Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

BACKGROUND: There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome. METHODS: We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined. RESULTS: The average modified Gartland and Werley wrist score improved from 65.5 +/- 8.1 preoperatively to 93.4 +/- 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 +/- 2.0 mm was reduced to an average of -0.6 +/- 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 +/- 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ. CONCLUSIONS: The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

Surgical Outcomes of Schwannoma Occurred at the Brachial Plexus

Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from 1.5x1.5x0.5 cm to 11.0x10.0x6.0 cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

Patient Satisfaction Interviews after TKA Successful Rehabilitation Achieved and Functions Still Desired by Respondents

PURPOSE: To determine the priority for the instrumental development of Total knee replacement arthroplasty(TKA) by assessment of patient interviews after TKA in Korea. MATERIALS AND METHODS: We assessed the responses of 168 patients with primary TKA a minimum of one year after surgery. In order not to limit their choices by using a survey, interviewees responded to two open-ended questions, "What was the best result achieved after TKA?" and "What was the result you most wished for but was not achieved after TKA?" RESULTS: All the patients expressed satisfaction with TKA except for 12 patients (7.1%) and for the question of the best result after TKA, 118 patients (70.2%) pointed out that pain relief was the most satisfactory. For the question of the most wished for function still to be restored after TKA, 59 patients (35.1%) answered "No inconvenience and no need" and the greatest proportion among the others who had a wish, 61 patients (36.3%) pointed to discomfort related to the degree of knee flexion with the response "Not easy to stand from the ground and to have deep knee flexion". The average knee flexion degree was 120.7degrees in the group who had a wish related to knee flexion but 127.5degrees in the "No need" group, and the difference was significant (P=0.004). CONCLUSION: Although there was a 93% satisfaction rate after TKA, the remaining function most wished for after TKA was to stand up from the ground easily, which is related to knee flexion degree. Therefore, we propose that the improvement of knee flexion after TKA should be the priority for instrumental development in Korea.

Flexion-distraction Injury in Cervico-thoracic Junction: A Case Report / 대한척추외과학회지

Injuries at the cervico-thoracic junction can be difficult to diagnose (with an incidence as high as 9% of all spinal injuries) and to stabilize, because of anatomic complexities. We report a case with that was treated with a lateral mass screw and transpedicular screw-rod fixation for a flexion-distraction injury at the cervico-thoracic junction and we present a review of the literature.

Combined Femoral and Sciatic Nerve Palsy Associated with Acetabular Fracture and Dislocation: A Case Report

Sciatic nerve palsy is the most common nerve injury associated with acetabular fracture and dislocation, but femoral nerve injury is known to be very rare because of relative protected position of nerve between the iliacus and psoas muscle, and as far as we know only one report was noted in English about combined femoral and sciatic nerve injury associated with acetabular fracture and dislocation, so we hereby report a case of combined femoral and sciatic nerve palsy associated with acetabular fracture and dislocation.

Alteration of PKC, PKC theta, NF-kappa B and AP-1 in Ischemic-reperfused Soleus Muscle of Rat with Ischemic Preconditioning / 대한정형외과연구학회지

PURPOSE: This study was designed to examine the expression patterns of PKC, PKC theta which is a house-keeping member of PKC family in the skeletal muscle, and two redox sensitive transcription factors, NF-kappa B and AP-1. MATERIALS AND METHODS: Male Sprague-Dawley rats, 9, 30 and 65 weeks old, were divided into 4 groups, such as normal controls, ischemic preconditioning controls, subjects receiving 4 hours of ischemia, and subjects receiving 4 hours of ischemia with ischemic preconditioning. Each group was divided into 5 subgroups based on reperfusion time. For ischemic preconditioning, left common iliac artery was occluded three times for 5 minutes of ischemia followed by 5 minutes of reperfusion using rodent vascular clamps. Ischemia was induced by occluding the same artery for 4 hours. The soleus muscles were removed at hours 0, 1, 3, 6, and 24 after the onset of reperfusion. Muscle samples were embedded in paraffin and 6 micrometer sections were made. The expression levels of PKC, PKC theta, NF-kappa B, and AP-1 were examined using immunohistochemical methods. RESULTS: Treatment of ischemia for 4 hours followed by reperfusion, resulted in the decrease in PKC, PKC theta, NF-kappa B, and AP-1 in 9 week-old rats, but consistant increase in 30 week-old rats. These factors were highly enhanced in the muscle from 65 week-old rats receiving 3 hours of reperfusion, followed by declined expression. And ischemic preconditioning reduced the expression variability. CONCLUSION: Ischemic precoditioning reduces the expression variabilities that activated by reperfusion after ischemia, such as PKC, PKC theta, NF-kappa B, and AP-1. But we couldn't predict the tissue damage by the patterns of expression of those factors.