Femoral Neck Stress Fractures in South Korean Male Military Recruits

Background@#Femoral neck stress fractures (FNSFs) are rare but potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. The aim of this study was to investigate and describe the characteristics and clinical course of FNSFs in South Korean male military recruits. @*Methods@#Between May 2015 and October 2019, 16 fractures in 12 young male military recruits were reviewed. The characteristics of the fractures were ascertained by detailed analysis of the history and clinical course, as well as radiographs, bone scintigrams, and magnetic resonance images. @*Results@#The median duration between endurance training and the development of hip pain was 5 weeks, while the median duration of pain before the patient sought medical attention was 3 weeks. Four patients (33.3%) exhibited bilateral fractures, and concomitant lesions involving the proximal tibia were found in 3 patients (25%). Fourteen of the 16 fractures (87.5%) were compression-type fractures, and surgery was performed for 7 hips. Complete union without malunion or osteonecrosis was achieved in all cases, and all cadets returned to their full activity levels in an average of 10 weeks. @*Conclusions@#We observed excellent prognosis of FNSFs. Our report highlights the importance of early reporting, detection, and treatment regarding the challenging management of FNSFs. When a military recruit reports hip pain, a FNSF should be considered; furthermore, the bilaterality of the fracture and the presence of concomitant lesions should also be investigated.

A Rare Hyperextension Injury in Thoracic Spine Presenting with Delayed Paraplegia

Hyperextension injury in the thoracic spine is uncommon with only a few cases documented in the literature. The mechanism of these injuries is hyperextension combined with axial or shearing force. These types of injuries are associated with a high risk of dural tears and paraplegia. A 91-year-old female presented with acute back pain from a hyperextension injury in thoracic spine with no neurological deficit. Lumbar magnetic resonance imaging showed a intervertebral disc rupture. On day 20 of hospitalization, the herniated intervertebral disc compressed the spinal cord with incomplete paraplegia. Hyperextension injuries involving the three columns are very unstable and we recommend surgical treatment as soon as possible, not only because of the initial trauma, but a ruptured disc herniation can damage the spinal cord.

Anterior Tibial Muscle Hernia Treated with Local Periosteal Rotational Flap: A Case Report

Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.

Herniation of Upper Lumbar Disc: Clinical Finding & Surgical Result

STUDY DESIGN: A retrospective study. OBJECTIVES: We attempted to establish an efficient diagnosis and treatment modality by analyzing clinical manifestations and operative results of upper lumbar disc herniations. SUMMARY OF LITERATURE REVIEW: Upper lumbar disc herniations represented a lower incidence but have become easier to diagnose by predictable clinical aspects and an MRI scan. The operative results have been satisfactory. MATERIALS AND METHODS: We evaluated 41 cases, which were operated with posterior laminectomy and discectomy from September, 1996 to November, 2009. We analyzed pre-operative history, clinical and MRI findings, and then assessed operative results by Kim's criteria and functional change in the follow up. RESULTS: The prevalence of upper lumbar disc herniations in all disc herniations was 8.8%. Pre-operative manifestations were lower back pain (85.4%), radiating pain (80.5%), sensory deficit (53.7%), motor deficit (53.7%), and depressed knee jerk (65.9%). The positive rate of the femoral stretching test (78.0%) was higher than the straight leg raising test (39.0%). The VAS score changed from preoperative 9.0+/-0.8 into postoperative 1.4+/-1.3 points. The operative results were excellent or good in 82.9%. The rate of resuming previous work, including slight modification was 90.2%. CONCLUSIONS: Predictable clinical aspects of the upper lumbar disc herniations are anterior thigh pain with lower back pain, variable motor deficit, sensory deficit, depressed knee jerk and the positive femoral nerve stretching test. Through careful examination and radiological evaluations such as MRI, operative treatment can obtain a symptomatic improvement and satisfactory results.

