Arthroscopic Treatment of an Osteoid Osteoma in the Femoral Neck: A Case Report / 대한정형외과학회잡지

A 21-year-old male had have a one-year history of persistent left hip pain that was aggrevated at night. The diagnosis was osteoid osteoma that was based on clinical examination, simple radiography, and computed tomography. Under spinal anesthesia, the tumor was localized using an image intensifier and its nidus was excised successfully using the burr down technique. We report upon a single case of arthroscopic excision of an osteoid osteoma using the burr down technique and the good result obtained at the 2 year follow-up.

Lateral Supramalleolar Free Flap / 대한정형외과학회잡지

To cover soft tissue defect, various types of flaps have been used. Although lateral supramalleolar flap has been used as rotation flaps or reversed island flaps to cover defects around the foot and ankle, there has been no report about its application as a free flap. The lateral supramalleolar island flap has proves to be supplied constantly by the terminal branch of the peroneal arterys perforating branch. The free lateral supramalleolar flap has the same skin territory. Its vascular pedicle can be extended to the main peroneal artery and vena comitans, which can be obtained by dissecting the peroneal vessels between the distal tibia and fibula through the interosseous membrane. We have successfully transferred this free flap in eight patients from April 1994 to February 1995. All of the patients had full thickness skin defects which were caused by contact thermal burn, electrical burn, flame burn or traffic accident. There were no complications. From our experience, we feel that this new free flap have some advantages, induding vascular anatomy and long pedicle with large diameter and a relatively thin flap with minimal morbidity of donor site.

Radiographic Comparison of Stable Burst Fractures with Compression Fractures in Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study was designed to evaluate the radiographic diagnostic method to detect any abnormal findings and differentiate stable burst fractures with compression fractures at thoracolumbar spine. OBJECTIVES: To evaluate diagnostic sensitivity of radiographic analysis and confirm the effectiveness of the radiographic diagnostic methods to differentiate stable burst fractures with pure compression fractures. SUMMARY OF BACKGROUND DATA: A data showed that the diagnostic sensitivity using radiographic analysis was 83%. The greater sensitivity was obtained at high posterior superior vertebral angle and PSVA/PIVA > 1.3. MATERIALS AND METHODS: Thirty-one patients with thoracolumbar spine fractures were evaluate to differentiate stable burst fractures with pure compression fractures. All patients were taken X-ray and CT. The PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA were checked using lateral plain radiographs during follow-up period, and the final data was analysed using radiological & statistical methods. RESULTS: Middle column failure of stable burst fractures was greatly observed at high PSVA(especially >100degree) and high PSVA/PIVA ratio(> 1.3). CONCLUSION: The radiographic analysis using PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA might be the one of useful methods to differentiate stable burst fractures with pure compression fractures at thoracolumbar spine during follow-up period.

The Results of the Surgical Treatment using Posterior Spinal instrumentation for Tuberculous Spondylitis / 대한척추외과학회지

STUDY DESIGN: Twenty-nine patients with spinal tuberculousis were evaluated according to the surgical treatment methods using posterior spinal instrumentation and conventional anterior excision and interbody fusion methods without posterior spinal instrumentation. OBJECTIVE: To confirm the effectiveness of the surgical treatment methods using posterior spinal instrumentation (combined with anterior radical excision and anterior interbody fusion ) in tuberculous spondylitis. SUMMARY OF BACKGROUND DATA: Relatively good results(maintaining corrected kyphotic angle , short fusion time, rapid rehabilitation etc.)were obtained in posterior spinal instrumetnation group, especially at thoracic and thoracolumbar spine, but no specific benefits of posterior instrumentation at low lumbar spine during follow-up period. METHODS: Twenty-nine patients with tuberculous spondylitis were divided into two groups depending on their use of posterior spinal instrument in surgical treatment methods ; one group consisted of 18 cases which were treated by anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation(Group I), and the other groups consisted of 11 cases which were treated by anterior radical excision of involved body and anterior interbody fusion(Group II). Change of corrected kyphotic angle according to the level of lesion, number of involved body and complications were measured using pre-, post-operative, and follow-up radiographs and chart review. RESULTS: Comparing the two groups, relatively short fusion time, less kyphotic angle loss, and low complication rates were obtained in posterior spinal instrumentation group(Group I) during the follow up period, especilally, at thoracic and thoracolumbar spine. However, there were no significant postoperative and follow-up results in both groups at low lumbar spine. CONCLUSIONS: Tuberculous spondylitis can be treated, and correction can be maintained with anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation during follow up period.

