Multidetector CT Findings of Acquired Spondylolysis and Spondylolisthesis after Posterior Lumbar Laminectomy

Purpose@#We aimed to analyze postoperative multidetector CT (MDCT) of acquired spondylolysis and spondylolisthesis after posterior lumbar laminectomy. @*Materials and Methods@#We enrolled 74 patients, from 2003 to 2017, who underwent posterior lumbar laminectomy with both pre and postoperative MDCT. The patients were categorized into the following two groups: group 1 without fusion and group 2 with fusion. We analyzed laminectomy width, level and location of spondylolysis or spondylolisthesis, facet changes, and fatty infiltration of paraspinal muscles on postoperative MDCT. @*Results@#Incidence of spondylolysis or spondylolisthesis was 4 of 20 patients in group 1 and 2 of 54 patients in group 2. The laminectomy width (%) was defined as the percentage of the width of laminectomy to total lamina length. Mean laminectomy width (%) in patients with spondylolysis or spondylolisthesis was 54.0 in group 1 and 53.2 in group 2, in contrast to that in patients without spondylolysis or spondylolisthesis, which was 35.0 in group 1. The spondylolysis was observed at the level of the laminectomy and below pars interarticularis in group 1 and below the fusion mass at isthmic region in group 2. @*Conclusion@#MDCT facilitates the diagnosis of postsurgical acquired spondylolysis and spondylolisthesis and demonstrates typical location of spondylolysis. Greater laminectomy width has been associated with occurrence of acquired spondylolysis and spondylolisthesis.

Causes of Residual Pain after Open Excision of Wrist Ganglion / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to verify the relationship between the residual pain and preoperative carpal instability, as well as the generalized laxity after open excision of wrist ganglion. MATERIALS AND METHODS: Sixty-four patients, who received open excision of wrist ganglion, were retrospectively enrolled. The relationships between residual pain (visual analogue scale, VAS) and postoperative function (quick disabilities of the arm, shoulder and hand, quick-DASH), between residual pain and preoperative carpal instability, as well as generalized laxity were evaluated. The carpal instability was assessed from radiologic carpal instability (dorsal intercalated segment instability and volar intercalated segment instability) and Watson scaphoid shift test. The generalized laxity was assessed by the Beighton hypermobility score. RESULTS: Pain VAS and quick-DASH were significantly improved postoperatively. There was a significant difference in postoperative residual pain between those with (n=6) and without carpal instability (n=58) (+: 2.50±1.76 vs. −: 1.18±1.24; p=0.022), but there was no correlation between carpal instability and postoperative quick-DASH. Both postoperative residual pain and quick-DASH had no correlation with generalized laxity (n=18). CONCLUSION: Patients with preoperative carpal instability had greater residual pain after excision of wrist ganglion than those without.

A Fast Recovery of Muscle Weakness after Zoster-Induced Brachial Plexitis / 대한정형외과학회잡지

Varicella zoster virus (VZV)-induced brachioplexitis is a rare disease, characterized by exacerbating ipsilateral upper extremity pain, muscular weakness, and delay in recovery. We report a 54-year-old female patient who made an early recovery from VZV-induced brachioplexitis via the treatment with stellate ganglion blocks, which may have prevented pain sensation, vasoconstriction, and nerve scarring during the early treatment period.

Is osteoporosis a risk factor for ankle fracture?: Comparison of bone mineral density between ankle fracture and control groups

