The Efficacy of Arthroscopic Debridement with Continuous Irrigation in Failed Arthroscopic Debridement for Septic Arthritis of the Knee / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the efficacy of arthroscopic debridement with continuous irrigation in patients with septic arthritis of the knee after failed primary arthroscopic treatment. MATERIALS AND METHODS: Among 69 patients undergoing arthroscopic debridement for septic arthritis of the knee from March 2008 to March 2013, 14 patients (5 male, 9 female; mean age, 68.9±11.3 years) with failed arthroscopic debridement for septic arthritis of the knee were reviewed retrospectively (mean follow-up period, 49.2±23.2 months). All 14 patients underwent re-do of the arthroscopic debridement, then continuous irrigation. Continuous irrigation following arthroscopic debridement was maintained for a mean 8.4±2.5 days. For clinical evaluation, Lysholm knee score and visual analogue scale (VAS) were used at 1 month, 3 months, and 12 months after surgery. During the entire follow-up period, recurrence of infection and operation-related complication were also assessed. RESULTS: Symptom improvement was observed in 12 cases (85.7%) of the 14 cases. Lysholm knee score was improved from 36.1±7.9 to 84.2±9.2 at 12 months after surgery (p<0.05). VAS was improved from 8.9±1.3 to 2.1±1.2 at 12 months after surgery (p<0.05). Synovial fluid cultures yielded positive findings in 9 of the 14 cases with the same bacteria in primary surgery. During the follow-up period, septic arthritis relapsed in 2 of the 5 cases with negative finding of cultures. After reoperation was performed in those 2 cases, no recurrence was observed to final follow-up. There was no complication related operation in any cases. CONCLUSION: Arthroscopic debridement combined with continuous irrigation is a safe and effective procedure for failed arthroscopic debridement for septic arthritis of the knee.

Comparative Study of Outcomes between Operative and Non-Operative Treatment of Unstable Distal Radius Fracture in the Elderly Patients

PURPOSE: The goal of this retrospective study is to compare radiologic outcome and clinical outcome between operative and non-operative treatment of unstable distal radius fracture in patients over 65-year-old. METHODS: From December 2006 to December 2011, 114 patients over 65-year-old were enrolled in the present study. 45 patients underwent non-operative treatment, and 69 patients underwent operative treatment. We retrospectively reviewed radiologic results and clinical results and then compared the two groups. Radiologic results include radial inclination (RI), volar tilt angle (VT) and radial shortening (RS) shown on the last radiograph and clinical results including disabilities of the arm, shoulder and hand (DASH) scores, modified Mayo wrist score (MMWS), and range of motion (ROM) of wrist. RESULTS: All cases presented bone-union. Among the patients who received non-operative treatments, average RI of 15.5degrees, average VT of 14.1degrees, average RS of 5.3 mm, The patients who received operative treatments showed average volar tilt of 3.9degrees, average VT of 18.2degrees, and average RS of 1.1 mm. RS showed a significant difference (p0.05). CONCLUSION: Our results suggest that non-operative treatment is initially recommended in patients over 65 years who have an unstable distal radius fracture in terms of functional results.

The Efficacy of Percutaneous Long-Segmental Posterior Fixation of Unstable Thoracolumbar Fracture with Partial Neurologic Deficit

STUDY DESIGN: Retrospective analysis. PURPOSE: The aim of this study was to evaluate the clinical and radiological outcomes of patients with unstable thoracolumbar fracture (UTLF) who were treated by percutaneous long-segmental posterior fixation (PLSPF) by two vertebrae cranial to the fracture with two vertebrae caudal. OVERVIEW OF LITERATURE: To the best of our knowledge, PLSPF for stabilization of UTLF has not been reported. METHODS: The study involved retrospective analysis and investigation from the results of 27 patients who had undergone PLSPF for stabilization of a UTLF with partial neurologic deficit, over a follow-up period of two years. Kyphotic angle (KA), anterior vertebral height percentage (AVHP) and cross-sectional ratio of the displaced fragment within the spinal canal were evaluated with simple radiographs and axial computed tomography scans preoperatively and two years postoperatively. The clinical outcome for pain was assessed by a visual analogue scale (VAS) and Denis' scale, and the degree of neurologic deficit was measured by modified Frankel classification. RESULTS: Five patients had minor complications. The KA, AVHP, and cross-sectional ratio of the displaced fragment improved significantly after surgery (p<0.001, p<0.001, p<0.003, respectively). Neurologic recovery of one or more for the Frankel grade was seen in 19 patients with an average improvement of 1.7. The VAS and Denis' score improved significantly at a two year follow-up (p=0.02, p=0.012, respectively). CONCLUSIONS: The technique of PLSPF is useful for the treatment of UTLF with partial neurologic deficit, and produces decreased morbidity and fewer complications.

