A Case of Sleeve Fracture at the Superior Pole of the Patella Secondary to Disuse Osteopenia

Sleeve fracture at the inferior pole of the patella in children is relatively common, yet it is rare for the superior pole to be affected. So, only a few such cases have currently been reported. We experienced a 15 years-old patient with a sleeve fracture at the superior pole of the patella secondary to disuse osteopenia after cast immobilization due to knee trauma. We report on this case and we review the relevant literature.

Medial Patellofemoral Ligament Reconstruction Using the Autogenous Hamstring Tendon for Recurrent Patellar Instability: A Preliminary Report

PURPOSE: We present the short-term results of medial patellofemoral ligament (MPFL) reconstruction using the autogenous hamstring tendon for recurrent patellar instability. MATERIALS AND METHODS: Seven patients with recurrent patellar instability were treated with MPFL reconstruction using a semitendinosus or gracilis autograft from February 2008 to November 2008. All the patients were evaluated preoperatively and postoperatively according to the physical findings, scores and radiographs, with a mean follow-up of 13.6 months (range: 12~15 months). RESULTS: The apprehension test was positive in all the knees preoperatively and no knee was found to be positive at the follow-up. The grind test was positive in all the knees preoperatively and one knee was found to be positive at the follow-up. The Q-angle was 16.9degrees preoperatively and 18.3degrees at the follow-up. The Kujala score improved from 33.7 points to 94.1 points (p=0.018), the Lysholm score improved from 42.4 points to 92.6 points (p=0.018) and the Tegner activity level improved 2.1 to 5.1 (p=0.026). The congruence angle was 10.2degrees preoperatively and -3.4degrees at follow-up (p=0.018). The patellar height was 1.95 preoperatively and 1.6 at follow-up (p=0.028). There were no patients with recurrent dislocation. CONCLUSION: MPFL reconstruction using the autogenous hamstring tendon for recurrent patellar instability is an effective operation, according to the short term follow-up.

The Effect of Adjacent Vertebral Body on Vertebroplasty for Compression Fracture

PURPOSE: To analyze the effect of adjacent vertebral body on local sagittal segment in performing vertebroplasty for thoracolumabr vertebral compression fracture on the terms of radiological results. MATERIALS AND METHODS: We experienced 61 cases of T12 and L1 Compression fracture between June 2003 and November 2005. We classified with 3 groups; no collapse of adjacent body, collapse of adjacent upper body, and collapse of adjacent lower body. The measuring factors were anterior, middle, posterior vertebral height, wedge angle and local kyphotic angle. RESULTS: In group I, Increase rate of anterior, middle, posterior vertebral height and restoration rate of wedge angle, and local kyphotic angle were average of 0.41%, 0.31%, 0.16%, 1.47%, ?3.48% respectively. Group II was -3.19%, 0.11%, -3.02%, -1.23%, -4.63%. Group III was -2.28%, 4.72%, -1.01%, -2.41%, -13.12%. There are no significant differences among the groups except local kyphotic angle in Group III statistically. CONCLUSION: The previous wedged collapse of adjacent vertebral body do not affect local sagittal segment performed vertebroplasty in the thoracolumbar compression fracture. However the previous wedged collapse of adjacent lower body affect significantly local kyphotic angle.

A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures

PURPOSE: To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and interlocking IM nailing in the treatment of distal tibia fracture without involvement of ankle joint retrospectively. MATERIALS AND METHODS: 38 patients with distal tibia fracture from Jan. 2004 to Oct. 2005 were divided into two groups. Minimum follow-up was for 12 months. Group MIPO consisted of 18 patients were treated with MIPO and group Nail consisted of 20 patients were treated with interlocking intramedullary nail. The results were compared between two groups by assessing bony union time and operation time. Clinical evaluation was evaluated by Olerud score. RESULTS: The mean bony union time was 14.4 weeks (12~17 weeks) in group MIPO and 16.7 weeks (13~19 weeks) in group Nail (p=0.011). The mean operation time was 1.05 hours (0.6~1.6 hours) in group MIPO and 0.74 hours (0.4~1.1 hours) in group Nail (p=0.044). The Olerud score was 83.8 (75~100) in group MIPO and was 89.6 (70~100) in group Nail (p=0.075). In Complication, group MIPO showed one metal failure and two skin irritations, group Nail showed three superficial wound infections. CONCLUSION: MIPO was the shorter bony union time and the longer operation time than the interlocking intramedullary nailing. There were no significant differences between the two groups in clinical results.

Results of the Ludloff Osteotomy for Moderate to Severe Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the clinical and radiologic results of the Ludloff osteotomy for moderate to severe hallux valgus deformity retrospectively. MATERIALS AND METHODS: Between January 2003 and October 2006, 33 patients (42 feet) who had undergone with Ludloff osteotomy combined with distal soft tissue procedure were followed up for more than one year. The average follow-up period was 14.6 months and the average age at the time of surgery was 47.7 years (26-70 years). The American Othopeaedic Foot and Ankle Society (AOFAS) score was used for clinical outcome assessments. We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA) and the degrees of the tibial sesamoid subluxation in preoperative and the last follow-up radiographs. RESULTS: The AOFAS score improved from a preoperative average of 45.6 points to an average 84.3 points at the last follow-up. HVA and IMA were 34.8 and 14.5 degrees preoperatively, 17.2 and 5.9 degrees at the last follow-up. The tibial sesamoid position improved from a preoperative average of grade 2.5 to the last follow-up average of grade 1.2. CONCLUSION: Ludloff osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

