Internal Carotid Artery Pseudoaneurysm Secondary to Skull Base Osteomyelitis: A Case Report

We report a case of a pseudoaneurysm secondary to skull base osteomyelitis (SBO) in an 82-year-old female. The patient was hospitalized with an acute episode of bleeding from the right ear, which persisted despite packing placed in the ear. We suspected bleeding from the internal carotid artery (ICA) and performed angiography, which revealed a pseudoaneurysm that presumably developed secondary to invasion of the wall of the petrous segment of the right ICA, and the patient underwent emergency coil embolization. Bleeding from the ear recurred a week later, and we performed repeat angiography, followed by embolization and deployment of multiple stents at the site of the pseudoaneurysm, which controlled the bleeding. Clinicians should be mindful of a pseudoaneurysm as a rare complication of SBO, following the spread of infection to adjacent soft tissues or vessels. A pseudoaneurysm should be considered in the differential diagnosis in patients with recurrent epistaxis or bleeding from the ears in addition to cranial nerve symptoms, and this condition warrants urgent evaluation.

Comparison of the Effect of Dietary Restriction and Free Diet on Postoperative Bleeding After Tonsillectomy / 대한이비인후과학회지

Background and Objectives@#There have been several studies on the factors affecting posttonsillectomy bleeding; however, investigations on the relationship between postoperative bleeding and diet are insufficient. Different countries have different types of food, and while there have been studies on the effects of diet in other countries, no such studies have been reported in Korea. Therefore, we aimed to investigate the relationship between Korean diet and postoperative bleeding after tonsillectomy.Subjects and Method To compare the postoperative bleeding outcomes, patients who underwent tonsillectomy by a single surgeon between January 2017 and 2020 were divided into those who had a diet restriction after surgery and those who had a free diet. Postoperative bleeding outcomes were divided according to the degree of intervention for hemostasis and compared. @*Results@#The study included 115 and 124 patients in the diet-restricted group and free-diet group, respectively. There were no statistical differences between the two groups in terms of gender, age, presence of snoring and frequent tonsillitis, and surgical method. Bleeding occurred in four patients in the diet-restricted group and three patients in the free-diet group. There was no statistical difference between the two groups in the frequency and severity of postoperative bleeding. @*Conclusion@#Since dietary restriction after tonsillectomy was not helpful to prevent postoperative bleeding, a free and sufficient diet after surgery may prove to be better.

Stress Fracture of the Capitate

Most capitate fractures occur in association with additional carpal injuries, particularly scaphoid fractures. Isolated fractures of the capitate account for only 0.3% of carpal injuries, and stress fractures are one form of this fracture. We report the case of a 20-year-old male who had a stress fracture of the capitate after serving as an honor guard in the military. Conventional radiographs and computed tomography of the right wrist revealed a minimally displaced fracture line located at the midcarpal aspect of the right capitate. A magnetic resonance imaging scan demonstrates a subarticular capitate fracture with diffuse bone marrow edema, small osteophytes, and irregularity of the midcarpal articular cartilage. We also review the carpal kinematics which possibly caused the stress fracture. Although stress fractures of the capitate are rare, they should also be accounted for with patients who perform repetitive motions of the wrist to a considerable extent.

An Unusual Cause of Knee Pain: Periosteal Glomus Tumor of the Distal Femur

Glomus tumors are rare neoplasms that characteristically occur in subungual regions, but may also be found in other regions of the body. The clinical diagnosis of this tumor may be difficult if the tumor is located in an extradigital site. Most extradigital glomus tumors form in superficial locations. Herein, we present the case of a 34-year-old woman who experienced chronic knee pain with pinpoint tenderness resulting from a deep-seated periosteal glomus tumor of the distal femur. Extradigital glomus tumors should be considered in the differential diagnosis when characteristic clinical features and imaging findings indicative of glomus tumors are present, even if the tumor is located within deep tissues.

An Uncommon Case of Bilateral Pathologic Hip Fractures: Antiviral Drug-induced Osteomalacia in a Patient with Hepatitis B / 대한고관절학회지

The long-term use of adefovir and tenofovir–antiviral medications commonly used to treat chronic hepatitis B–can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.

Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures / 대한정형외과학회잡지

PURPOSE: We evaluated the outcome of femoral stem revision for Vancouver B2 and B3 periprosthetic femoral fractures. MATERIALS AND METHODS: We conducted a retrospective assessment of 15 patients who had received treatment for a periprosthetic unstable femoral fracture after primary hip arthroplasty between May 1997 and September 2009. According to Vancouver classification, 11 patients were type B2 and four were B3. Open reduction and long stem revision were performed in all 15 cases. In Vancouver type B3 fractures, we treated patients with open reduction and long stem revision with an allogenic cancellous bone graft, which is the same as in that used in Vancouver type B2 fractures. An allogenic onlay cortical bone graft was used when additional stability was required. The mean age of patients was 67.1 years at the time of surgery and the mean duration of follow-up was 31.5 months. We described the clinical and radiographic results. RESULTS: Using Beals and Tower's criteria, fair to good clinical and radiologic results were observed at the latest follow up, with an average Harris hip score of 94.4 points. Fractures were united in all 15 patients. One patient had non-union of the greater trochanter of the femur, one patient had superficial infection, and one patient had non-union of onlay bone graft, however, there were no further complications, such as dislocations, periprosthetic infections, or nerve injuries. There was no loosening of the femoral stems. CONCLUSION: In Vancouver type B2 and B3 fractures, when there is loosening of the femoral stems, open reduction and long stem revision with allogenic cancellous bone graft provided a satisfactory result. However, long-term follow up is needed.

Short Term Results of AO Type C Fractures of the Distal Radius Treated with Volar Locking Plating System

PURPOSE: To evaluate clinical and radiological results of AO type C distal radius fractures treated with a volar locking plating system. MATERIALS AND METHODS: We retrospectively reviewed 31 patients with AO type C distal radius fracture treated with a volar locking plating system. We evaluated the clinical results according to the Mayo wrist performance scoring system and disabilities of the arm, shoulder and hand (DASH) score and evaluated the radiographic results. RESULTS: All cases had bony union. The mean Mayo wrist performance score was 81.9. The mean DASH score was 11.2. Between preoperative and immediate postoperative radiographic measurements, the mean radial length was improved from 8.8 mm to 13mm, radial inclination from 14.7degrees to 22.5degrees, volar tilt from -11.3degrees to 9.4degrees and intra-articular step-off from 2.2 mm to 0.3 mm (p0.05). Internal fixation using volar locking compression plate could allow early postoperative exercise and could result in low incidence of postoperative complication. All cases showed bone union showing no evidence of malunion, nounion, nor metal failure. CONCLUSION: Treatment of AO type C fractures using a volar locking plate showed satisfactory outcomes. It is a good option to obtain stable fixation without significant loss of reduction.

Short Term Results of AO Type C Fractures of the Distal Radius Treated with Volar Locking Plating System

PURPOSE: To evaluate clinical and radiological results of AO type C distal radius fractures treated with a volar locking plating system. MATERIALS AND METHODS: We retrospectively reviewed 31 patients with AO type C distal radius fracture treated with a volar locking plating system. We evaluated the clinical results according to the Mayo wrist performance scoring system and disabilities of the arm, shoulder and hand (DASH) score and evaluated the radiographic results. RESULTS: All cases had bony union. The mean Mayo wrist performance score was 81.9. The mean DASH score was 11.2. Between preoperative and immediate postoperative radiographic measurements, the mean radial length was improved from 8.8 mm to 13mm, radial inclination from 14.7degrees to 22.5degrees, volar tilt from -11.3degrees to 9.4degrees and intra-articular step-off from 2.2 mm to 0.3 mm (p0.05). Internal fixation using volar locking compression plate could allow early postoperative exercise and could result in low incidence of postoperative complication. All cases showed bone union showing no evidence of malunion, nounion, nor metal failure. CONCLUSION: Treatment of AO type C fractures using a volar locking plate showed satisfactory outcomes. It is a good option to obtain stable fixation without significant loss of reduction.