A Medication for Newly Diagnosed Rheumatoid Arthritis in Patient with Lactose Intolerance / 대한정형외과학회잡지

The side effects of rheumatoid arthritis (RA) medication, such as irritation and ulceration of the gastrointestinal mucosa, have been observed and many patients find it difficult to swallow tablets and hard gelatin capsules. This results in a high incidence of noncompliance and ineffective therapy towards treating RA. Fast-dissolving and fast-dispersing drug delivery systems may offer a solution to these problems, and as a result, fast disintegrating tablets are gaining prominence as a new drug-delivery system; one such system is the binding of the active ingredient with lactose. There have been no reports on the rate of lactose intolerance against medication in patients with newly diagnosed RA, because lactose intolerance has not been associated with particular problems with most existing RA therapies. We encounterd a 56-year-old lactose intolerant female patient who had severe diarrhea after receiving drugs to treat her newly diagnosed RA.

A Comminuted Spiral Fracture with Butterfly Fragment of Distal Humerus by Arm Wrestling: A Case Report / 고신대학교의과대학학술지

The fracture of the humerus during arm wrestling are uncommon, but may occur in the shaft or medial condyle. In the shaft of humerus, the fractures are usually spiral and between the middle and distal third, with or without neurological involvement. A case of a comminuted spiral fracture with butterfly fragment of the distal third of the humerus is reported which had occurred during arm wrestling and was treated by open reduction and internal fixation. The possible mechanism of injury and the question of treatment are discussed.

Anti-TNF-alpha Therapy for Ankylosing Spondylitis

BACKGROUND: This review evaluated the safety and efficacy of etanercept in patients with ankylosing spondylitis (AS). METHODS: Of 59 patients with AS, this study reviewed 11 patients who were refractory to conventional therapy and treated with etanercept from September 2005 to January 2008. The mean follow-up duration was 13.6 months. The general improvement was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and adverse effects, complications and inflammatory markers were also assessed. RESULTS: The mean BASDAI decreased from 7.1 +/- 1.6 before treatment to 4.2 +/- 1.8 at 3 months after the etanercept treatment (p = 0.001). The mean erythrocyte sedimentation rate and C-reactive protein were decreased significantly by the etanercept treatment. The greatest improvement in symptoms was enthesitis, followed by skin involvement and morning stiffness. There was a significant difference in the improvement in BASDAI along with the follow up duration (p = 0.04). A serious infection was observed as a complication in 1 case. CONCLUSIONS: These results suggest that etanercept can induce significant improvement in most patients with less damage. A trial of tumor necrosis factor inhibition is indicated in all AS patients who do not achieve adequate disease control with disease-modifying antirheumatic drugs, such as methotrexate, leflunomide etc. The patients treated with etanercept should be educated about the possibility of infection and monitored closely.

Renal Artery Pseudoaneurysm after Blunt Renal Trauma

Renal artery pseudoaneurysm after blunt renal trauma is an uncommon complication of delayed hemorrhage, and diagnostic difficulties are experienced due to its rarity. Delayed hemorrhage after renal trauma is a lifethreatening complication. Angiography is considered the gold standard to diagnose a traumatic renal artery pseudoaneurysm. We report here a case of delayed bleeding from a renal artery pseudoaneurysm that was diagnosed at 17 days after the injury and that was managed successfully with selective renal artery embolization without medical complication.