OBJECTIVES: There remains controversy over osteoporotic feature of the ankle. Therefore, we investigated the possibility of the existence of a relationship between axial bone mineral density (BMD) in patients with ankle fracture group with that of the normal population in Korea under control of other confounding factors such as body mass index (BMI). METHODS: This study retrospectively reviewed medical records of patients who were treated in our institution from 2005 to 2015. A comparative analysis was carried out between 116 patients with ankle fracture (ankle fracture group) and 113 patients admitted with other orthopedic reasons (control group). Sex, age, energy level of trauma, and BMI were analyzed as variables affecting axial BMD. RESULTS: Age and sex of ankle fracture group were not different from them of control group (P = 0.968 and P = 0.870, respectively). BMI of ankle fracture group was higher than that of control (P = 0.029). The other variables showed no differences between the 2 groups. The energy level of trauma in ankle fracture group was related to only BMI (P = 0.013). CONCLUSIONS: Axial BMD of ankle fracture patients showed no difference from that of a control group in Korean population. The occurrence of ankle fracture is affected by only BMI rather than axial BMD. Evaluation of osteoporosis for patients with ankle fracture should be considered separately.

Electron Microscopy Pathology of ADSSL1 Myopathy

No abstract available.

Magnetic Resonance Imaging Findings in Small Patella Syndrome

Small patella syndrome (SPS) is characterized by aplasia or hypoplasia of the patella and pelvic girdle abnormalities, including bilateral absence or delayed ossification of the ischiopubic junction and infra-acetabular axe-cut notches. Here, we report a case of SPS in a 26-year-old female. Magnetic resonance image (MRI) showed a small patella with thick eccentric non-ossified patellar cartilage and femoral trochlear dysplasia with hypoplastic patellar undersurface. To our knowledge, this is the first report of MRI findings in SPS. MRI findings could be clinically relevant because elongation of the medial patellofemoral ligament and trochlear dysplasia with eccentric non-ossified patellar cartilage might lead to patellofemoral maltracking with an osteochondral lesion or acute dislocation or an extensor mechanism injury. Though the patient presented in this case report only had a gastrocnemius injury at the origin site, physicians should carefully examine abnormalities with MRI when an SPS patient has a trauma to the knee.

Normal Mastoid Air Cell System Geometry: Has Surface Area Been Overestimated?

OBJECTIVES: The aim of this study was to emphasize the necessity of a standard in segmentation threshold and algorithm for measuring volume and surface area of mastoid air cell system (MACS). METHODS: First, we obtained axial computed tomography scans of 54 normal temporal bones from 27 subjects. Then, we manipulated Hounsfield units (HU) image data in DICOM (digital imaging and communications in medicine) files directly using our program. The volume and surface area of MACS were computed and compared at segmentation thresholds (HU) from -700 to 0 at intervals of 50 using 2 algorithms; square pixel based (SP) algorithm and marching square (MS) algorithm. RESULTS: No significant difference was found between the volumes computed by SP and MS algorithms at each segmentation threshold. The surface area computed by SP algorithm, however, was significantly larger than that by MS algorithm. We could minimize this significant difference through a modification of the SP algorithm. As the lower HU threshold value was set, the smaller volume was measured. The surface area showed a plateau at a threshold of approximately -200 HU. The segmentation threshold had greater influence on the measured volume of MACS than the algorithm did. CONCLUSION: A standard method for measuring volume and surface area of MACS is thought to be necessary. We suggest that the MS algorithm and -200 HU of the threshold could be a standard in the measurement of volume and surface area of MACS.

A Metastatic Lung Adnocarcinoma Misdiagnosed as Trauma Induced Sternoclavicular Joint Arthrosis / 대한스포츠의학회지

The prevalence of metastatic tumorous lesion at medial clavicle or sternoclavicular joint is low. Herein, we presented a 45-year-old female patient with left sternoclavicular joint pain followed a weight-lifting exercise. The patient was initially diagnosed as traumatic sternoclavicular arthrosis, however, on later computed tomography scan demonstrated the bony destruction of medial clavicle which was diagnosed as metastasized non-small cell lung carcinoma after a fine needle biopsy.

