Simultaneous Bilateral Quadriceps Tendon Rupture in Patient with Chronic Renal Failure

Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

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.

The common orthopedic problems in parent's concern / 소아과

Roughly one third of medical problems in children are related to the musculoskeletal system. Most of these problems are common and can be precisely diagnosed. For these problems, nonoperative treatment or reassurance can be given by the pediatrician. Occasionally, a problem needs surgical treatment, but a precise diagnosis must be made. There is little agreement about what types of orthopedic problems a primary care pediatrician should understand in order to effectively care for children. Many pediatric residencies lack an organized teaching curriculum that effectively covers these topics or that includes a required pediatric orthopedic rotation. In this article the authors delineate pediatric orthopedic problems that require recognition and urgent surgical treatment and are relatively common, but have different treatment options (observation, conservative treatment, and surgery) depending on their natural history. Whenever possible, the diagnosis should be made before a decision to refer is made. An accurate diagnosis allows the pediatrician to discuss the natural history of the condition properly. Referral to the wrong specialty can needlessly generate expensive tests and further delay in treatment or generate inappropriate treatment. The parents can be reassured rather than waiting to hear the same information from another physician. In particular, orthopedic problems are known to generate pressure from the parents to seek specialty consultation for reassurance. It is important to communicate to the specialist that the reason for the referral is for parental reassurance rather than for further work-up or treatment. After a proper diagnosis, communication directly between the pediatrician and the appropriate specialist can often avoid an unnecessary referral, and avoid unnecessary tests. The authors reviewed our experience at our outpatient clinic over last 1 year and found that it is useful to classify conditions as common or uncommon, and whether they require surgical or nonsurgical treatment. Many conditions fall in between. The following is a discussion of some of these more important or common conditions.

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.

Type I, II Acute Necrotizing Fasciitis of the Low Extremity / 대한정형외과학회잡지

PURPOSE: To retrospectively analyze the clinical presentations, radiographic findings, and surgical results of type I and II acute necrotizing fasciitis of the low extremity. MATERIALS AND METHODS: From April 1998 to March 2005, 13 patients who underwent surgery for the necrotizing fasciitis were reviewed. At the initial diagnosis, 6 patients were diagnosed with cellulitis and 3 patients were diagnosed correctly with necrotizing fasciitis. The underlying diseases, affected sites, official readings of MRI, the intervals between the onset of symptom and surgery, the duration of admission, and complications were investigated. RESULTS: The underlying diseases were 3 cases of diabetes, 3 cases of liver disease, 1 case of alcoholism and 1 case of cervical cancer with chemotherapy. Regarding the location of the disease, 5 cases were observed below the knees, and 8 cases were observed above the knees. Five out of 9 cases who underwent a preoperative MRI study, were diagnosed correctly as necrotizing fasciitis by the radiologist. The average period between onset of symptoms and surgery was 4.8 days. The complications were hip disarticulation in 1 case, below knee amputation in 1 case, toe amputation in 1 case, and a limited range of motion of the knee joint in 1 case. The 9 patients who healed without complications had no limitation in the range of joint motion and daily activity. CONCLUSION: Type I and II acute necrotizing fasciitis of the low extremity shows variable clinical presentations and radiological findings. Therefore, the possibility of the necrotizing fasciitis needs to be considered when dealing with patients with soft tissue infections in the low extremities.