Minimally Invasive Reduction and Pin Fixation Treatment for Displaced Intraarticular Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: To evaluate the clinical efficacy of the minimally invasive posterior approach for the surgical treatment of intraarticular fracture of calcaneus. MATERIALS AND METHODS: From March 2006 to October 2008, we studied retrospectively 45 patients, 56 cases who were treated with minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and AOFAS score, circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. RESULTS: By Creighton-Nebraska score, Sanders type 1 was 81, type 2 was 75, type 3 was 69, type 4 was 61. By AOFAS score, Sanders type 1 was 88, type 2 was 82, type 3 was 78, type 4 was 63. And by circle draw test, type 1 was 8.8 cm, type 2 was 8.5 cm, type 3 was 8 cm, type 4 was 6.6 cm. Preoperative Bohler angle and Gissane angle were 7.2degrees, 98degrees, and it increased to 21.2degrees, 116degrees after postoperative 1 year. CONCLUSION: Minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture was considered to be an effective treatment modality.

Single Dorsal Incision Technic for Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: In this study, we introduced a newly developed technique of operation for hallux valgus. We used a single dorsal incision to correct major components of Bunion in stead of two or three incisions, which had been used by most of surgeons for long time. MATERIALS AND METHODS: Between 2003 and 2005, 27 feet with hallux valgus deformity were operated through single dorsal incision. 10 out of 17 patients underwent operation on both feet, 5 patient underwent operation on left feet, remaining 2 underwent operation on right. There were 16 women and 1 man. Average age of patients was 45 (range, 21-59). Post operatively all feet were evaluated by physical examination, Maryland Foot score profile, radiographic measurements and complication. RESULTS: Maryland foot score profile increased from preoperative 67/100 to postoperative 95/100. Most patients satisfied pain relieve and cosmesis. Average preoperative intermetatarsal angle was 15 degrees, which were decreased to 9 degrees after operation and average preoperative hallux valgus angle was 32 degrees, which were decreased to 12 degrees after operation. CONCLUSION: According to our experience, the single dorsal incision technic for correction of moderate to severe hallux valgus deformities was rather safe and easily performed without noticeable complication with almost same results as multiple incisions technics. We highly recommend this technic to be tried by foot surgeons without hesitation.

Heel Pad Thickness: Measurement by Simple Plain Radiography / 대한족부족관절학회지

PURPOSE: The heel fat pad has a unique structure that is important for its shock absorbing function. Loss of elasticity and change in the thickness of the heel pad have been suggested as cause of heel pain. The present study shows the relationship between the thickness of heel fat pad and age, sex, obesity and plantar heel pain. MATERIALS AND METHODS: A study of heel pad thickness using plain lateral radiographs, unloaded by body weight, was carried out on 66 patients with plantar heel pain and 326 normal subjects. The population was divided into two or three groups according to their age, sex, body mass index, and the presence of symptom. We evaluated the differences in heel pad thickness between groups, and the relationship between BMI and Sex and Age was also determined, using statistically analytic method by SPSS version 10.1 program. RESULTS: Heel pad thickness was greater in the subject over 40 years old (p<0.001), and in the overweight (p<0.001), and male heel pad was thicker than female (p<0.001). But there was no statistically significant difference for heel pad thickness between normal subject and plantar heel pain group. CONCLUSION: In this study, we found that there is a relationship between heel pad thickness and age, sex, and obesity. But we could not show that the difference of heel pad thickness is contributing factor to plantar heel pain. Although it could not be proved statistically, we believe that a change of heel pad thickness play a role in the development of heel pain. So we are planning to assess a relationship of heel pad elasticity and thickness and plantar heel pain again with prospective study method on the basis of the results of this study.

Alterations of Glutamate and GABA Immunoreactivities in the Anterior Horn of the Ischemic Spinal Cord of the Rabbit / 대한정형외과학회잡지

PURPOSE: This study was carried out to investigate chronological changes of glutamate and gamma-aminobutyric acid (GABA) immunoreactivities in the anterior horn of the spinal cord after ischemia-reperfusion. MATERIALS AND METHODS: Spinal cord ischemia was induced by clamping the abdominal aorta for 15 minutes in New Zealand white rabbit, and then the spinal cord was reperfused. These animals were sacrificed at 0.5, 1, 3, 6, 12, 24 and 48 hours after ischemia-reperfusion. Spinal cord sections at the level of L7 were immunostained against glutamate and GABA. RESULTS: Glutamate immunoreactive neurons and fibers were first detected in the lamina IX at 30 minutes, but at 1 hour, the immunoreactivity returned to the control level. At 6 hour, glutamate immunoreactivity was observed around the blood vessels and its immunoreactivity increased between 6 and 12 hour. Thereafter the immunoreactivity decreased and eventually disappeared at 48 hours. GABA immunoreactivity increased in the anterior horn from 6 to 12 hours. Thereafter, GABA immunoreactivity decreased and eventually disappeared at 48 hours. CONCLUSION: These results suggest that the alteration of the glutamate immunoreactivity may occur much rapidly than that of GABA immunoreactivity in spinal anterior horn after ischemia-reperfusion.

