Atypical Fracture-Like Insufficiency Fracture of the Tibia with Prolonged Bisphosphonate Drug: A Case Report

Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.

Traumatic Lumbar Plexopathy by Seat Belt Injury

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss an extremely uncommon cause of lumbar plexopathy seat belt injury. SUMMARY OF LITERATURE REVIEW: For patients who undergo traffic accidents, most cases of seat belt injury cause trauma to the lower torso. Seat belt injury is associated with variable clinical problems such as vascular injury, intestinal injury (perforation), vertebral injury (flexion-distraction injury), chest wall injury, diaphragmatic rupture/hernia, bladder rupture, lumbosacral plexopathy, and other related conditions. MATERIALS AND METHODS: A 38-year-old male truck driver (traffic accident victim) who suffered monoplegia of his right leg due to lumbar plexus injury without spinal column involvement. Injury to a lumbar plexus and the internal vasculatures originated from direct compression to internal abdominal organs (the iliopsoas muscle and internal vasculatures anterior to the lumbar vertebrae) caused by the seat belt. We have illustrated an extremely uncommon cause of a neurologic deficit from a traffic accident through this case. RESULTS: Under the impression of traumatic lumbar plexopathy, we managed it conservatively, and the patient showed signs of recovery from neurologic deficit. CONCLUSIONS: We need to review the lumbar plexus pathway, in patients with atypical motor weakness and sensory loss of the lower extremities which are not unaccompanied by demonstrable spinal lesions. Therefore, close history taking, physical examination and comprehension of injury mechanism are important in the diagnosis.

Thoracic Epidural Cavernous Hemangioma / 대한정형외과학회잡지

A 31-year-old male presented with severe back pain and paraparesis. Imaging studies demonstrated an extraosseous, extradural mass without bone invasion at the T11-T12 vertebral level, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was completely excised after a T11-T12 laminectomy. Histopathological examination revealed a cavernous hemangioma. The patient's symptoms improved after excision of the lesion.

The Effect of Extracorporeal Shock Wave Therapy for Calcific Tendinitis of the Shoulder / 대한스포츠의학회지

To evaluate the functional and radiologic outcomes of extracorporeal shock wave therapy (ESWT) in shoulders with chronic calcific tendinitis. We report a retrospective study to compare the outcome after ESWT (group l, 15 cases) with the effect of medication treatment (group 2, 15 cases) in patients with chronic calcific tendinitis. Patients were aged 42 to 58 years, mean of 48 years and treated with extracorporeal shock waves or medication from September 2012 to May 2014. The ESWT was performed six cycles of shock waves, weekly treatment for the three cycles and the rest cycles after 2 weeks of pause. In the same period, there were 12 women and 3 men treated with medication treatment for calcific tendinitis. The clinical outcomes were evaluated according to Constant and Murley score and pain visual analogue scale. Radiologic evaluation was performed to confirm disintegration of calcific deposits 3 months and 6 months after treatment. Clinical outcomes were significantly improved in ESWT group, and there was significant difference between ESWT group and medication group. In radiographic evaluation, the calcific deposit was significantly decreased in ESWT group. ESWT therapy is more effective to achieve functional improvement and to alleviate pain in the patients with calcific tendinitis of the shoulder.

Congenital Anomaly of the Atlas Misdiagnosed as Posterior Arch Fracture of the Atlas and Atlantoaxial Subluxation

Partial or complete absence of the posterior arch of the atlas is a well-documented anomaly but a relatively rare condition. This condition is usually asymptomatic so most are diagnosed incidentally. There have been a few documented cases of congenital defects of the posterior arch of the atlas combined with atlantoaxial subluxation. We report a very rare case of congenital anomaly of the atlas combined with atlantoaxial subluxation, that can be misdiagnosed as posterior arch fracture.

Solitary Ancient Schwannoma in Upper Arm: A Case Report / 대한골관절종양학회지

Ancient schwannoma is a variant of schwannoma and is characterized slowly growing tumor with degenerative change. And it is reported that schwannoma is relatively rare in extensor area. As a rare cause of solitary ancient schwannoma in extensor area of upper arm, we report it.

