I showed a more significant reduction in VAS score according to T-test although both types showed a decrease in VAS score after the procedure. In regards to spinal canal dimension, both types showed decreased VAS scores after the procedure in patients with spinal canal size larger than 172.2mm2; however, there were no changes in VAS score before and after the procedure for those with spinal canal size smaller than 73mm2. CONCLUSIONS: There was a short term effect of selective nerve root block (sNRB) in patients with spinal stenosis regardless of their contrast pattern, type I group showing a stronger correlation. In regards to spinal canal dimension, patients with larger spinal canal sizes not only showed a significant decrease in VAS score after selective nerve root block (sNRB) but also showed differences depending on the contrast pattern. On the contrary, there was no significant difference in VAS score before and after selective nerve root block (sNRB) in patients with small spinal canal sizes, and there was also no difference in the outcome depending on the contrast pattern in patients with small spinal canal sizes. Therefore, when performing selective root nerve block (sNRB), the operator should remember to manipulate the angle and position of the spinal needle when injecting the appropriate drug after confirming that the contrast material reached the spinal canal. The operator should also consider surgical management when performing selective nerve root block (sNRB) in patients with severe central spinal stenosis.