The Percutaneous Pinning of the Displaced Supracondylar Fracture of the Humerus using Skin Traction

PURPOSE: The purpose of this study was to evaluate a new treatment method, which was using intraoperative skin traction and Steinmann(S)-pin for anatomically reduction by gentle manipulation to treat the displaced supracondylar fracture of the humerus with percutaneous pinning. MATERIALS AND METHODS: Clinical analysis was performed on thirty displaced supracondylar fractures (Gartland type III) of the humerus patients with a minimal three month follow up, who were treated percutaneous pinning after reduction with by intraoperative skin traction and S-pin. Clinical results were analyzed according to the Flynn grading system. RESULTS: According to the Flynn grading system, excellent results were obtained in 12 cases (43%), good in 14 case (47%), fair in 4 cases (10%), poor in 0 cases (0%) and we obtained all satisfactory results. There was one case which was reoperated for closed reduction and percutaneous pinning repeatedly due to reduction loss and no case with conversion to open reduction. CONCLUSION: To avoid the forceful manipulation, gentle closed reduction and percutaneous pinning using intraoperative skin traction and S-pin especially for rotational correction in the displaced supracondylar fracture of the humerus is considered to be useful method because showed satisfactory results.

Isolation of Klebsiella Oxytoca Clinical Isolate Producing AmpC beta-lactamase, DHA-1 / 대한임상미생물학회지

BACKGROUND: Klebsiella oxytoca strain exhibiting an unusual inducible beta-lactam resistance phenotype was isolated from a wound specimen of a patient at a university hospital in August 2002. The isolate was resistant to ampicillin, ampicillin-sulbactam, cephalothin, cefoxitin, and demonstrated reduced inhibition zone diameters for ceftazidime in combination with clavulanate versus those for ceftazidime when tested alone. METHODS: Antimicrobial susceptibilities were tested using the Etest and disk diffusion method. AmpC beta-lactamase production was determined by modified Hodge test. The disk antagonism method was used to detect inducibility of beta-lactamase. Conjugation experiments were performed by the filter mating method using the recipient Escherichia coli J53 Azir strain. PCR and DNA sequencing of DHA-specific PCR products were tested. RESULTS: The double disk synergy test was negative and the modified Hodge test was positive for the K. oxytoca isolate. Antagonism was observed between cefoxitin and oxyimino-cephalosporins. Sequence analysis of the DHA-specific PCR products revealed that they were identical to the amino acid sequence of the DHA-1 beta-lactamase. Transfer of the resistance by conjugation experiments was successful. CONCLUSIONS: We found a plasmid-mediated DHA-1 beta-lactamase-producing K. oxytoca possessing an unusual inducible beta-lactam resistance phenotype was found in a university hospital in Korea. The resistance phenotype was conferred by DHA-1 encoded by a self-transferable plasmid.

Flat Foot Survey in 8 Year Old Primary School Children / 대한족부족관절학회지

PURPOSE: To estimate the prevalence of flat foot in the 1st grade primary school children in the Kang-Dong Gu, Seoul, Korea. MATERIALS AND METHODS: We examined 1336 8 year old the first grade children (2672 feet) in primary school at 5 primary school for prevalence of flat foot and the associating factors in Kang-Dong Gu in April 2003. The group was examined with 2 mm-pannel in physical examination at erect position to put diagnosis of flat foot which showed no plantar arch. The height, weight, foot length and foot width were estimated in all children. We used obesity grading system of Korean Pediatric Association for overweight evaluation. RESULTS: We enrolled 728 boys and 608 girls, and prevalences of each gender were 20.8% and 14.9%. The children who had flat foot were 243 and the prevalence of flat foot was 18.2%. The foot length ranges between 152 mm and 300 mm (mean value 183.6 mm, SD 10.6), and the foot width were between 50 mm and 107 mm (mean value 2.16 mm, SD 4.8). Of the 1336 children group, 1215 children (90.0%) were in range of normal weight, 72 children (5.4%) were in grade-1 overweight, 38 (2.8%) were in grade-2 overweigh and, 11 (0.8%) were in grade-3 overweight. The prevalence of flat foot of each overweight group were 16.3%, 34.7%, 39.5% and 45.5%. Overweight in children effected increased prevalence of flat foot. But there were no significant relationship with flat foot in other factors. CONCLUSION: Over all prevalence of flat foot of 8 year old children was 18.2% and most of patients were flexible flat foot. The prevalence of flat foot was influenced by overweight remarkably.