Screw Fixation Techniques for Talar Neck Fractures (Anterior versus Posterior insertion) / 대한족부족관절학회지

PURPOSE: To compare the clinical and radiological results between the anterior and posterior screw fixation for the treatment of talar neck fracture. MATERIALS AND METHODS: Among 30 patients who received surgical treatment for talar neck fracture from 2001 to 2008. Twenty-seven patients with a follow-up period of more than 1 year were divided into two groups. Twelve patients were treated with anterior screw fixation and 15 patients with posterior approaches. We analyzed preoperative, postoperative and follow-up radiographs. Clinical results were evaluated by Hawkins criteria. RESULTS: The posteriorly inserted screws were placed across the more central portion of the talar neck and perpendicular to the plane of fracture (p<0.05). There were no difference in clinical results, the duration of union, and complications including avascular necrosis between two groups. However, 2 patients complained of pain around the talonavicular joint in the anterior insertion group. CONCLUSION: Although the clinical results were good irrespective of insertion methods, the posterior approach of screw fixation for talar neck fractures allows for a better mechanical advantage than anterioly placed screws. This may allow early motion with a reduced risk of failure of fixation or of displacement of the fracture.

Multiple Punctures and Steroid Injection in the Treatment of Ganglion Cyst

PURPOSE: Authors applied multiple punctures and steroid injection as a modified treatment of ganglion cyst and report objective and subjective outcomes. MATERIALS AND METHODS: We prospectively evaluated 40 patients with ganglion cysts of hands and wrists who underwent multiple punctures and steroid injection. Symptom improvement, recurrence rate and complications were evaluated after minimum follow-up period of 12 months. RESULTS: Pain and discomfort improved in 31 patients (78%), however, recurrence was observed in 32 patients (80%). The factors associated with low recurrence rate included ganglions located at the hand or palm, with small diameter, and with short period of symptoms. CONCLUSION: Multiple punctures and steroid injection resulted in relatively high recurrence rate of mass itself in the treatment of ganglion cyst. However, from the view point of symptom improvement, this procedure could be considered as a simple modified treatment before surgical excision.

Percutaneous Retrograde Intramedullary Pin Fixation for Isolated Metacarpal Shaft Fracture of the Little Finger

PURPOSE: To evaluate the anatomic and functional outcome of retrograde intramedullary single wire fixation for metacarpal shaft fractures of the little finger. MATERIALS AND METHODS: hirty one consecutive patients with closed metacarpal shaft fractures of the little finger who have been treated with retrograde intramedullary single wire fixation were evaluated. Fracture union and angulation were analyzed radiologically, and clinical evaluations were performed including range of motion, DASH score and complications. RESULTS: Fracture union was achieved in all cases and callus formation was obvious at postoperative 41 days. Average angulation of fracture site was 3degrees in the coronal plane and 1.2degrees in the sagittal plane at the last follow up and no measurable metacarpal shortening was observed. Mean TAM was 253degrees and DASH score was 2.6. There were two cases of pin migration as intermediate complications. CONCLUSION: Closed reduction with subsequent percutaneous retrograde K-wire fixation produced good radiological and functional results. We recommend this minimally invasive technique which provides adequate fixation of displaced little finger metacarpal shaft fractures with good functional results and low morbidity.

Femoral Neck Fracture

The incidence of the femoral neck fracture is increasing, and the mechanism of the injuries is quite different in the young and elderly groups (high energy injury and osteoporosis, respectively). In the young group, early anatomical reduction and rigid fixation by such measures as multiple cannulated screws are mandatory to decrease the complications. In the elderly group, hip arthroplasty is recommended to decrease the complications due to early mobilization.

Operative Treatment of Tongue Type Intra-articular Calcaneal Fractures: Comparison of the Open Reduction and Essex-Lopresti Technique / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological results of operative treatment in patients with tongue type intra-articular calcaneal fracture, and to compare the open reduction and Essex-Lopresti technique. MATERIALS AND METHODS: We examined a consecutive series of 42 patients who received surgical treatment for tongue type calcaneal fracture (24 cases of the open reduction and 18 cases of the Essex-Lopresti technique) and the postoperative data was compared with a minimum 1 year follow-up. The clinical outcome was analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and Salama's criteria. The preoperative, postoperative, and last follow-up changes in the Bohler angle was radiologically analyzed. RESULTS: There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. However, for the Sander's type 3 and 4 fractures, the open reduction group showed more improvement of AOFAS score and less reduction loss in the Bohler angle. CONCLUSION: Although the clinical results were good irrespective of surgical technique, the open reduction and internal fixation can improve clinical outcome and reduce the reduction loss as compared with the Essex-Lopresti technique in the comminuted tongue type calcaneal fracture.