Comparison of F Calcaneal Plate and Locking Calcaneal Plate Fixation Using an Lateral Extensile Approach to Intra-articular Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. RESULTS: Radiollogically, the mean Bohler angle was improved from 5.5degrees preoperatively to 20.1degrees postoperatively and 18.8degrees at the last follow up in group 1 and 8.6degrees preoperatively, 21.4degrees postoperatively and 20.3degrees at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. CONCLUSION: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.

A Case of Deep Vein Thrombosis in Common Iliac Vein after Arthroscopic Partial Meniscectomy / 대한스포츠의학회지

Knee arthroscopy is generally considered a very safe operation with very high success rates. Few reported cases of complications arising from only arthroscopic partial meniscectomy include deep vein thrombosis and pulmonary embolism. In this study, we present the case of a 44-year-old female patient with complications of deep vein thrombosis arising after undergoing an arthroscopic partial meniscectomy. Eight days post-operation, the patient presented with pain and swelling of the lower limb and inguinal area of the same side as the operation and was diagnosed by computed tomography scan with deep vein thrombosis. Apart from obesity, the patient presented with no other risk factors for deep vein thrombosis. The patient was given heparin treatment and discharged once her symptoms were relieved.

The Inferior Accessory Ossicle of the Anterior Arch of the Atlas Misdiagnosed as Anterior Arch Fracture: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a very rare case of the inferior accessory ossicle of the anterior arch of the atlas misdiagnosed as anterior arch fracture. SUMMARY OF LITERATURE REVIEW: It is necessary to know the existence of inferior accessory ossicle of the anterior arch of the atlas, even though it is extremely rare. MATERIALS AND METHODS: A 29-year-old woman was referred to our emergency service unit with symptoms of neck pain and scalp laceration, after being involved in a car accident. She was diagnosed as the inferior accessory ossicle of the anterior arch of the atlas, by multiple diagnostic mordalities. RESULTS: The symptom of neck pain was relieved spontaneously, and her symptom has been relieved at her latest visit, as a follow up within 3 months. CONCLUSIONS: It is important to be aware of cervical anatomical variants because we commonly confuse it with other pathologic conditions, such as a fracture and thus, misdiagnose the condition.

A Case of Arthroscopic Excision of Synovial Hemangioma with Dual Coagulation Shaver

A 17-year-old male patient visited our hospital with a palpable mass on the lateral aspect of the knee joint of five years duration without any related trauma history. The patient felt tenderness around the mass and had limitations in doing flexion exercises. Magnetic resonance imaging of the knee suggested the possibility of synovial hemangioma, and thus surgical treatment was planned. A tumor within the knee joint was found by arthroscopy, and a resection was carried out by dual coagulation shaver. The biopsy confirmed the diagnosis of a synovial hemangiomas. The patient presented months later at the out-patient clinic with no evidence of recurrence.

Sural Nerve Entrapment by Fragments of Calcaneal Fracture (A Case Report) / 대한족부족관절학회지

Sural nerve is a sensory nerve that innervates the lateral side of ankle and foot, and the injury of this nerve can be usually caused by surgical approch of calaneal fracture or achilles tendon injury. Entrapment neuropahty of sural nerve caused by bony fragment after calcaneal fracture is not reported, yet. Authors experienced one case that sural nerve injury due to bony fragment after calcaneal fracture and we regard that it is a rare case, so we report this case after reviewing literatures.

Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Spondylolisthesis and Degenerative Segmental Instability

STUDY DESIGN: This is a retrospective case study. PURPOSE: This study was designed to analyze the surgical outcomes of patients who underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) for the treatment of spondylolisthesis and degenerative segmental instability. OVERVIEW OF LITERATURE: If the surgical outcomes of a procedure are evaluated together with multiple indications, it is not clear how the procedure helped each subgroup of patients. For the reason that some indications achieve better outcomes than the others, we performed a subgroup analysis using validated outcome measures to demonstrate the optimal indications and the treatment results of TLIF. METHODS: We conducted subgroup analyses by comparing the prospectively collecting data from the consecutive patients who underwent single-level minimally invasive TLIF for the treatment of the following 3 subgroups of indications: 23 cases of low-grade spondylolytic spondylolisthesis, 24 cases of degenerative spondylolisthesis, and 19 cases of degenerative segmental instability. RESULTS: The average duration of follow up was 36.1 +/- 9.9 months (range, 24 to 63 months). The preoperative pain and disability scores were significantly improved at final postoperative follow-up in all the subgroups (all measurements: p < 0.0001). The 3 subgroups exhibited an equivalent improvement of the pain and disability scores at the final follow-up. The rates of radiographic solid fusion and complications were also similar among the 3 groups. CONCLUSIONS: Our data suggests that minimally invasive TLIF optimally and equivalently alleviates all of the associated symptoms and disabilities from low-grade spondylolisthesis and degenerative segmental instability. Furthermore, these patients seem to have optimal surgical indications for minimally invasive TLIF, while maintaining favorable surgical outcomes.