Treatment of a Segmental Ulnar Shaft Fracture and an Olecranon Fracture / 대한정형외과학회잡지

We would like to report a case of treating a segmental fracture of ulnar shaft, with a concomitant olecranon fracture. The patient was treated using tension band wiring and intramedullary nailing procedures. Based on the nature of the olecranon, we believe this should be a recommended treatment method that minimizes complications for the patient that has multiple fractures and a dislocation of the forearm.

Role of Mesenchymal Stem Cells in Patients with Nontraumatic Osteonecrosis of the Femoral Head / 대한정형외과연구학회지

Mesenchymal stem cells are stem cells originated from the mesoderm have the capacity to differentiate into cells of connective tissue lineages, including bone, fat, cartilage and muscle. Nontraumatic osteonecrosis of the femoral head has been suggested the cause is likely relevant to the poor proliferation activity of mesenchymal stem cells in the femoral head region. The altered function of mesenchymal stem cells may be responsible for the pathogenesis and progression of osteonecrosis, in steroid or alcohol induced nontraumatic osteonecrosis of femoral head.

Prevalence of Radiographic Knee Osteoarthritis in Elderly Koreans

PURPOSE: This study was conducted to investigate the epidemiologic characteristics of knee osteoarthritis (OA) in elderly Koreans with respect to its detailed prevalence and association with demographic factors such as gender, age and body mass index (BMI). MATERIALS AND METHODS: Six hundred and ninety six subjects (men 298 and women 398) aged 65 years or older were recruited from an urban population. Radiographic evaluations were conducted using three plain radiographs (weight bearing anteroposterior view, 45 degree of flexion posteroanterior view, and the Merchant view). Radiographic severity was determined using the Kellgren-Lawrence (K/L) grading scale and radiographic OA was defined as K/L grade 2 or higher. Overall prevalence of OA was analyzed with regard to gender, age and BMI using multivariate logistic regression. RESULTS: The overall prevalence of knee OA in the study cohort was 38.1%. Women had the much higher prevalence of knee OA than men (53.8% vs. 17.1%). Female gender, obesity and ageing were associated with the risk of knee OA, but a female gender was found to be the strongest predictor for knee OA. CONCLUSION: This study documents that knee OA is highly prevalent among Korean elderly, and that elderly Korean women are at much greater risk of development of knee OA. It is hoped that our findings provide information that aids the creation of national health policies that better target the prevention and treatment of knee OA.

Primary Total Hip Arthroplasty with Cementless VerSys Femoral Stem: a Minimum 5-years follow-up

PURPOSE: This study evaluated the clinical and radiographic results of primary total hip arthroplasty with a noncemented VerSys Fiber Metal Midcoat stem. MATERIALS AND METHODS: Thirty nine hips in thirty three patients were followed up for a minimum of five years. The clinical results were evaluated based on the Harris hip scores. Radiographic analysis of the femoral component was performed by evaluating the radiolucent lines, cortical hypertrophy, stress shielding, osteolysis and fixation stability. Radiographic analysis of the acetabular component was performed by evaluating the osteolysis and fixation stability. RESULTS: The average Harris hip score improved from 54.3 points preoperatively to 95.4 points at the last followup. In the results of radiographic analysis of the femoral component, stable bony ingrowth was noted in thirty-eight cases and stable fibrous ingrowth was observed in one. Non-progressive radiolucency<2 mm in width was observed in eight cases. There were three cases of osteolysis, thirty-six cases of stress shielding, and one case of cortical hypertrophy. Radiographic analysis of the acetabular component revealed stable bony ingrowth in thirty-eight cases and unstable fixation in one case. There were two cases of osteolysis. CONCLUSION: The results of primary total hip arthroplasty using cementless VerSys femoral stem after a minimum of five-year follow up revealed that the rate of femoral osteolysis had decreased and the rate of bone resorption by stress shielding was relatively high. However, a longer-term follow up will be needed.