A Comparison of Fusion Rates and Clinical Results Between Single-Level Cervical Corpectomy and Two-Level Discectomies and Fusion with Plating / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the radiographic and clinical results of two-level discectomies and fusion with plating and a singlelevel corpectomy with plating. SUMMARY OF LITERATURE REVIEW: Previous studies of multisegment fusion have shown decreased fusion rates correlating with the number of increasing levels, and the use of anterior plate in multilevel fusions may be warranted because of the increased pseudoarthrosis rates. MATERIALS AND METHODS: A total 30 consecutive patients operated at our institutions between Oct. 1995 and Mar. 2000 were entered into this study. Twenty patients with cervical spondylosis had performed two-level discectomies with tricortical bone grafts and plating, and ten patients with cervical myelopathy had a single-level corpectomy with plating. Follow up averaged 2.4 years, radiographic and clinical follow up evaluation was performed. We assessed the radiologic value by postoperative and follow-up sagittal radiograms at monthly intervals until fusion was judged to be solid, and the clinical evaluation by Odom's criteria. RESULTS: Comparing the radiographic data between the two groups of patients, the values were not different. Of the thirty patients, no non-unions occurred in all patients. The average amount of graft collapse for patients with single-level corpectomy with plating or a two-level discectomy with plating was less than 1 mm for both groups. And, the average amount of kyphotic deformity was less than 1 degrees for both groups. The clinical results of the operations graded by Odom's criteria are no statistical significance between the two groups. (p < 0.9, chi test) CONCLUSION: There is no significant statistical differences for two-level discectomies with plating and a single-level corpectomy with plating in fusion rate and clinical results, and each methods can be used a viable alternative procedure by anatomical structure that were primarily causing the neural impingement with more reliable fusion rates.

Bilateral Brodie's Abcess on the Proximal Tibia / 대한정형외과학회잡지

Brodie's abcess, a local form of subacute osteomyelitis, is a rare disease and usually occurs in the metaphysis or epiphysis of the long tubular bone in young adults. Generalized symptoms and signs resembling infectious disease are uncommon. Abnomalities in laboratory findings are not severe. Because of these characteristics and nonspecific radiology, there are difficulties in the differential diagnosis with other infectious disease and tumorous conditions. The authors experienced a case of Brodie's abcess in the proximal tibia bilaterally.

Comparison of Results obtained from the Modified Brostrom and the Chrisman-Snook Procedures for Chronic Lateral Ankle Instability / 대한정형외과학회잡지

PURPOSE: To compare results of the modified Brostrom procedure and the Chrisman-Snook procedure for chronic lateral ankle instability. MATERIALS AND METHODS: Twenty-eight patients (30 ankles) who underwent 20 modified Brostrom procedures or 10 Chrisman-Snook procedures were available. Follow-up averaged 3.2 years (1.3-5.4 years). Clinical results were graded according to the AOFAS clinical rating system. The talar tilting angle was also measured. RESULTS: Clinical results were rated as excellent in 15, good in 4, and fair in 1 ankle after the modified Brostrom procedure, and excellent in 7, and good in 3 ankles after the Chrisman-Snook procedure. Three complications occurred after the Chrisman-Snook procedure; delayed wound healing in 1 ankle, and transient neuralgia in 2. Mean talar tilting angle was improved from 17.4+/-6.6degrees to 6.6+/-1.2degrees by the modified Brostrom procedure, and from 15.6+/-5.9degrees to 3.0+/-1.1degrees by the Chrisman-Snook procedure. CONCLUSION: Significant differences were found in the clinical results obtained using the two procedures, and good function was obtained in a high percentage of patients. The procedure of choice should be decided upon based on the patient's condition and the doctor's preference.

