Whole Blood Titanium Concentration after Limb Salvage Surgery with Three-Dimensional-Printed Ti6Al4V Implants

Background@#Three-dimensional (3D)-printed customized implants can be fabricated and utilized for all bones with massive bone defects. The main safety issues with 3D-printed implants made of Ti6Al4V alloy are related to the release of metal debris and residual powder. In this study, we investigated the perioperative titanium concentrations in whole blood and peri-implant fluid samples of patients who underwent limb salvage surgery with a 3D-printed Ti6Al4V implant. @*Methods@#Nineteen patients who underwent limb salvage surgery with 3D-printed Ti6Al4V implants were divided into two groups:the serial samples group and the follow-up group. To observe metal distribution and clearance in the body, serial samples of blood and peri-implant fluid from the surgical drain were prospectively collected for five patients in the serial samples group. For the remaining 14 patients who were followed up for more than a year, blood samples were collected only once. @*Results@#In the serial samples group, the mean baseline titanium concentration was 0.78 μg/L (range, 0.1–2.2 μg/L): 3 patients showed peak concentration before the third postoperative month, while 2 patients still showed an increasing pattern at this point.Total titanium mass in the surgical drain showed a wash-out phenomenon in a week, with a significant uniform decrease (p = 0.04).In 14 patients in the follow-up group, the mean titanium concentration in the whole blood was 10.8 μg/L (range, 0.3–36.6 μg/L). For the 14 patients with a long-term follow-up, the aluminum and vanadium concentrations were all negligible. @*Conclusions@#Whole blood titanium concentrations were higher after surgery using 3D-printed implants than after that using conventional orthopedic implants, but markedly lower than in patients with implant failure. None of the patients developed serious clinical adverse effects during follow-up.

A Case of Peroneal Nerve Palsy Secondary to Fibular Head Osteochondroma

Osteochondroma of the proximal fibula is relatively common, but there are only rare reports of this lesion in conjunction with peroneal nerve palsy. We report here on a case of the peroneal nerve palsy secondary to fibular head osteochondroma, and the patient experienced complete recovery of function following the excision of the tumor and neurolysis of the peroneal nerve.

Achilles Tendon Rupture Associated With Ipsilateral Medial Malleolar Fracture (A Case Report) / 대한족부족관절학회지

Ankle fracture and Achilles tendon rupture are common as an isolated injury. However, Achilles tendon rupture with ipsilateral ankle fracture is uncommon, and occurs by a different injury mechanism with a risk of negligence. We report a case of Achilles tendon rupture with ipsilateral medial malleolar fracture.

Usefulness of Kyphoplasty in Sacral Insufficiency Fracture: A Case Report

Kyphoplasty has recently attended as a potential treatment for sacral insufficiency fracture. We report a 85-years-old female patient with osteoporotic S1 insufficiency fracture with absence of trauma history treated with kyphoplasty which has no symptom improve with conservative treatment. Kyphoplasty is an effective and useful procedure in the treatment of the sacral insufficiency fracture, additionally reviewed of the literatures.

Multiple Non-contiguous Spine Fractures with Concomitant Injuries: A Case Report

Multiple non-contiguous spinal fracture is a special type of multi-level spinal injury, which is rare but most frequently occur in motor vehicle accident or a falling from a height. We report five patients of multiple non-contiguous spinal fractures. All patients underwent segmental pedicle screws fixation without fusion for preserving facet joints and minimizing blood loss and operation time. We performed necessary operation for any concomitant injuries at the same day.

Relationships of Bone Mineral Density, Blood Pressure, and Physical Characteristics of Third and Fourth Decade College Students / 대한정형외과연구학회지

The purpose of this study was to analyze the relationship of body mass index (BMI), bone mineral density (BMD) and blood pressure (BP) in third and fourth decade college students. Total of 114 (67 male and 47 female) students who received health examination in April 2010 participated in this research. Bone status was measured by a peripheral dual energy X-ray absorptiometry method and T-score was calculated via WHO guideline. For body composition measurements, body fat, height and weight were measured and BMI was calculated. Among male students, 3.6% belong to the UW (under weight) group, 49.1% to the NW (normal weight) group, 18.2% to the OW (over weight) group and 29.1% belong to the obese group, while 2.1% of female students belong to the UW group, and 68.1% to the NW group, 14.9% to the OW group and 14.9% belong to the obese group. Differences of body weight among male and female students were statistically significant (p<0.001). Above overweight groups showed higher systolic and diastolic BP than normal group. Differences among two groups were statistically significant (systolic BP: p=0.041, diastolic BP: p=0.021). The mean BMI of normal BP group is 22.6+/-2.87, hypertension group is 24.1+/-2.95. Differences among two groups were statistically significant (p=0.045). The mean T-score of male students is -0.1+/-1.17, female is -0.6+/-0.88(total -0.5+/-0.91). Differences of T-score among male and female students were statistically significant (p=0.007). In conclusion, our results showed that many college students had the problems in the BMI, BMD and BP, and BP increased according to the increase of BMI. Therefore, nutritional education and weight control is required for normal blood pressure and bone health.