The Relationship between Limb-Length Discrepancy on Function, Dislocation, Pain and Acetabular Wear after Bipolar Hemiarthroplasty for Femoral Neck Fracture

PURPOSE: To evaluate the relationship between a limb-length discrepancy and the clinical and radiological outcomes after bipolar hemiarthroplasty for femur neck fractures in elderly patients. MATERIALS AND METHODS: Between August 2004 and January 2007, 60 out of 80 cases over 65 years who underwent cemented bipolar hemiarthroplasty for femur neck fractures with a more than 2 years follow-up were evaluated retrospectively by dividing the patients into two groups, > 5 mm (group 1) and 0.05). CONCLUSION: Limb-lengthening by hemiarthroplasty may be a cause of pain but with little effect on the overall functional outcome.

Effectiveness of Arterial Embolization in Hemodynamically Unstable Pelvic Fracture

Purpose: To assess the effectiveness and appropriate time for arterial embolization with angiography in patients who sustained a hemodynamically unstable pelvic bone fracture Materials and methods: Nineteen cases with hemodynamically unstable pelvic bone fractures that were managed with arterial embolization out of 287 pelvic bone fractures between May, 2002 and February, 2007 were reviewed retrospectively. The blood pressure, pulse rate, hemoglobin, prothrombin time, partial prothrombin time and platelet checked were evaluated immediately after arrival at the emergency room, before and after embolization. Repeated measures analysis of variance was used for the statistical evaluation. Results: The blood pressure showed a statistically significant increase from before and after embolization. The hemoglobin and prothrombin time checked upon arrival were significantly lower than those checked before embolization. In addition, the hemoglobin and prothrombin time was significantly higher before embolization than after embolization. The partial thromboplastin time and platelet checked immediately upon arrival were significantly lower than those checked before embolization. Conclusion: Interventional angiography and embolization can be an effective treatment modality in patients with hemodynamically unstable pelvic bone fractures showing rapid changes in the hemoglobin level, prothrombin time, partial thromboplastin time and platelet count but little response to fluid and transfusion resuscitation,.

Short Term Results of Cementless Total Hip Arthroplasty with Using a Accolade TMZF Femoral Stem

PURPOSE: We wanted to evaluate the short term clinical and radiological results and the complications of primary total hip arthroplasty with using a Accolade TMZF femoral stem. MATERIALS AND METHODS: 66 cases among 80 cases underwent total hip arthroplasty by one surgeon with using an Accolade TMZF femur stem from January 2002 to August 2006. The minimum follow-up was 30 months and we retrospectively analyzed these 66 patients. RESULTS: The mean Harris Hip Score improved from 54 to 92 at the last follow up. On the last follow-up X-ray, all the femoral stems (100%) showed stable fixation and there was no osteolysis or loosening, but there were 34 cases of stress shields and 20 cases of cortical hypertrophy. The acetabular component revealed stable fixation in 65 cases (98.5%) and loosening in one case (1.5%). There was no acetabular osteolysis, but 22 cases of radiolucency were observed in the Dee Lee and Charnley zone II. As complications, there were 5 cases of heterotrophic ossification, 1 case of greater trochanteric bursitis, 2 cases of thigh pain and 1 case with a squeaking sound. CONCLUSION: Primary total hip arthroplasty using a cementless Accolade TMZF femoral stem showed good results in the short term, but long term follow up is needed.

The Relationships between Homocysteine, Folate, MTHER and TSER Polymorphism for Osteoporotic Compression Fracture in Postmenopausal Women / 대한정형외과학회잡지

PURPOSE: To analyze the relationships between homocysteine, folate, MTHFR and TSER polymorphism for postmenopausal women with osteoporotic compression fractures. MATERIALS AND METHODS: Forty-three postmenopausal compression fracture patients and as many normal controls were included. The plasma homocysteine and folate levels were measured using a FPIA (fluorescent polarizing immunoassay) kit. The MTHFR and TSER genotypes were amplified by PCR (polymerase chain reaction) and separated by RFLP (restriction fragment length polymorphism) in a 3.5% agarose gel. RESULTS: The plasma folate level was significantly lower in the postmenopausal women with osteoporotic compression fractures, particularly in the MTHFR 677CT and TSER 2R (-) genotypes. However, the plasma homocysteine level and MTHFR C677T polymorphism were similar to the control group. CONCLUSION: A low folate level and the TSER 2R (-) genotype can be associated with osteoporotic compression fractures in postmenopausal women.