Divergence of Femoral interference screw versus Knee Flexion Angle during Endoscopic ACL Reconstruction

The endoscopic single-incision technique using interference fit screws to secure patellar tendon-bone plugs in the femoral and tibial tunnels has been very popular method for ACL reconstruction. However, several potential complications has been reported such as violation of the posterior wall of the femoal tunnel, laceration of graft during femoral screw insertion, protrusion of the tibial bone block distally due to a lengthy graft and more frequently divergence of the femoral interference screw. We performed 56 consecutive endoscopic ACL reconstruction. In Groi.p I, femoral tunnel drilling were performed at 70-80 degrees of knee flexion. In Group 11, they were done at $5 degrees of knee flexion. Postoperative radiographic analysis of bone-interference screw divergence angle shows 5.9 degrees in AP view, 6.21 degrees in Lateral view in Group I and 3.14 degrees, 3.35 degre.s in Group II respectevely. In conclusion, Bone-interference screw divergence can be decreased with less knee flexion about 45 degree during preparing femoral tunnel.

Benign Fibrous Histiocytoma of the Patellar Fat Pad: A Report of One Case

SUMMARY: Benign fibrous histiocytoma of the knee is a very rare entity. We report on one case of benign fibrous histiocytoma that involved the patellar fat pad, an areas of involvement not previously reported. Diagnostic arthroscopy was performed to show retrobulging of infrapatellar fat pad without specific synovial changes. The lesion was completely resected. At short-term follow-up, all symptoms were resolved. Arthroscopy can be used as an diagnostic tool for identification of intraarticular lesions of the knee, but appears not to be a good tool for clean removal of mass within patellar fat pad.

Minimum Flexion Angle of the Knee Joint during Femoral Tunneling and Interference Screw Fixation in Endoscopic ACL Reconstrution / 대한정형외과학회잡지

Isometric positioning of the ACL graft is an important consideration in successful reconstruction of the ACL-deficient knee. The purpose of this study is to get a certain guideline in the endoscopic one-tunnel technique of anterior cruciate ligament reconstruction by measuring the skin angle and determine the degree of minimum flexion of the knee joint during femoral tunneling and interference screw fixations. To get the guide lines, first we get the tibial tunnel angle parallel to the Blumensaat's line from fully extended lateral knee joint radiography. Secondly measure the differences between angles of the femur-tibia shaft and anterior thigh-leg skin. Then measure the minimum femur-tibia flexion angle does not perforated the posterior cortex of the distal femur during femoral tunneling. Intraoperative measuring the angle between interference screw guide pin and tibial tunnel to get the parallelism of the femoral tunnel and interference screw. The results were as follows; The average femur-tibia shaft angle with 30degrees anterior thigh-leg skin angle was 30.2+/-1.75degrees, with 45degrees was 45.2+/-1.23degrees, with 60degrees was 61.9+/-4.23degrees, with 75degrees was 78.6+/-2.62degrees, with 90degrees was 97.8+/-3.96degrees. Predetermined sagittal tibial tunnel vector on the 0degrees extension knee joint lateral radiographs were applied to the several knee joint dynamograms. The mean minimum flexion angle of the femur-tibia shaft that doesn't perforate the posterior cortex of the femur was 45+/-1.58degrees (male), 44.5+/-4.97degrees (female). The average angle between interference screw guide pin and tibial tunnel was 23.0+/-2.23degrees. The findings of the present study suggest that anterior thigh-leg skin angle can be used instead of the true femur-tibia shaft angle. Less knee flexion angle makes good arthroscopic view during the tibio-femoral tunneling and interference screw fixation.

