Musculoskeletal Injuries by Weapons in Korean Soldiers: Four-Year Follow-Up / 대한정형외과학회잡지

Purpose@#To date, studies of firearm and explosive injuries in the Korean military have been limited compared to its importance. To overcome this, this study examined the characteristics of musculoskeletal damages in soldiers who have suffered firearm and explosive injuries over the past four years. @*Materials and Methods@#From January 2015 to July 2019, military forces who had suffered musculoskeletal injuries from firearms or explosive substances were included. The medical records and radiographs were reviewed retrospectively, and telephone surveys about Short Musculoskeletal Functional Assessment (SMFA) for this group were conducted. To compare the functional outcomes, statistical analysis was performed using a t-test for the types of weapons, and ANOVA for others. @*Results@#Of the 61 patients treated for firearms and explosives injuries, 30 patients (49.2%) were included after undergoing orthopedic treatment due to musculoskeletal injury. The average age at injury was 26.4 years old (21–52 years old). The number of officers and soldiers was similar. Eleven were injured by gunshot and 19 by an explosive device. Sixteen were treated in the Armed Forces Capital Hospital and 10 at private hospitals. More than half of the 16 patients (53.3%) with a fracture had multiple fractures. The most common injury site was the hand (33.3%), followed by the lower leg (30.0%). There were 14 patients (46.7%) with Gustilo-Anderson classification 3B or higher who required a soft tissue reconstruction. Fifteen patients agreed to join the SMFA survey for the functional outcomes. Between officers and soldiers, officers had better scores in the Bother Index compared to soldiers (p=0.0045). Patients treated in the Armed Forces Capital Hospital had better scores in both the Dysfunction and Bother Index compared to private hospitals (p=0.0008, p=0.0149). @*Conclusion@#This is the first study to analyze of weapons injuries in the Korean military. As a result of the study, the orthopedic burden was high in the treating patients with military weapon injuries. In addition, it is necessary to build a military trauma registry, including firearm and explosive injuries, for trauma treatment evaluation and development of military trauma system.

Posterior condylar offset changes and its effect on clinical outcomes after posteriorsubstituting, fixed-bearing total knee arthroplasty: anterior versus posterior referencing

Background@#We sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. We also assessed whether the PCO and PCOR changes, as well as patient factors were related to range of motion (ROM) in each referencing system. @*Methods@#This retrospective study included 130 consecutive patients (184 knees) with osteoarthritis who underwent primary posterior cruciate ligament (PCL)-substituting fixed-bearing TKA. The difference between preoperative and postoperative PCO and PCOR values were calculated. Clinical outcomes including ROM and Western Ontario and McMaster University (WOMAC) scores were evaluated. Furthermore, multiple linear regression analysis was performed to determine the factors related to postoperative ROM in each referencing system. @*Results@#The postoperative PCO was greater in the AR group (28.4 mm) than in the PR group (27.4 mm), whereas the PCO was more consistently preserved in the PR group. The mean postoperative ROM after TKA was greater in the AR group (129°) than in the PR group (122°), whereas improvement in WOMAC score did not differ between the two groups. Preoperative ROM was the only factor related to postoperative ROM in both groups. @*Conclusions@#There was no difference in postoperative PCO in AR and PR group and the PCO was not associated with postoperative ROM. PCO was more consistently preserved after surgery in the PR group. The postoperative PCO and PCOR changes did not affect the postoperative ROM. Furthermore, similar clinical outcomes were achieved in the AR and PR groups.

Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe

PURPOSE: Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed.MATERIALS AND METHODS: The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively.RESULTS: The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days.CONCLUSION: Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.

Expression of Pro-inflammatory Cytokines during Distraction Osteogenesis of the Rat Tibia / 대한정형외과학회잡지

PURPOSE: The purposes of this study were to investigate the expression pattern of pro-inflammatory cytokines during distraction osteogenesis and to compare these with expression during simple fracture healing. MATERIALS AND METHODS: Regenerated bones from the rat tibia subjected distraction osteogenesis and simple fracture healing models were harvested over three-week periods. Temporal expressions of mRNA of pro-inflammatory cytokines were investigated by RNase protection assay. Immunohistochemical studies for IL-6 were performed in postoperative day 7 and 9 tissue section specimens. RESULTS: IL-1beta and IL-6 produced detectable signals, while IL-1alpha, TNFalpha and TNFbeta did not. The mRNA expressions of IL-1beta and IL-6 were markedly upregulated on postoperative day 1 and then subsided to the preoperative level. IL-1beta mRNA expression remained the same even when distraction began. However, IL-6 mRNA expression was reactivated during the distraction phase. Immunohistochemical study revealed the expressions of IL-6 not only at the transitional zone of the transchondroid ossification, in young osteoblasts lining newly formed trabeculae and in hematopoietic cells in the marrow but also in primitive mesenchymal cells at the distraction gap. CONCLUSIONS: Distraction strain re-induced IL-6 expression during distraction osteogenesis, which suggests that well-controlled inflammatory reaction might contribute to active new bone formation in distraction osteogenesis.

Treatment of Spinal Deformities with Neurofibromatosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: By analyzing the patients of neurofibromatosis with spinal deformities, to identify presence of dystrophic changes, progression of deformity and associated factors, and treatment results according for sagittal curve pattern and operative methods. SUMMARY OF LITERATURE REVIEW: A single thoracic curve involving four, five, or six vertebrae is recognized as the most common pattern. Risk factors for progression of curve were anterior vertebral scalloping, particularly in younger patients, three or more penciled ribs, abnormal kyphosis, etc. It has been stated that the most effective management for dystrophic curves is early and aggressive surgery. MATERIALS AND METHODS: Thirty nine patients with neurofibromatosis and spinal deformities were reviewed with chart and radi-ographic review from 1977 to 1999. RESULTS: Four of thirty nine patients were nondystrophic type, and all patients were treated nonoperatively. Thirty five of thirty nine patients were dystrophic type, and twenty seven patients were treated operatively. Eight of these patients had been in progress till operation with 7.9 degrees/year progression rate, and their commonest pattern of deformity is a single curve in lower thoracic area with dystrophic changes such as vertebral scalloping, wedging, pencilling of average four ribs, particularly. Forty three percent of dystrophic type has sagittal plane deformities. The pedicle screw system was most excellent among the instrumentations. The complications of surgery were 6 progression of curve, 2 metal failure. Reoperation was done in 5 of 27 operated patients. CONCLUSIONS: Nondystrophic type had good results with nonoperative treatment, but dystrophic type mostly required surgical intervention and had rapid progression. The treatment should be done by rigid fixation after considering sagittal plane deformi-ties and long term follow-up was needed for progressions of curve.

Interpositional Arthroplasty using Pronator Quadratus Pedicled Bone for the Treatment of Stage III Kienbock's Disease / 대한정형외과학회잡지

Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.