The Effect of Distal Location of the Volar Short Arm Splint on the Metacarpophalangeal Joint Motion

BACKGROUND: The goals of this study were to compare maximal metacarpophalangeal joint (MCPJ) flexion angles after application of a volar short arm splint at 3 different locations and verify the relations between the three different physical and radiological locations. METHODS: Forty dominant hands of healthy subjects were analyzed in the study. We defined a transverse skin folding line as a line drawn from the radial aspect of the thenar crease to the ulnar aspect of the distal transverse palmar crease. The distal end of the volar short arm splint was applied on 3 parallel locations to this line. Location A was on this transverse skin folding line; location B was 1 cm proximal to location A; and location C was 1 cm distal to location A. Two orthopedic surgeons measured the maximal MCPJ flexion angles of each finger except the thumb with the application of a volar short arm splint at 3 different locations as well as without a splint as a control. Radiological locations of the 3 different distal ends of the volar short arm splint were also assessed by anteroposterior radiographs of the wrist. RESULTS: When the splint was applied at location A and C, the maximal MCPJ flexion angle decreased to a mean of 83° (91% of control value) and 56° (62% of control value), respectively (compared to the control, p < 0.001). At location B, the maximal MCPJ flexion angle was a mean of 90° (99% of control value); no significant difference was observed compared to the control or without the splint (p = 0.103). On radiography, the average length from the metacarpal head to the distal end of the splint at all fingers decreased in the order of location B, A, and C (29 mm, 19 mm, and 10 mm, respectively; p < 0.001). CONCLUSIONS: We recommend applying the distal end of a volar short arm splint at proximal 1 cm to the transverse skin folding line to preserve MCPJ motion perfectly, which is located at distal 44% of the whole metacarpal bone length radiologically.

The Effect of Distal Location of the Volar Short Arm Splint on the Metacarpophalangeal Joint Motion

BACKGROUND: The goals of this study were to compare maximal metacarpophalangeal joint (MCPJ) flexion angles after application of a volar short arm splint at 3 different locations and verify the relations between the three different physical and radiological locations. METHODS: Forty dominant hands of healthy subjects were analyzed in the study. We defined a transverse skin folding line as a line drawn from the radial aspect of the thenar crease to the ulnar aspect of the distal transverse palmar crease. The distal end of the volar short arm splint was applied on 3 parallel locations to this line. Location A was on this transverse skin folding line; location B was 1 cm proximal to location A; and location C was 1 cm distal to location A. Two orthopedic surgeons measured the maximal MCPJ flexion angles of each finger except the thumb with the application of a volar short arm splint at 3 different locations as well as without a splint as a control. Radiological locations of the 3 different distal ends of the volar short arm splint were also assessed by anteroposterior radiographs of the wrist. RESULTS: When the splint was applied at location A and C, the maximal MCPJ flexion angle decreased to a mean of 83° (91% of control value) and 56° (62% of control value), respectively (compared to the control, p < 0.001). At location B, the maximal MCPJ flexion angle was a mean of 90° (99% of control value); no significant difference was observed compared to the control or without the splint (p = 0.103). On radiography, the average length from the metacarpal head to the distal end of the splint at all fingers decreased in the order of location B, A, and C (29 mm, 19 mm, and 10 mm, respectively; p < 0.001). CONCLUSIONS: We recommend applying the distal end of a volar short arm splint at proximal 1 cm to the transverse skin folding line to preserve MCPJ motion perfectly, which is located at distal 44% of the whole metacarpal bone length radiologically.

Periprosthetic Fracture after Hook Plate Fixation in Neer Type II Distal Clavicle Fracture: A Report of 3 Cases

Hook plate fixation is a treatment method for the displaced distal clavicle fracture with favorable results regarding bone union and shoulder function, however possible complications include impingement syndromes, subacrormial erosions, acromial fractures, and periprosthetic fractures. In this report, we observed 3 cases of periprosthetic fracture after hook plate fixation. All cases of periprosthetic fractures were initiated at the medial end screw holes. The causes of these periprosthetic fractures appeared to be the off centered fixation of medial end screws near the anterior or posterior cortex which were specific during operations with hook plates with more than 6 holes and the increased stress on the medial end screw by over-reduced or inferiorly reduced position of the distal end of the clavicle by the hook plate.