Tibial tunnel Placement in Arthroscopic ACL Reconstruction using Preoperative Radiographic Measurement / 대한정형외과학회잡지

A major cause of less than ideal results following intraarticular anterior cruciate ligament (ACL) reconstruction has been imprecise nonanatomic tunnel position for graft placement either in the femur, the tibia, or both. Lack of defined constant reference landmarks for reproducible tunnel placement has contributed to this problem on both sides of the joint. The purpose of this study was to define constant anatomic intraarticular and extraarticular landmarks that can be used as definitive reference points to reproducibly create a tibial tunnel for ACL reconstruction that (1) results in an impingement-free graft in full extension; (2) positions the tibial tunnel such that the sagittal tunnel-plateau angle is parallel with the sagittal intercondylar roof-plateau angle in full extension to minimize shear seen by the graft at the tibial tunnel inlet. Preoperative full extension and 90degrees flexion lateral radiographs were obtained. Preoperative measurements of the tibial tunnel-tibial shaft angle and distance from inferior pole of patella to entry point of tibial tunnel were useful tool for impingement free, Blumensaats line paralleling ACL reconstruction with autogenous bone patella tendon bone graft. The average tibial tunnel-tibial shaft angle was 34+/-4.59degrees (male), 33.5+/-3.37degrees (female). The mean distance between patella inferior pole and tibial tunnel entry point was 6.62+/-0.61cm (male), 6.21+/-0.89cm (female). This study sought to define constant anatomic landmarks extraarticularly as well as intraarticularly that can be used to reliably create an ideal tibial tunnel for ACL reconstruction.

Surgical Treatment of Cervical Spondylotic Myelopathy / 대한정형외과학회잡지

Myelopathy or dysfunction of the spinal cord, can be caused by degenerative processes of the cervical vertebrae. Cervical spondylotic myelopathy can be divided into five distinct syndromes on the basis of clinical presentation by Ferguson. Absolute indication for surgery is the progression of neurologic deficit. Decompression may be achieved using an anterior, posterior, or a combined approach, but each patient has unique clinical conditions that require individualized treatment. The purpose of the study was to evaluate the operative results by the clinical manifestation. In evaluating the results, the evaluation system established by the Japanese Orthopedic Association was employed. The average preoperative score in the 14 patient was 8.7 points and the average postoperative score was 12.7 points. The better results have been obtained for those who were managed with decompression within 1 year after onset of symptoms and those who had lateral type. In conclusion, the prognosis for the recovery of the spinal cord function is related with the onset of clinical symptoms and degree of neurological deterioration, so early detection and operative decompression for cervical spondylotic myelopathy may be the best method for the prevention of those unwanted and potentially devastating neurological deteriorations.

A Calcified Fibrocartilagenous Nodule in the Ligamentum Nuchae with Clinical Symptoms: A report of two cases / 대한정형외과학회잡지

The ligamentum nuchae is a midline structure extending from the occiput to the spinous process of the 7th cervical vertebra. Radio-opaque formations in the soft tissues behind the processes of the cervical spine has been known to radiologists since Barsony's description in 1929. It may actually be a normal sesamoid, or it may have developed as a result of previous trauma. But this remains hypothetical in that histological endochondral ossification sequence has not yet been demonstrated. These are generally asymptomatic and of clinical significance only in so far as they may be confused with fracture or tumors. Two patients who had clinical symptoms with or without previous trauma visited and they were relieved of their clinical symptoms by surgical excision. Then, we report on two unusual cases which were symptomatic.

Bilateral Naviculo-Medial Cuneiform Coalition: One Case Report / 대한정형외과학회잡지

We report one case of bilateral naviculo-medial cuneiform coalition in ten year old girl. She complained of pain in the medial aspect of the mid-foot related to long periods of standing and activity. Routine roentgenographs, specifically lateral views showed a bony bridge between the navicular bone and medial cuneiform. A biopsy revealed as fibrocartilaginous tissue. The bony bridge consists about one third in lateral view and 30 degree cephalad tilting in the antero-posterior view. Bilateral resection arthroplasty, with interposing flesh muscle fibers of the abductor hallucis, was performed for restoration of motion in the naviculo-medial cuneiform joint and relief of localized pain. Four months after surgery, pain around the mid-foot had almost complete subsided. One year postoperative, neither recurrence nor disability was observed. We will discuss the diagnosis and treatment of this rare case of bilateral naviculo-medial cuneiform coalition.