Comparison of Adjacent Spinal Compression Fracture after Old Osteoporotic Spinal Compression Fracture and Percutaneous Vertebroplasty / 대한골다공증학회지

OBJECTIVES: New adjacent spinal compression fractures occur not only in patients with osteoporotic spinal compression fractures after vertebroplasty but also in untreated old spinal compression fractures. The objective was to analyze and compare the characteristics in a group who had untreated old osteoporotic spinal compression fractures with those who had adjacent spinal compression fractures, which occurred after a vertebroplasty. MATERIALS & METHODS: From April 2006 to April 2009, 103 patients who had undergone vertebroplasty were evaluated. Eighteen patients (22 cases) who had untreated old osteoporotic spinal compression fractures were in group I, and 12 patients (13 cases) who had adjacent spinal compression fractures, which occurred after a vertebroplasty were in group II. In each group, we measured age and gender, body mass index (BMI), lumbar bone marrow density (BMD), sagittal index, and compression rate at the initial fracture site.

Popliteal Artery Pseudoaneurysm after Arthroscopic Posterior Cruciate Ligament Reconstruction: A Case Report / 대한스포츠의학회지

The pseudoaneurysm of the popliteal artery following an arthroscopic posterior cruciate ligament reconstruction is rare. We present a case of the delayed pseudoaneurysm of the popliteal artery after arthroscopic posterior cruciate ligament reconstruction. Open excision of the pseudoaneurysm and pin-point repair were done. Retrospectively reviewing the case, we found that the relation of the popliteal artery and posterior cruciate ligament on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery.

Minimally-invasive Percutaneous Screw Fixation of Displaced Intra-articular Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: The purpose of this study is to analyze the clinical and radiological results of minimally invasive percutaneous screw fixation in intra-articular calcaneal fractures and its complications. MATERIALS AND METHODS: This study is based on 30 intra-articular calcaneal fractures that treated by index operation from June 2005 to November 2006 with at least 6 months follow-up. We assessed the clinical and radiological outcomes and complications. RESULTS: According to Sanders classification, there were 8 in type IIA, 7 in type IIB, 3 in type IIIAB, 6 in type IIIBC, 6 in type IV. And according to Essex-Lopresti classification, there were 9 in the tongue type, 21 in the joint depression type. Average follow-up period was 14.6 months (range: 6-23 months). Average interval between from injury to operation was 2.3 days. Average AOFAS score was 87.7 (range: 52-92). Satisfactory results were obtained in 22 cases (73.3%) by AOFAS score and in 20 cases (66.7%) by VAS score (mean: 3.4). Radiological results improved from 8.7 to 20.3 degrees in the Bohler angle and from 40.2 mm to 52.1 mm in calcaneal height. Postoperative complications were 2 skin and soft tissue problems and 1 sural neuropathy. CONCLUSION: Minimally invasive percutaneous screw fixation may be useful alternative surgical method in the management of Sanders type II and III calcaneal fractures, which is possible to achieves the anatomical restoration and minimizes postoperative complication in patients with high risks of soft tissue compromise and allows relatively early operation.

The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures

PURPOSE: To assess the behaviour of fresh frozen cancellous allograft used for supporting the reconstructed articular surface in impacted tibial plateau fractures. MATERIALS AND METHODS: Between May 2004 and May 2008, 13 cases of impacted tibial plateau fracture were evaluated retrospectively. All fractures were treated with open reduction-internal fixation after restoration of the tibial plateau surface and insertion of fresh frozen cancellous allograft chips for subchondral support. Mean age was 46.6 (31~65) years. Average follow-up period was 36 (13~58) months. The radiological and clinical result for every patient was assessed according to the modified Rasmussen's system and Lysholm's knee score. RESULTS: According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10+/-0.7 weeks. The mean range of motion was 135 (115~145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2+/-4.3. CONCLUSION: We concluded that fresh frozen cancellous allograft in impacted tibial plateau fractures showed good results in terms of bone union and functional improvement and was considered to be a good structural supporter.

Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

PURPOSE: We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications. MATERIALS AND METHODS: We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD). RESULTS: The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm. CONCLUSION: To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.