Survey for Musculoskeletal Pain of Korean Junior Tennis Players / 대한스포츠의학회지

The aim of this survey was to analyze the characteristics of musculoskeletal pain of Korean junior tennis players and its effect on games and psychology of players. Surveys were administered to 30 healthy male junior tennis players who took part in a 50th national junior tennis meet in 2015. We analyzed the incidence, location, cause and preferred prevention or treatment method of musculoskeletal pain, the correlation between training time and musculoskeletal pain as well as the effect of musculoskeletal pain on games and psychology of players. Overall, 22 out of 30 (73.3%) responded the experience of musculoskeletal pain. The incidence of lower extremity pain (16 out of 30, 53.3%) were higher than upper extremity pain (9 out of 30, 30%) and low back pain (8 out of 30, 26.7%). The long training hours per day (r=0.574, p=0.001) and old age (r=0.390, p=0.033) were correlated with intermittent back pain in univariate anlaysis. In multivariate ananlysis, the long training hours per day was a single risk factor of intermittent low back pain (p=0.038, odds ratio 10.01). 43.3% of players responded that the insufficent preventive conditioning program was thought to be the cause of musculoskeletal pain. The most preferred treatment or prevention method for musculoskeletal pain was rehabilitation (55.3%). Twelve players reported the negative affection of musculoskeletal pain to the performance in game. Six players experienced the frustration, 9 players experienced the loss of interest and 9 players experienced the emotional avoidance of games due to the musculoskeletal pain.

Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

The double compression syndrome of the ulnar nerve is a rare condition. Herin, we experienced double compression of ulnar nerve at cubital tunnel and Guyon's canal by re-evaluation after surgical decompression of cubital tunnel. We might suspect the double compression lesion in cases of worsening of symptom or nerve conduction velocity findings in a relative short duration of symptom as in our case. Meticulous physical examination might be needed to detect the Guyon's canal syndrome as a comorbidity in the treatment of cubital tunnel syndrome and re-evaluation for dual compression might be recommended if the resolution of symptom was not achieved after surgical decompression of single nerve lesion.

The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

PURPOSE: The purpose of this study was to evaluate the radiologic and clinical outcomes after intramedullary nailing with Poller screw insertion at initial stage in infraisthmal femur shaft fractures. MATERIALS AND METHODS: Seven consecutive patients (7 femurs) treated with antegrade intramedullary nailing with Poller screw insertion for the infraisthmal femur shaft fracture were reviewed retrospectively. There were 4 male and 3 female patients. Mean age was 46.1 years (20-72 years). Operative time including Poller screw insertion, time for union, malalignment, and range of motion were evaluated. RESULTS: All 7 cases had primarily healed successfully. Mean time for radiologic union was 19.1 weeks (16-24 weeks) postoperatively. One case had 5 degree valgus malalignment. One case of 15 mm shortening was reported and he required shoe lift orthosis. All cases had a full range of motion in hip and knee joint. CONCLUSION: Antegrade intramedullary nailing with Poller screw insertion is useful in the initial treatment of infraisthmal femur shaft fracture, because it could provide additional stability. An additional 20 minutes were required but a Poller screw should be considered according to the anatomic location of a femur shaft fracture.

A Schwannoma Originating from Median Nerve at Proximal Forearm Caused Ulnar Nerve Symptom by Compression

A schwannoma is a benign soft tissue tumor arising from the nerve sheath of a Schwann cell. Clinically, a schwannoma is an asymptomatic mass rarely causing neurologic deficits. However, it can cause discomfort as well as motor and sensory disturbances by compressing the nerve of its origin. The authors encountered a huge schwannoma arising from the median nerve at the proximal forearm, which caused symptoms mainly in the ulnar nerve. The tingling sensation along the ulnar nerve disappeared completely after enucleation of the schwannoma originating from the median nerve.