Adherence of Slime / 대한정형외과학회잡지

There were many studies to investigate the pathogenesis and prevention of infection in artificial joint replacement due to the difficulty in management of infected arthroplasty in spite of using large amounts of antibiotics. Biomaterials play a major role in the development of infection because of the way the body responds to their chemical and physical characteristics. Exopolysaccharide glycocalyx or biofilm(slime) which is produced by organisms adhered to the biomaterials has been detected and regarded as an important factor in pathogenesis. The production of slime on the biomaterials in turn makes the pathogens resistant to the antibiotics and therefore they survive. The objects of this study are to evaluate which materials are more susceptible to the adherence by Staphylococcus epidermidis, to evaluate the amount of antibiotics needed to kill the S. epidermidis adhered to the biomaterials(Polymethymethacrylate, Titanium-6Aluminum-4Vanadium alloy, Ultrahigh molecular weight polyethylene), and to evaluate the timing of administration of the antibiotics(cephradine, gentamicin) and potadine for prevention of postoperative infection. The results are as follows. 1. The materials in order of greatest adherence due to the number of organisms colonized are poly- methylmethacrylate(PMMA), ultrahigh molecular weight polyethylene(UHMWPE), and titanium alloy(Ti-6A1-4V alloy) being the least adherent. 2. With the production of biofilm the S. epidermidis becomes resistant to even that of 4 times the minimum bactericidal concentration(MBC) of antibiotics. 3. For prevention of postoperative infection, the prophylactic administration of cephradine if effective when used within 4 hours after contamination and the gentamicin and potadine are effective when used within 8 hours after the contamination with S. epidermidis.

Ankle Arthrodesis by Chevron Osteotomy: Report of 16 cases / 대한정형외과학회잡지

The Marcus ankle arthrodesis was carried out in 16 patients at department of orthopaedic surgery of Korea Veterans Hospital from January 1989 to December 1993. All of patients were reviewed and evaluated with subjective and functional rating scales according to the Mazur scoring system. The average follow up was 23 months, ranging from 12 months to 60 months. The Marcus ankle arthrodesis involves a chevron osteotomy, tibial onlay graft medially, internal fixation with staples and screws. According to the Mazur score, the results were 6 cases of Excellent, 7 cases of Good. The average Mazur score was 75.1. There were 4 cases of complication, a non-union, a superficial wound infection, a bursitis, and a tendon injury. In summary the Marcus ankle arthrodesis by chevron osteotomy seems to be a good procedure, which gives solid bony union with short duration, relief of pain, normal looking ankle configuration without leg length discrepancy and good function with few complications.

The Fate of Untreated ACL Insufficient Knee Joint / 대한정형외과학회잡지

The purpose of this study is to access and describe the status of patients with untreated anterior cruciate ligament ruptures to determine if prediction of functional deterioration in these knees were inevitable. 29 patients with rupture of the anterior cruciate ligament verified arthroscopically were evaluated at an average of 3 years and 8 month after injury. This group of patients was selected by the retrospective review in patients who were treated with traumatic ligament injury of the knee joint. The average age at the injury time was 25.9 years ranged from 16 to 44 years and most of injuries occured during sports activities including 12 cases (4196) occured while the patients were playing football. Meniscal lesions were found in 21 cases(72.4%) of all 29 cases of which were 15 cases in the medial, 4 in the lateral and 2 in both side. Follow up functional average score using the Hospital for Special Surgery Knee was 35.8 which would be fall in the Fair range defined as moderate functional disability and depending on the condition of thigh muscle, the functional score was 38.3 in case of less than 2cm atropy of the thigh on the involved side and 32.6 in case of more than 2cm atrophy. There was statistically significant difference (p < 0.05) of the functional score. Reinjuries of the same knee joint were experienced in 22 cases (76%). Rehabilitation of thigh muscles would play an important part in recovery from the injuries.

A clinical study on Legg-Perthes' disease of early onset / 대한정형외과학회잡지

No abstract available.