Treatment of Soft Tissue Defects after TKA using Saphenous Neurocutaneous Island Flaps

PURPOSE: The purpose of this study was to evaluate clinical outcomes in patients receiving saphenous neurocutaneous island flaps for reconstruction of soft tissue defects after total knee arthroplasty (TKA). MATERIALS AND METHODS: Four patients (2 men, 2 women mean age 61 years) with post-TKA soft tissue defects were treated with saphenous neurocutaneous island flaps between November 2001 and August 2007. The mean follow-up period was 3.5 years. Initial diagnoses were traumatic arthritis, rheumatoid arthritis, arthritis due to previous osteomyelitis, and tuberculous arthritis. One patient developed deep infection after TKA, so revision TKA with Nexgen(R) LPS (Legacy(R) posterior stabilized) was performed after soft tissue reconstruction. One soft tissue defect developed after TKA with Nexgen(R) LPS due to long-term steroid use for rheumatoid arthritis. Two cases occurred after placement of Nexgen(R) LCCK (Legacy(R) constrained condylar knee). Two cases developed secondary to diabetes mellitus and tuberculous arthritis. Soft tissue defects were located over the patella (1 case), patellar tendon (1 case), and medial side of the knee (2 cases). The flaps ranged in size from 3x4 cm to 8x5 cm. All flaps were proximally based. RESULTS: All flaps survived completely. The postoperative range of motion was between 3degrees and 100degrees. CONCLUSION: Because saphenous neurocutaneous island flaps are well matched with local tissue and are tough, thin, pliable and sensate, they are an ideal option for reconstruction of soft tissue defects after TKA.

Analysis and Measurement of the Lumbar Spinal Canal Dimension using Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: It is very difficult to measure the spinal canal dimension in elderly patients because of disc degeneration and facet joint hypertrophy. The purpose of this study is to determine reference values of the spinal canal dimension in a population of normal Korea subjects and to evaluate other measurement methods of the spinal canal dimension that correlate to normal spinal canal dimensions determined using Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: We studied 100 patients who had mild symptoms and had normal MRI findings from 2475 outpatients that had undergone lumbar MRI from November 2002 to May 2004. The dimension of the spinal canal and dural sac was measured at the center of intervertebral discs L3/4, L4/5 and L5/S1. The dimension of the spinal canal and vertebral body was measured and was compared at the transverse plane perpendicular to the spinal canal that transected L4, L5 and the S1 pedicle. RESULTS: For the sequence of L3/4, L4/5 and L5/S1, the mean spinal canal dimensions were 249.38+/-38.30 mm2, 253.04+/-48.62 mm2 and 288.46+/-57.62 mm2, respectively. For the sequence of L4, L5 and S1, the mean spinal canal dimensions were 279.78+/-42.36 mm2, 301.50+/-54.26 mm2 and 355.10+/-60.65 mm2, respectively. The correlation coefficient was high at 0.913 for the L3/4 and L4 interpedicular transverse plane. The correlation coefficient for L4/5 and L5 was 0.905, and the correlation coefficient for L5/S1 and S1 was 0.845. CONCLUSION: The lumbar spinal canal dimension measured at the intervertebral disc level in a population of normal Korean subjects is expected to be useful as reference data. The transpedicular plane perpendicular to the spinal canal can give information for estimating the spinal canal dimension at the disc level.

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Disc Herniation / 대한정형외과학회잡지

PURPOSE: The purpose of the study is to evaluate the effectiveness of selective nerve root block (SNRB) in advance to the patient who is going to undergo the operation for lumbar herniated intervertebral disc (HIVD). MATERIALS AND METHODS: 103 cases were selected from among SNRB conducted to the patients who had been diagnosed by this hospital to have lumbar HIVD from December 2004 to November 2005 and assigned for operations. The follow-up period was 10 months in average (2.5-30 months) and the average age was 35.5 years (19-72 years). Patients had been monitored by means of clinical records, interviews and telephone and features of symptoms and stage of nerve root compression were compared between the group of operated patients and that of the non-operated. RESULTS: As for stages of nerve root compression, 15 cases could be classified to belong to the 1st stage, 4 cases to the 2nd stage and 1 case to the 3rd stage. Among 42 cases for which operations were conducted because there was no improvement after SNRB. Divided by stages of nerve root compression, 13 cases belonged to the 1st stage, followed by 10 cases to the 2nd stage and 4 cases to the 3rd stage. No statistically significant difference turned out to exist the clinical results between 42 cases which underwent operations and 61 cases which experienced improvement after nerve root block. No significant difference, either, was confirmed from the statistical outcomes between SNRB group and operations. CONCLUSION: The preserving treatment using SNRB for the patients with lumbar HIVD seems to have positive clinical effects. Features of radiating pains or stages of nerve root compression, however, can't be regarded to be factors foretelling the treatment effects of SNRB.