Radiologic Patellar Change and Clinical Results of Total Knee Arthroplasty without Patella Resurfacing

PURPOSE: To evaluate the clinical and radiologic results in patients with total knee arthroplasty without patellar resur- facing. Subject and Method: In this study, 64 cases of total knee arthroplasty without patellar resurfacing were performed nonselectively by a single surgeon from January 2000 to January 2004, and followed up for more than 2 years(range, 24~72 months). The clinical results according to Hospital for Special Surgery knee score and Feller's patellar score, and radiological evaluations about patellar subluxation were analyzed for the correlation of the two results. RESULT: HSS score improved from 54 to 83 points, and Feller's patellar score improved from 18 to 27 after surgery. In preoperative radiologic evaluation, 61 cases(95.3%) were assessed as 'open laterally', the average patellofemoral index was 1.4(0.6~2.5) and the lateral patellar displacement was 1.2mm. In the latest follow-up, 56 cases(87.5%) were assessed as 'open laterally', the average patellofemoral index was 1.5(0.5~3) and the lateral patellar displacement was 1.5(0~8)mm. In comparison between the clinical and radiologic results, no statistic significance was noted in their correlation(p>0.05). CONCLUSION: Total knee arthroplasty without patellar resurfacing was performed nonselectively, satisfactory clinical outcome was observed despite radiologic changes such as patellar subluxation and displacement. It was considered that there was no significance in correlation between radiological changes and clinical results.

Total Knee Arthroplasty without Patellar Resurfacing in Moderate to Severe Patellofemoral Arthritis

PURPOSE: To analyse clinical result of total knee arthroplasty without patellar resurfacing who had moderate to severe patellofemoral arthritis. MATERIALS AND METHODS: Unilateral knee joints of 54 cases, diagnosed to be moderate to severe patellofemoral arthritis on the basis of Ahlback's radiographic evaluation score of patella on preoperative plain radiography among the patients undergone the total knee arthroplasty due to primary degenerative osteoarthritis at this hospital between January 2000 and March 2004, were subject to this study. Patellar resurfacing was not performed in any cases. Likewise, the knee score of Hospital for Special Surgery and Feller's patellar score were used in clinical assessment preoperatively, and was used two years after the operation. RESULTS: The knee score of Hospital for Special Surgery was increased from 55.1 (35~78) to 82.8 (67~95), and also Feller's patellar score was increased from 19.1 (11~24) to 28.3 (18~30) after operation. Mild anterior knee pain was observed in 5 cases (9.3%) after the operation, but medication was needed in just 2 cases. The 42 cases (77.8%) could normally go up and down stairs without holding the rail. CONCLUSION: The total knee arthroplasty without patellar resurfacing, performed for the patients diagnosed with moderate to severe patellofemoral arthritis related with the indication for patellar resurfacing, derived satisfactory outcomes.

Analysis of Patients 'Satisfactory Level after Total Knee Replacement Arthroplasty

PURPOSE: The object of this study was to evaluate the quality of life after total knee replacement arthroplasty concerning objective and subjective satisfaction. MATERIALS AND METHODS: This study included 46 cases in 30 patients who underwent total knee replacement arthroplasty during August 1998 and March 2003. The knee score and the function score were measured using the Clinical Rating System of the American Knee Society, and the degree of satisfaction before and after the operation was also evaluated by the Medical Outcomes Study Short Form-36(SF-36). RESULTS: After total knee replacement arthroplasty, an increase from 41.3 to 85.6 was seen using the Clinical Rating System, and the increase was 31 to 82 in the SF-36 evaluation method; the two methods showed relation in the satisfaction level. An average increase of 6% was seen in the activity level of patients after the operation, and 47% of the patients using hot-stone beds changed their beds to normal beds. CONCLUSION: The analysis using Clinical Rating System and SF-36 in patients who underwent total knee replacement arthroplasty was seen to efficiently express the patients 'subjective symptoms to objective data, and were more useful than other analysis methods in observing the patients 'prognosis.

The Effect of a High Dose of Methotrexate on Type II Collagen induced Arthritis in Rats / 대한정형외과학회잡지

PURPOSE: Rat arthritis was induced by bovine type II collagen. To present the remedial effects on type II collagen arthritis and clinical efficacy, a high dose of methotrexate, of a level similar to that used in cancer patients was given to rats. MATERIALS AND METHODS: Healthy male Brown Norway rats were used, of mean weight; 300 g. There were 7 subgroups: a control group, given collagen only, an orally methotrexate treated (2.5mg/week), high methotrexate dose groups; 10 mg/kg, 30 mg/kg, 50 mg/kg, 100 mg/kg and a low dose methotrexate group (0.375 mg/kg/week, 4 times) were included in the present study. Type II collagen was injected for arthritis induction and a single intraperitoneal injection of methotrexate was administered after 15 days. Orally treated group was administered 4 times (2.5 mg/week). Histopathologic findings were evaluated. RESULTS: 50 mg/kg methotrexate was effectively reduced the arthritis index and significantly decreased inflammatory cell number between 2nd and 6 weeks. CONCLUSION: A high dose of methotrexate may be clinically effective in the short period treatment of rheumatoid arthritis patients.