Migration of Multiple Cannulated Screws in the Treatment of Femur Neck Fractures

PURPOSE: We wanted to assess the characteristics and clinical significance of screw migration after surgical treatment of femoral neck fractures. MATERIALS AND METHODS: We reviewed 44 hips (22 males, 22 females) that were treated with closed reduction and multiple cannulated screws between February 1998 and May 2005. The medical records and radiographs were analyzed retrospectively at a minimum of 18 months after surgery. 3 mm migration was arbitrarily chosen as the differentiating measure between the migration (27cases) and the nonmigration (17 cases) groups. The anatomical location of the fracture, Garden's classification, comminution, the screw position in the femoral head and the complications were statistically compared between the migration and nonmigration groups. The time sequence of events after surgery and the distance of migration were evaluated in the migration group. RESULTS: No significant differences between the two groups were noted in regard to complications, the screw position in the femoral head, the degree of displacement of fractures with using Garden's classification and the anatomic location of the fracture. There was a statistically significant difference between the two groups with regard to comminution (p=.001). In the migration group, the screws started migrating from 1 month after the operation and this was remarkable at 3~6 months. The average migration was 6.51 mm with 4.23 mm migration occurring in the first 3 months. CONCLUSION: For comminuted femur neck fractures that are treated with multiple cannulated screws, screw migration and shortening of the femoral neck can be anticipated to happen at 3 months after surgery.

The Comparison of the Cable Fixation of Lesser Trochanter in the Treatment of Kyle-Gustilo Type III Unstable Intertrochanter Fractures

PURPOSE: To evaluate the availability of cable fixation of the lesser trochanter in the treatment of unstable intertrochanter fractures using a sliding compressive hip screw (CHS) on the clinical and radiological results related to osteoporosis. MATERIALS AND METHODS: Fifty-four cases of Kyle-Gustilo type III unstable intertrochanter fractures between January 1999 to January 2005 were classified into 2 groups: groups 1(30 cases CHS) and 2(24 cases additional cable). The sliding distance of the lag screw, bony union, weight bearing time, and the loss of fixations related to osteoporosis in the two groups were compared retrospectively after a follow up of at least 1 year. RESULTS: The average sliding distances of the lag screw in groups 1 and 2 was 15.27 and 12.13 mm (p=0.0453), respectively. The time to bony union in groups 1 and 2 was 14.63 and 13.71 weeks (p=0.4623), respectively. The average weight bearing time in groups 1 and 2 was 3.03 and 2.83 weeks (p=0.1697), respectively. Early weight bearing was allowed in patients in group 2 with a Singh index greater than grade IV (p=0.0291), and a loss of fixation was encountered 5 cases in each group (p=0.9688), which increased significantly with increasing severity of osteoporosis (p<0.05). CONCLUSION: Additional cable fixation of the lesser trochanter for mild osteoporotic patients in unstable intertrochanter fractures is recommended for preventing the excessive sliding of lag screws and for allowing early ambulation. However, this procedure is not effective in patients with severe osteoporotic.

Comparison of Influenceon Displaced Femoral Neck Fractures in Young Adults : Fracture Level and Comminution, Time to Operation and Reduction / 대한정형외과학회잡지

PURPOSE: To analyze the influences of fracture level and comminution, time to operation and reduction quality on the results of displaced femoral neck fractures in young adults. MATERIALS AND METHODS: From January 1996 to January 2003, 39 of 51 cases of displaced femoral neck fractures that were treated with closed reduction and percutaneous internal fixation using cannulated screws, were evaluated after at least two years of follow-up with respect to the fracture level, comminution, time to operation, and reduction quality. RESULTS: The incidence of AVN and non-union were 6/39 (15.4%) and 3/39 (7.7%), respectively. The differences in the incidences of complications among subcapital, transcapital, and subcapital fractures was not significant (p=1 & p=1). There was a higher incidence of AVN (p=0.0066) and non-union (p=0.0219) with posterior comminutions than anterior ones. The time to operation was not an important factor in influencing the development of complications (p=0.4984 & p=1). Between acceptable and poor reductions, the differences in the incidences of AVN was significant (p=0.0105), but not in the incidences of non-unions (p=0.1011). CONCLUSION: We concluded that good quality of reduction is more important than the time to operation for achieving good results, and that comminution is a more important prognostic factor than is the fracture level.