The analysis of Affecting Factors for the Dissociation of the Polyethylene Liner in Cementless Harris-Galante Acetabular Component

PURPOSE: This study was performed to evaluate the factors associated with dissociation of the polyethylene liner with using a Harris-Galante I or II acetabular component in a stably positioned acetabular cup. MATERIALS AND METHODS: Between January 1998 and February 2007, 32 cases underwent revision of the acetabular component due to osteolysis, wear of the polyethylene liner or locking mechanism failure around the acetabulum in spite of stable positioning. 5 cases were primarily operated on using the type I Harris-Galante Hip Prosthesis and 27 cases used the type II. We divided the 32 cases into the two groups: Group I (18 cases) was composed of cases with the existence of polyethylene liner (PE) dissociation and Group II (14 cases) had no dissociation. The analyzed factors were age, gender, body weight, the type and the size of the acetabular cup, the thickness of the polyethylene liner, the duration of the time interval from the primary surgery, the inclination and ante-version of the acetabular cup, the wear rate of the PE liner, the degree of the osteolysis around the acetabulum and the existence of failure of the locking mechanism in the acetabular component. Statistical analysis was performed using the Mann-Whitney test (SPSS 12.0). RESULTS: Statistical significance was noted only for the wear rate of the PE liner (Group I: 0.40+/-0.19 mm/year, Group II: 0.19+/-0.08 mm, p=0.002) and the existence of failure of the locking mechanism (Group I: 16 cases (88.9%), Group II: 6 cases (42.9%), p=0.006). CONCLUSION: According to this study, the dissociation of the PE liner was influenced by the wear rate of the PE liner and the existence of failure of the locking mechanism in the acetabular component. In order to prevent PE liner dissociation, improvement of the locking mechanism and the PE liner system are essential.

Retrospective Study of Clinical Results of Anthovy's Technique with Scaphocapitate and Hamatocapitate Arthrodesis in Advanced Kienbock's Disease / 대한정형외과학회잡지

PURPOSE: A retrograde analysis of the clinical results of 11 cases of Kienbock's disease (Lichtman stage III), who underwent surgery for scaphocapitate or hamatocapitate arthrodesis followed by a rolled palmaris tendon replacement after a collapsed lunate excision. MATERIALS AND METHODS: This study followed-up 11 patients diagnosed with advanced Kienbock's disease for more than 5 years from January 1989 through May 2000. The patient's age ranged from 25 to 65 years old. Among the 11 patients, 7 patients received hamatocapitate arthrodesis, and the remainder received scaphocapitate arthrodesis. The Evans' scoring system was used for the clinical evaluation. RESULTS: After surgery, all patients showed complete radiologic fusion and an increase in grip strength, and most patients showed an increase in the ROM of a wrist joint, particularly in the group who received hamatocapitate arthrodesis. CONCLUSION: In advanced Kienbock's disease, a lunate excision followed by rolled tendon replacement with limited intercarpal arthrodesis showed relatively good results during the follow-up period, and had a particularly better ROM of the wrist joint in hamatocapitate arthrodesis, than the scaphocapitate arthrodesis because of the arthrodesis between the proximal and distal carpal row in the biomechanical aspect of the carpal bone.

The Effectiveness of Polylactic Acid Bioresorbable Film in the Prevention of Adhesion Formation in Tendons / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of a polylactic acid bioresorbable film in the prevention of tendon adhesion after tendon repair. MATERIALS AND METHODS: Twenty-four adult rabbits (48 cases) were used in this study. In the first (control) group, the flexor tendons of the third toe were cut and a tenorrhaphy was performed. The 2nd group was injected with hyaluronic acid between the tendon and tendon sheath after suturing. The 3rd group underwent an enveloping of the tendon with polylactic acid film, followed by tenorrhaphy. The test animals were euthanized at 1, 2, 3, and 6 weeks after surgery, and the histology and biomechanics were evaluated. RESULTS: Microscopic evaluations revealed fibrosis to be most apparent in group 1, while groups 2 and 3 showed no significant differences. The biomechanical tests, which were carried out using a Universal Testing Machine, revealed that an increase in adhesion strength with time. At 6 weeks after surgery, group 1 exhibited an adhesion strength that was 2.5-3 times greater than that exhibited by groups 2 and 3. Group 2 had a higher adhesion strength than group 3, but this difference was not statistically significant. CONCLUSION: Increases in granulation tissue and fibrosis during the healing of sutured tendons were observed, and the tested polylactide resorbable film was found to be effective in reducing the level of adhesion formation after tendon repair.