Arthroscopic Treatment in Degenerative Arthritic Knee with Moderate Joint Space Narrowing / 대한정형외과학회잡지

PURPOSE: This study was performed to determined by follow-up observation, the result of the arthroscopic treatment for advanced degenerative arthritis of the knee joint. MATERIALS AND METHODS: During the period from January 1991 to December 1995, 270 cases had been followed for more than one year after arthroscopic treatment for degenerative arthritis of the knee joint. There were 66 males and 204 females of average age 61 years. On the Kellgren and Lawrence radiological grading system, follow-up radiography was conducted after the treatment in those cases Grade III before the treatment. A clinical assessment was performed pain, range of motion and the Hospital for Special Surgery (HSS) knee score before and after operation, and the Baumgaertner scale was used for the 2 and 48 month follow-up after operation. Recurrence was considered to have occurred when conditions were the same as before treatment. RESULTS: According to the Baumgaertner scale, clinical assessment showed overall rates of excellent and good in 191 cases (70.8%) at 2 month post-operatively, and 157 cases (58.1%) at 48 month post-operatively. Comparing the radiologic results before and after treatment using Baumgaertner's scale. the radiologically lower grade was the better result And a degenerative symptom was aggravated an average of 3.8 years. CONCLUSION: This study shows that the arthroscopic treatment is an effective option if used during the early stage of degenerative arthritis of the knee joint.

The Effect of High Dose Methotrexate loaded Acrylic Cement in Type II Collagen Induced Arthritis in Rats / 대한정형외과연구학회지

PURPOSE: We had examined the effect of high dose MTX loaded acrylic cement in the treatment of type II collagen induced arthritis. MATERIALS AND METHODS: we used inbreed rat(16weeks - 20weeks) and divided into control group and experimental groups. inbreed rat was induced arthritis by prepared collagen through injection at the tail base. The control group was injected with collagen only. but the experimental groups were inserted intraperitoneally MTX-loaded acryl cement: 25mg, 20mg, 15mg, and 10mg MTX in acrylic cement (0.5gm) respectively. The histopathologic results were investigated to determine the effect of MTX on the 3rd, 7th, 14th, 28th, 42th, and 56th day after inserting high dose MTX loaded acrylic cement which was inserted intraperitoneally 2weeks later of collagenase injection RESULTS: The arthritis index of the MTX-loaded groups had reduced than arthritis index of the control group according to the dosage and In histopathological test, the experimental group injected with 15mg, 20mg, and 25mg of MTX had distinctive effects, compared to the control group, as dosage chronologically. CONCLUSION: The treatment of high-dose MTX loaded acrylic cement might be effective on rheumatoid arthritis managment.

Recycling Autograft with Extracorporeal Irradiation for Reconstruction in Malignent Bone and Soft Tissue Tumors / 대한정형외과학회잡지

PURPOSE: This report is comprehensive results of our clinical series in which we report theoretical advantages and indication of recycling autograft following extracorporeal irradiation in malignant bone and soft tissue tumors. MATERIALS AND METHODS: We have treated in 24 patients by en bloc resection, extracorporeal irradiation and reimplantation of irradiated bone from june 1994 to june 1999. All patients were evaluated radiologiccal union, functional results and complication. RESULTS: The radiologiccal union of junctional sites had appeared at 9.1 months postoperatively. The mean functional results was 73%, we used the criteria of Enneking et al.. There are 10 cases (47.6%) of complication, witch were nonunion, epiphyseal collapse, joint instability, infection, local recurrence and metal failure. CONCLUSION: The recycling autograft following extracorporeal irradiation is a useful method on minimal bony destruction, preserving joint function as osteoarticular autograft, using bone with soft tissue (ligament and tendon) attachment in periarticular tumor and biological spacer in immature skeletal age.