Evaluation of Website that Provide Information about Scoliosis / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the quality and accuracy of information on the Web about scoliosis. MATERIALS AND METHODS: Five search engines were selected and the key word "scoliosis" was entered. 25 web site were chosen. Each Web site was evaluated for the type, quality, accuracy of Web site. Web site type was classified as academic, commercial, physician, nonphysician. Web site quality was evaluated according to scoliosis specific content using 32 disease specific key words. The accuracy was evaluated by three board certified orthopaedic surgeons. One point was given when we agreed with less than 25% of the information and four points were given when we agreed with greater than 75%. RESULTS: 25 Web sites were evaluated, 20% were academic, 64% were physician based. The quality score for academic was 13.4, physician 8.2. The accuracy score for academic was 10.6, physician 6.9. CONCLUSION: The internet information about scoliosis is limited for quality and information value. The majority of the Web sites were physician site but the quality and accuracy score were poor. The lowest scoring Web sites were physician sites. The public and medical association need to be aware of the limitation of the Web site. The guide line and certification for the Web site about scoliosis should be established.

Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures

PURPOSE: To evaluate the outcomes of distal tibial open fractures treated by two-staged delayed minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. MATERIALS AND METHODS: 25 cases of distal tibial open fractures were treated with temporary ring fixation and two-staged delayed MIPPO. A mean age was 46 years old, follow-up was 23 months. The type of fracture was evaluated using the AO/OTA classification. The type of open fracture was evaluated using the Gustilo-Anderson classification that revealed 6 cases of type I, 9 cases of type II, 8 cases of type IIIA and 2 cases of type IIIB. We analyzed the radiologic results and postoperative complications. The clinical and functional result were evaluated by using Teeny and Wiss scores. RESULTS: The average time of bone union was 18 weeks in 24 cases. There were three delayed union that achieved union twenty weeks after second operation, and 1 case underwent bone graft with additional plate fixation. 6 cases of skin necrosis were treated with skin graft, 2 cases were treated with flap. The clinical and functional assessment showed that 6 cases were excellent, 16 cases were good, 2 cases were fair, and 1 case were poor results. CONCLUSION: Two-staged MIPPO technique for distal tibia open fractures seems to be a good procedure to obtain bone union.

The Modified Brostrom Procedure for Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the surgical results of modified Brostrom procedure for chronic lateral ankle instability and to assess whether or not associated injuries may affect postoperative satisfaction. MATERIALS AND METHODS: Twenty-four patients with chronic lateral ankle instability were evaluated retrospectively from August 1998 to March 2002. Average age was 29.3 years. All patients were performed pre & postoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device, MRI and intraoperative arthroscopic evaluations before ligament reconstruction. RESULTS: Of the 24 cases, 23 cases was improved more than average 12 points on AOFAS scales. On modified scales of Hamilton, 3 excellent, 20 good, 1 fair results. On stress view, average 2.2 mm difference was improved on anterior drawer test and average 1.7 degree on varus test. Associated injuries were 8 osteochondral defects, 4 anterior impingements, 2 loose bodies, 2 os subfibulare, 2 os submalleolare and 2 partial ruptures of peroneus brevis. 8 cases with no associated injuries rated excellent or good. CONCLUSION: The modified Brostrom procedure is believed to be an effective and successful method for chronic lateral ankle instability that didn't respond to conservative treatment. Because associated injuries in chronic lateral ankle instability may affect postoperative satisfaction, appropriate detection and treatment may need for postoperative satisfaction.

Effects of Variable Infusion Rates of Propofol on Arterial Baroreflex Sensitivity / 대한마취과학회지

BACKGROUND: Induction of anesthesia with propofol caused a decrease in arterial blood pressure and systemic vascular resistance. This effects of propofol on the circulation can be more clarified by studying cardiovascular control mechanism such as baroreflex sensitivity during variable rate infusion of propofol. METHODS: The effects of three infusion rates of propofol (3, 6, 12 mg/kg/hr) to supplement 66% nitrous oxide in oxygen anesthesia on baroreflex sensitivity were studied and compared with awake value in 80 ASA I or II patients (20-55 years old, n=20 in each group). Baroreflex control of heat rate was studied by pertubing the patients' arterial pressure with 100 microgram of phenylephrine in each three infusion rates of propofol which was maintained at least 30 min without any surgical stimulation. RESULTS: Baroreflex slope representing baroreflex sensitivity among three infusion rates of propofol did not show any significant differences. The slope of each infusion rate was 8.4+/-0.7 at awake, 8.9+/- 1.7 at 3 mg/kg/hr, 8.0+/-1.3 at 6 mg/kg/hr, 7.2+/-1.0 at 12 mg/kg/hr, respectively. But, resetting of the reflex occured at low heart rates. CONCLUSIONS: Usual propofol-nitrous oxide-oxygen anesthesia was not associated with impairment of baroreflex sensitivity, but showed reflex resetting at low heart rates.