Origins of Dorsal Root Ganglion Cells Innervating Medial, Lateral Collateral Ligaments and Patellar Tendon of the Rat Knee Joint / 대한정형외과학회잡지

PURPOSE: The present study was designed to examine the distribution and type of dorsal root ganglion (DRG) cells innervating the medial and lateral collateral ligaments and patellar tendons of the rat knee joint. MATERIALS AND METHODS: We selectively injected neural tracers (FG and HRP) into both collateral ligaments and patellar tendons and then charaterized the distribution and type of DRG cells in section. RESULTS: FG-labelled DRG cells, innervating the medial and lateral collateral ligaments, were located in L1-S3 (former) and L1-L5 (later). The HRP-labelled DRG cells innervating the medial and lateral collateral ligaments were smaller than 600 m2. FG-labelled DRG cells innervating the patellar tendons were found in L1 to S1. The HRP-labelled cells innervating the patellar tendons were variable in size (100 m2 to 3000 m2). CONCLUSION: This study indicates that the DRG origins of sensory nerves in the collateral ligaments and the patellar tendon of the rat knee joint are different. The majority of DRG cells innervating the patellar tendons are proprioceptive and mechanoceptive sensory cells. This finding suggests that the patellar ligaments have more neurological functions than the collateral ligaments.

Outcome Analysis of Cervical Myelopathy in Patients More Than 70 Years of Age / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the surgical outcomes and image by mid-sagittal MRI in patients with cervical myelopathy who were more than 70 years of age. SUMMARY OF LITERATURE REVIEW: Surgical outcomes of cervical myelopathy in the elderly patients were worse than in the younger patients, but decompression surgery is helpful for improving neurologic function in the elderly. MATERIALS AND METHODS: Nine patients more than 70 years of age who underwent surgery were reviewed. Neurologic deficits after surgery were assessed using a scoring system proposed by Japanese Orthopaedic Association( JOA ) and clinical results and morphological changes on MRI were compared with those of patients less than 70 years old age. RESULTS: The preoperative mean JOA score was 8.5 and the postoperative mean JOA score 12.8 and the maximum recovery rate was 51.1%, but these were significantly inferior to scores in those less than 70 years of age. At the time of final follow up , the mean JOA score had decreased 11.3 and the recovery rate was 32.6%. All patients except one were improved their daily living function. On the postoperative midline T1 sagittal MRI, morphological improvement was seen in 44% in patients more than 70 years of age, while 69% of patients were improved in the control group. CONCLUSIONS: Surgical decompression appears to be necessary as soon as possible after the onset of progressive myelopathy in the elderly patients for improving neurologic function and ability to engage in daily living.

Origings of Dorsal Root Ganaglion Cells Innervating Anterior and Posterior Cruciate Ligaments of the Rat Knee Joint

PURPOSE: The present study was designed to examine the distribution of dorsal root ganglion(DRG) cells innervating the anterior and posterior cruciate ligaments of the Sprague-Dawley rat knee joint. MATERIALS AND METHODS: Fluoro-gold(FG) was used to identify the distribution of DRG cells innervating the ligaments, and horseradish peroxidase(HRP) was used to measure the DRG cell size innervating the ligaments. RESULTS: Neural tracers-labelled DRG cells were found ipsilaterally only in the lumbosacra1 DRGs. FG-labelled DRG cells innervating the anterior and posterior cruciate ligaments were found from the 1st lumbar DRG to the 1st sacral DOR(L1-Sl). The majority of FG-labelled DRG cells innervating the poste-rior cruciate ligaments were located in the L4, and the majority innervating the anterior cruciate ligaments were found in the L3, The size of HRP-labelled DRG cells innervating the cruciate ligaments was below 800 micromiter (c), showing that these cells were small. CONCLUSION: This study indicates that the DRG origin of sensory nerves is different in each cruciate ligament of the knee joint. But the size and the type innervating each ligament is similar.

Prospective Comparison between the Anterior Interbody Fusion and the Posterolateral Fusion / 대한척추외과학회지

OBJECTIVES: To campare the differences of clinical and radiological results between the posterolateral fusion and the anterior interbody fusion. MATERIALS AND METHOD: For prospective study, the anterior interbody fusion was performed in 20 patients(Group I) and the pos-terolateral fusion was performed in 20 patients(Group II). The operation time, pre- & post-operative hemodynamic changes, functional recovery and fusion rate were compared. RESULTS: The average operation time was 180 min in group I and 100 min in group II. The average estimated blood loss and transfusion amount were assessed 1225cc, 926cc in group I and 1034cc, 880cc in group II. Clinical results were as follows: excellent 25%, good 65%, fair 10% in group I and excellent 15%, good 50%, fair 30%, poor 5% in group II. The fusion rate was 100% in group I and 75% in group II. CONCLUSION: The anterior interbody fusion with posterior instrumentation is considered encouraging operative methods.

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.

Isolated Simultaneous Dislocation of All Five Carpometacarpal Joints: A Case Report / 대한정형외과학회잡지

Isolated dislocation of all five carpometacarpal joints is extremely rare, only eleven cases had been reported since 1873. In Korea, we have not seen it probably. We experienced one case of isolated dislocation of all five carpometacarpal joints with a good result in I year after closed reduction and internal fixation.

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.