Radiation Synovectomy by 166Holmium-Chitosan complex in Collagenase Induced Arthritis of the Knee in the Rabbit / 대한정형외과학회잡지

PURPOSE: To evaluate the histological changes of the synovial membrane treated by 166Ho-Chitosan complex in collagenase induced arthritis of the knee in the rabbit. MATERIAL AND METHOD: Arthritis was induced in sixteen rabbits by intra-articular injection of 1mg collagenase II and then treated by intra-articular injection of 0.4mCi 166Ho-Chitosan complex 2weeks later. The radioisotope scan was checked in each rabbit for the distribution and extra-articular leakage of the 166Ho-Chitosan complex. The synovial tissues from the femorotibial joints were evaluated for serial histological changes 2, 4, 8, 12 weeks after the 166Ho-Chitosan complex injetion. RESULTS: Two weeks after 166Ho-Chitosan complex administration, inflammatory cells such as giant cells, lymphocytes, histiocyte, and fibroblasts appeared in the subsynovial stroma. The most synovial cells were necrotized. Four weeks after 166Ho-Chitosan complex administration, the inflammatory cells were decreased and many fibroblasts appeared on the subsynovial stroma. There was neovasculization in the synovial membrane 4 weeks after administration. The fibers of collagen were noticed in the synovial membrane and subsynovial stroma at 8 weeks. There was no synoviocyte in the synovium and the thickness of fibrosis was increased at 12weeks. There were fragmentation of the nucleoli of synoviocyte and endothelial cell on the transmission electron microscope (TEM) . CONCLUSION: This study suggests that the synovial membranes treated by 166Ho-Chitosan complex in the collagenase induced arthritis of the knee in the rabbit show early radiation damage and then subsequently develop the fibrosis, and no synovial cell regeneration was observed until 12 weeks.

Measurement of BMD ( Bone Mineral Density ) and Hip Axis Length for Predicting Hip Fracture / 대한정형외과학회잡지

Osteoporosis is a disease characterized by excessive bone loss or osteopenia particulary in the axial skeleton at the site of fracture, such as the spine and proximal femur. Since the strength of both spine and femur is directly proportional to the bone mass, this osteoporosis always increases the risk of fracture. In this study, to evaluate whether a simple measurement of femoral geometry and BMD value are related with hip fracture, we obtained DEXA Scan (Lunar Expert-XL) of hip by retrospective study. DEXA scan was measured on 70 control people and 17 hip fracture patients aged 50 or older. The result is I. The mean Ward BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.52g/cm2, Control group: 0.67g/cm2 P=0.0001) 2. The mean L-spine BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.81g/cm, Control group: 0.97g/cm2 P=0.0002) 3. The mean femur axis length of hip fracture group is longer than control group (Hip fracture group: 6.77g/cm2, Control group: 6.57g/cm2 P=0.006) As a conclusion, the measurement of BMD and hip axis length in DEXA scan is an effective method for screening the hip fracture risk patient and BMD value of femur, hip axis length and L- spine BMD value are strongly associated with hip fracture.

Surgical treatment of Giant Cell Tumor / 대한정형외과학회잡지

Giant cell tumor is a predominantly benign condition but often the tumor is locally aggressive and tends to have high rate of recurrence and it can evolve into a malignant tumor. Thus the lesions have a practically difficult therapeutic problem for the orthopaedic surgeon and any method of treatment has not been satisfied. Between March 1984 and March 1993, clinical observation was carried out on 22 cases of giant cell tumor of bone to analyse the recurrence rate and functional evaluation of the joint according to the treatment methods, pathological grade and cortical destruction. The mean follow-up time was 75. 2 months. The recurrence rate of the intralesional excision group was 54.5% and that of the wide excision group was 9%, There was no relationship between the pathologic grade and recurrence rate. There was no recurrent case in the grade I cortical destruction but almost all of recurrence was occurred in the grade I or II cortical destruction. The functional result of the giant cell tumor occurred around the knee joint was that the mean ratings in the intralesional excision group were 79% and in the wide excision group were 51%. In conclusion, to achieve better joint function and less recurrence rate, intralesional or marginal excision with heat using bone cement or with chemical cauterization using phenol and alcohol can be used for cases of radiological grade I or II, and wide excision for grade III.

Comparision of the effect of chemotherapy on 2-year relapse free survival rate in patient with osteosarcoma / 대한정형외과학회잡지

No abstract available.

Clinical study of the cementless total hip replacement arthroplasty / 대한정형외과학회잡지

No abstract available.

Clinical study of the femoral neck fractures in adult / 대한정형외과학회잡지

No abstract available.