Short Term Result of Minimally Invasive Total Knee Arthroplasty with Mini-Midvastus Approach / 대한정형외과학회잡지

PURPOSE: To investigate the effectiveness of minimally invasive total knee arthroplasty using the mini-midvastus approach through analyzing the short-term clinical outcomes. MATERIALS AND METHODS: Seventy-seven consecutive total knee arthroplasties were performed with the mini-midvastus surgical technique from August 2005 to February 2006 and were followed for more than 1 year after the procedure. All operations were performed with the Nexgen LPS-flex total knee system using a MIS quad-sparing instrument. The evaluation included preoperative and postoperative clinical data, surgical and radiological outcomes. RESULTS: The length of skin incision was average 8.4+/-0.6 cm and the operation time was average 95.5+/-15.7 minutes. The blood loss was average 727.5+/-315.5 cc. The tibial component alignment angles averaged 0.2+/-1.3degrees varus and the tibiofemoral angles averaged 5.8+/-1.8degrees. The mean ROM and the mean HSS score was 117+/-10degrees and 120+/-11degrees, 88.9+/-7.1 and 96.2+/-4.5 at eight weeks and one year after surgery respectively. CONCLUSION: If proper surgical procedures are performed using the appropriate surgical instruments, minimally invasive total knee arthroplasty with the assistance of the mini-midvastus approach, can result in good clinical outcomes and alignment of the implants.

Intraoperative Balloon Angioplasty in Diabetic Foot with Peripheral Artery Occlusive Disease During Amputation: Two Case Reports / 대한정형외과학회잡지

Amputation should be considered for the patients with limb necrosis or infection due to major vessel obstruction combined with diabetes. Patients with peripheral artery occlusive disease combined with diabetes have a higher risk of amputation and a higher possibility of reoperation than those patients without diabetes because of complications that include hematoma, infection and necrosis of the stump. We report here on 2 cases for which balloon angioplasty was used to promote wound healing on the stump site during amputation, and the patients had peripheral artery occlusive disease with a diabetic foot. The wounds healed early without complication in both cases.

Treatment of Recurrent Spontaneous Acute Hemarthrosis after Total Knee Arthroplasty: A Case Report

A 67-year-old woman presented with six acute recurrent hemorrhagic episodes sixteen months after primary total knee arthroplasty. Femoral angiography demonstrated a prominent vascular blush on the superolateral side of the knee joint. The patient underwent therapeutic embolization of the superior lateral geniculate artery and a muscular branch from the popliteal artery. However, neglected embolization to the lateral inferior artery induced another episode of acute hemarthrosis. Finally, open arthrotomy allowed for identification and coagulation of the focus of acute bleeding in the lateral inferior geniculate artery.

Delayed Intestinal Injury Caused by Intrapelvic Pin Migration after Open Reduction of an Acetabular Fracture: A Case Report

Intrapelvic pin migration of the Kirschner wires or the Steinman pins that are used for the treatment of hip fracture is rare, but it can be serious when it occurs. We experienced a delayed intestinal injury that was caused by the migration of an intrapelvic pin, and this happened 10 years after performing fixation for an acetabular fracture. For preventing this potential complication, the pins have to be used only as a temporary fixation and the end of the pins should be bent. Further, the patients should be followed up clinically and radiographically for a long time. If pin migration does occur, the pin should be removed.