Minimal Invasive Plate Osteosynthesis for Distal Femoral Fracture

PURPOSE: To evaluate the clinical and radiologic results of minimally invasive plate osteosynthesis, We analyzed the cases of distal femoral fracture treated with this newly developed surgical technique. MATERIALS AND METHODS: We reviewed 12 cases of distal femoral fracture which had been treated with minimally invasive plate osteosynthesis and each patients had been followed up for a minimum twelve months. Post-operative function was evaluated with checking the range of motion of knee joint and Knee Society Score. Union period and post-operative alignment was measured on radiograph. RESULTS: In all cases, bony union was obtained in average fifteen weeks after operation without bone graft. The arc of motion of knee joint which was checked at the last follow up was 123.75 degrees on average. According to Knee Society Score, there were 9 excellent, 1 fair and 1 poor results. The post-operative complications were malunion in 1 case, soft tissue infection in 1 case and joint stiffness in 1 case. CONCLUSION: The treatment of distal femoral fracture with minimally invasive plate osteosynthesis is one of the good surgical options for clinically preferable results with high union rate without bone graft and early joint motion.

Nontraumatic Myositis Ossificans with an Unusual Location: Case Report

Myositis Ossificans is known to be a benign heterotopic pseudomalignant bone formation in muscle and other soft tissue. When it is revealed as a localized form, 75% of the cases are associated with significant blunt trauma. We report a rare case of a nontraumatic ossificans in the lower leg of a 59-year-old woman, which has been spontaneously developed for 15 years.

Prevalence and Persistence of Transferred Maternal Hepatitis. A Antibody During The Second Year of Life in Korean Infants / 감염

BACKGROUND: Although the incidence of hepatitis A infection has dramatically declined in developed countries, it is still endemic in many of developing countries, and sporadic outbreak has developed in many middle classed endemic area. Many reports indicate that hepatitis A vaccine would have to be used for widespread immunization of infants, who live in endemic or non-endemic region, for eliminating this infection from circulation. Therefor, the optimal immunization schedule and dose of vaccine should be determined. Recent several studies suggested that high dose hepatitis A vaccination at the time of disappearance of maternal antibody promise protectable immunogenicity in infants. The purpose of our study to find out the prevalence and persistence of maternal HAV antibodies in Korean infants (below 2 years old age). METHODS: 60 mother without past-history of hepatitis A, and 300 heathy infants without history of hepatitis A vaccination and intra-familial contact history of hepatitis A were enrolled in this study. The infants below 2 years old age were classified into 5 groups as following; 0~3 months, 4~6 months, 7~9 months, 10~12 months, 13~24 months, and the number of each group were 60 and sex distribution of each group was equal. Positive rates of Anti-HAV were determined by ELISA. And comparisons of seroprevalence of anti- HAV between groups were analyzed by ANOVA repeated t-test. RESULTS: The seropositive rate of maternal group was 81.7%, and the seropositive rate of 0~3 months of age group was 43.3%. The seroprevalence of anti- HAV significantly declined after 4~6 months of age, and reached below 10% at the age of 7~9 months of age and the low rate of anti-HAV maintained until 2 years old age. And positive rates of anti-HAV showed no significant differences between males and females. CONCLUSION: The results of our study showed that the seroprevalence of anti-HAV significantly declined after 4~6 months of age and the anti-HAV almostly disappeared at 7~9 months of age. So, low seropositive rate of anti-HAV at 7 months of age may justify trials on infant vaccination in Korea.

A Case of Mastoiditis and Sinus Thrombosis as Complications Following Acute Otitis Media / 감염

No abstract available.