Structural Analysis of Proximal Humerus in Korean / 대한정형외과학회잡지

PURPOSE: Third generation shoulder arthroplasty is widely performed nowadays; however, few studies on the anatomy of the proximal humerus in the Korean population have been reported. The authors have attempted to review the anatomy of the proximal humerus. MATERIALS AND METHODS: The study sample consisted of 100 humeri of patients with a mean age of 48 years (range of 17 to 83 years) who underwent computed tomography imaging between January 2009 and October 2011 at Myongji Hospital. Diameter of the articular surface, head thickness, radius of curvature, head inclination, head to tuberosity height, bicipital groove-shaft angle, lateral angle, medial offset and posterior offset were analyzed. Results were compared depending on age and gender. RESULTS: Mean values of diameter of the articular surface was 42.70+/-3.57 mm, head thickness was 14.3+/-2.0 mm, and radius of curvature was 22.50+/-1.97 mm; these three variables showed significant sex differences. Head inclination was measured as 130.00+/-4.28 degrees, head to tuberosity height was 7.50+/-0.99 mm, bicipital groove-shaft angle was 6.60+/-0.92 degrees, and lateral angle was 163.40+/-4.05 degrees. Mean medial and posterior offset were 5.2+/-2.1 mm and 3.1+/-1.8 mm, respectively. CONCLUSION: Based on the results of this study, the measurement values of Korean humeri can be used in design of the arthroplasty prosthesis, and this will lead to more accurate anatomical reconstruction of the shoulder joint.

Perioperative Blood Loss in Bipolar Hemiarthroplasty for Femoral Neck Fracture: Analysis of Risk Factors / 대한고관절학회지

PURPOSE: We compared visible blood loss and calculated blood loss after bipolar hemiarthroplasty in femoral neck fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS: A total of 356 patients who underwent bipolar hemiarthroplasty in femoral neck fracture between 2004 and 2010 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score, use of cement, and use of antithrombotic agents. RESULTS: Total calculated blood loss(1,408+/-72 ml) differed significantly from visible blood loss(980+/-102 ml). In addition, calculated blood loss differed between risk factors(1,526+/-369 ml in cardiovascular disease, 1,588+/-279 ml in general anesthesia, 1,645+/-920 ml in obesity, and 1,605+/-439 ml in use of antithrombotic agents). CONCLUSION: Total calculated blood loss was much greater than visible blood loss. Patients with risk factors such as cardiovascular disease, obesity, use of antithrombotic agents, and general anesthesia should be treated with care in order to reduce blood loss.

Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings

BACKGROUND: Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. METHODS: Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. RESULTS: Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. CONCLUSIONS: Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.

Double Dislocation of Interphalangeal Joints in a Single Digit: A Case Report

Double dislocation of the interphalangeal joints in a single digit is very rare. We describe the results of conservative treatment for the double interphalangeal dislocations of 5th finger caused by hyperextension during bicycle accident.

Comparative Analysis of the Results of Fixed-angle versus Variable-angle Volar Locking Plate for Distal Radius Fracture Fixation

PURPOSE: To compare the outcomes of distal radius fractures in a fixed-angle volar locking plate group and variable-angle volar locking plate group. MATERIALS AND METHODS: Forty-one patients observed at least 6 months after surgery were included in this retrospective study. We used the range of motion, visual analogue scale score, Disabilities of the Arm, Shoulder and Hand Questionnaire score, and radiologic findings to measure the clinical results. RESULTS: No differences in clinical results or radiologic results were noted between the fixed-angle volar locking plate group and variable-angle volar locking plate group. CONCLUSION: We believe that it is important to minimize complications by using appropriate screws and plates according to the fracture type, though no differences in the surgical outcome were noted between the fixed-angle volar locking plate group and variable-angle volar locking plate group with distal radius fracture.