Displacement of Polished Femoral Stem during Reduction of a Dislocated Cemented Total Hip Arthroplasty: A Case Report

Displacement of a polished femoral stem from its cement mantle occurred during an attempted reduction of a dislocated total hip arthroplasty. This might be related to the geometry and surface finish of the stem, as well as the wedge-shaped and highly polished design. The stem became displaced when the femoral head impinged the acetabular margin during the reduction of the dislocated prosthesis. Surgeons need to be aware of this complication associated with using a polished femoral stem. This can be avoided by cementing over the shoulder of the stem as well as careful reduction under fluoroscopic control.

Minimally Invasive Posterior Lumbar Interbody Fusion: Comparison with Traditional Open Surgery / 대한정형외과학회잡지

PURPOSE: To compare the the clinical and radiographic results of the two approaches for posterior lumbar fusion, one-level posterior lumbar interbody fusion (PLIF) performed with a minimally invasive approach or the traditional open approach. MATERIALS AND METHODS: This study examined a consecutive series of 46 patients who underwent one-level PLIF procedure (27 cases performed with minimally invasive approach and 19 cases with traditional open approach) by one surgeon at one hospital. The following data were compared with a minimum 1-year follow-up: the clinical and radiographic results, surgical time, estimated blood loss, transfusion requirements, postoperative back pain, time needed before ambulation, length of hospital stay, and complications. RESULTS: There was no statistical difference between the two groups in terms of the clinical and radiographic results at the last follow-up. The minimally invasive group was found to have a less blood loss, fewer transfusion requirements, less postoperative back pain, a shorter recovery time, and a shorter hospital stay. However, minimally invasive group required a longer surgical time and there were 2 cases with technical complications. CONCLUSION: This study confirmed the favorable results reported by previous uncontrolled cohort studies. It also showed that the minimally invasive approach had a similar surgical efficacy to that of traditional open approach. However, minimally invasive technique requires a steep learning curve and attention in order to lower the risk of complications.

Quad-Sparing Minimally Invasive Total Knee Arthroplasty

PURPOSE: The purpose of this study was to investigate and define the factors affecting the success of quad-sparing (QS) minimally invasive total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 120 patients(150 knees) were tried consecutively to undergo QS minimally invasive TKA from July 2004 to February 2005. Seventy knees (Group 1) could be performed with this technique, but 80 knees (Group 2) were failed and required further incision. Two groups were compared for clinical, radiological and postoperative data. These cases were also divided into three groups according to the time undergone surgery. For these three groups, we analyzed the clinical data and surgical results. RESULTS: Age, height, weight, body mass index and pre-operative knee score were not significantly related to the success of QS minimally invasive TKA. Greater preoperative range of motion, low patella height, and smaller size of the tibial implant were of a significant correlation with the success of surgery. As the number of cases were cumulated, the success rate of this method increased and the operating time was shortened. CONCLUSION: QS minimally invasive TKA could not be successfully applied to every patients. For the success of this surgery, adequate preoperative assessment of the patient and sufficient experience on this surgical technique would be necessary.

Minimally Invasive Lumbar Microdiscectomy using Tubular Retractor: A Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the early clinical results of lumbar microdiscectomy using minimally invasive tubular retractor (METRx-MD system, Medtronic Sofamor Danek, Memphis, TN), and to validate the merits of minimally invasive spinal surgery. MATERIALS AND METHODS: From April, 2003 to April 2004 we retrospectively studied a consecutive series of 45 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. In all cases, minimally invasive approach using the tubular retractor were performed with a 2 cm sized paramedian incision. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, need for blood replacement, time needed before ambulation, length of hospital stay, and complications. The clinical outcomes were assessed by the modified MacNab criteria. RESULTS: Minimally invasive tubular microdiscectomy was performed in 45 patients over a 12-month period with an average follow-up of approximately 8 months. The clinical outcomes assessed by MacNab criteria were excellent in 33 patients (73%), good in 10 patients (22%). The average operative time was 63 minutes (range, 35 to 95 minutes). The average blood loss was 62 mL (range, 50 to 110 mL). None of the patients needed blood replacement. With the exception of 2 patients, all patients could walk at the day of surgery. The average hospital stay was 2.3 days. None of the patients had dural tear, wound problem, or other complications. CONCLUSION: Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further long-term, randomized, prospective investigations are needed to fully evaluate the impact of this technique.