Salmonella Pyomyositisina Multiple Myeloma Patient: A Case Report / 대한정형외과학회잡지

Pyomyositis is a bacterial infection of the skeletal muscle with Staphylococcus aureus being the most common pathogen. Pyomyositis by salmonella is quite rare accounting for less than 1% of the total pyomyositis, and has some different characteristics and a poor prognosis compared with those of the typical pyomyositis caused by other bacteria. Among these differences, an older age, other combined diseases, and an immune deficient condition are factors predisposing a patient to pyomyositis by salmonella. We experienced a very rare case of pyomyositis by salmonella at the inguinal area in a multiple myeloma patient. This is the first case reported in South Korea.

Internal Fixation with Two Lowprofile Plates in Fractures of the Distal Tibia

PURPOSE: To evaluate the functional results after internal fixation with two low profile plates in fractures of the distal tibia. MATERIALS AND METHODS: From March 1998 to October 2002, twelve patients with fractures of the distal tibia were treated with internal fixation using two low profile plates and followed for at least one year. Fractures according to AO/OTA classification were one Type A1, four Type A2, two Type C1, two Type C2 and three Type C3. We analyzed the functional results by the Olerud and Molander ankle scoring system and the postoperative complications. RESULTS: The average functional score was 81.2 points and the results were three excellent, six good, one fair and two poor. Bony union was achieved in all cases. There was 1 case of superficial wound infection as a complication. CONCLUSION: Internal fixation with two low profile plates in fractures of the distal tibia may minimize the incidence of soft tissue complications and provide good bony union and functional results. Therefore, we consider internal fixation with two low profile plates as a good alternative treatment of the distal tibial fracture.

Femoral Head and Neck Fractures developed in Avascular Necrosis of the Femoral Head

Femoral head and neck fractures during the course of avascular necrosis are rare with only few reports in the English literature. Moreover, there are very few reports on an analysis of the patterns of these fractures. Four cases of femoral head fracture caused by minor trauma, which were quite different from the crescent fractures during the course of avascular necrosis were analyzed in regard to the underlying disease, causes, sites, types, directions, pattern of fractures and the injury mechanism of the fractures. The results are reported with special regard to the pattern of the stress fracture of the femoral head and neck during the course of avascular necrosis.

Wedge Tibial Shaft Fractures Treated with Interlocking IM Nailing

PURPOSE: To investigate the bone union time of patients treated with interlocking intramedullary nailing in wedged tibial shaft fracture and to evaluate the factors that influence this result. MATERIALS AND METHODS: 32 patients treated with interlocking intramedullary nailing for wedge tibial shaft fracture were reviewed with a follow-up period of more than 1 year. Radiographic results were assessed with diameter (%) and length (mm) of wedge fragment, pre and postoperative displacement (mm) of wedge fragment. We also checked the bone union time of the main fragment and the wedge fragment (paired t-test). We investigated the bone union time acocording to the diameter, length of wedge fragment, pre and postopertvie displacement (correlation analysis). RESULTS: Bone union time of the main fragments averaged 15.3 weeks (6~53 weeks) and that of wedge fragment averaged 24.2 weeks (8~64 weeks) (p=0.005). There was no correspondence between wedge fragment diameter and bone union time (p=0.681), but the bone union time of wedge fragment increased in proportion to its diameter (r2=0.747, p=0.031). There was no correspondence between preoperative displacement of wedge fragment and bone union time (p=0.574), but the bone union time increased in proportion to postoperative displacement of wedge fragment (r2=0.730, p=0.001). CONCLUSION: Wedge fragments need longer time for bone union than main fragments in interlocking intramedullary nailing for wedge tibial shaft fractures. We need to pay attention to the displacemet of fragments in treating tibial shaft fractures with large wedge fragment.