Comparison between Vertebroplasty and Kyphoplasty in Osteoporotic Vertebral Compression Fractures / 대한정형외과학회잡지

PURPOSE: To compare the outcome of vertebroplasty with kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. MATERIALS AND METHODS: From May 2002 through April 2004, 55 patients were analyzed. Vertebroplasties were performed on 29 patients under local anesthesia. The patients were divided into two groups: group I consisted of 15 patients who underwent vertebroplasties within two weeks from the onset of the fractures; group II consisted of 14 patients who underwent kyphoplasties after two weeks from the onset of the fractures. Kyphoplasties were performed on 26 patients under general anesthesia. These patients were also divided into two groups, based on the same criteria as those patients who underwent vertebroplasties. For the radiological assessment, we measured the kyphotic angle with Cobb's method and the reduction rate in the anterior, middle, and posterior portions of the vertebral bodies. The clinical results were assessed with the Oswestry Disability Index and Visual Analogue Scale. RESULTS: The reduction rates of the anterior and middle portions of the vertebral bodies were greater than 50 % in patients who underwent vertebroplasties within two weeks from the onset of the fractures and the patients who received kyphoplasty. The reduction rates of the anterior and middle parts of the vertebral bodies in patients who underwent vertebroplasties after two weeks from the onset of the fractures, was much less than in other three groups. There were no significant differences in clinical comparison among the 4 groups: i.e., all the patient had satisfactory results in terms of pain relief and pre-fracture activity levels. CONCLUSION: We obtained better results from kyphoplasties when we compared vertebroplasties with kyphoplasties, regardless of the operation dates. However, when we performed vertebroplasties within two weeks from the onset of the fractures, we obtained radiological results that were similar to those with kyphoplasties. In clinical comparison, there were no statistically significant differences among the 4 groups. The pain scores improved dramatically after the operations and pre-fracture activity levels resumed.

Cystic adventitial disease of the popliteal artery: a case report

Cystic adventitial disease of the popliteal artery (CADPA) is a rare but a well-known cause of intermittent claudication, especially in young patients. The etiology of the disease is still controversial. Diagnosis starts with thorough history taking, physical examination, and radiography. A 44-year-old man presented with intermittent left calf claudication that had begun 9 months earlier (; the symptom-free interval was about 500 m). 3D-CT and CT-angiography revealed an oval cystic mass that compressed the popliteal artery, causing severe stenosis. Surgery was performed; the affected segment of the artery was successfully excised and replaced with an autogenous saphenous vein graft. Follow-up is on going. No cyst recurrence has so far been detected either clinically or by duplex-sonography during the 6-month postoperative period. The graft was patent and the patient was completely symptom free. Severe claudication in young patients, possibly without significant vascular risk factors, should prompt the clinical suspicion of CADPA.

Early course and Long term follow-up after Automated Percutaneous Lumbar Discectomy and Short term follow-up after Nucleoplasty / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to compare the early course of APLD with the long term follow-up after APLD and also the long term follow up after APLD with the short term follow-up after nucleoplasty. SUMMARY OF LITERATURE REVIEW: We evaluated the postoperative clinical course of both APLD and nucleoplasty. The evaluation of the postoperative clinical course was performed by using the Oswestry Disability Index (ODI). MATERIALS AND METHODS: We studied 59 patients who underwent APLD and nucleoplasty from 1989 to 2004. We defined the 26 cases with less than 5 years follow up as the early course follow-up after APLD, the 20 cases with over 5 years follow up as the long term after APLD, and 13 cases with less than 5 years follow up as the short term follow up after nucleoplasty. We then compared three groups. We inspected the condition of the discs on MRI and the level of the operated disc. RESULTS: The most common type of disc was a protruded disc (69.4%). Its ODI was lower than that of the extruded type. 5 cases out of the total group underwent open discectomy after APLD. In our study, the extruded type patients underwent a worse clinical course than protruded type patients. The patients who under went procedures at two affected disc levels had higher ODI scores compared to patients who underwent procedures at one level. The ODI score of the early course follow-up after APLD was 12.4%, the ODI of the long term follow up was 6.9% and that of the short term follow-up after nucleoplasty was 4.6%. CONCLUSIONS: On the long term follow-up, the patients who underwent APLD had significant improvement for any of the clinical parameters, as compared with their preoperative status. The patients who underwent nucleoplasty had a better prognosis than those patient who underwent APLD with less than 5 years follow up.

Shockwave Therapy for Tennis Elbow / 대한정형외과학회잡지

PURPOSE: The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) an lateral epicondylitis of the elbow. MATERIALS AND METHODS: Twenty-four patients with refractory lateral epicondylitis were treated with shock waves. The patients were evaluated by assessing of pain using visual analog scale (VAS) and a simple elbow test (SET). Overall clinical outcomes were evaluated using Roles and Maudsley scores at 12 months after ESWT. RESULTS: Significant symptom improvement were observed in 20 (83%) patients at the 12 months follow up according to the Roles and Maudesley scores. Average SET and VAS scores were also significantly improved after ESWT (p<0.05). CONCLUSION: This study suggests that shock waves therapy could be considered as an effective and noninvasive treatment modality for refractory lateral epicondylitis of the elbow.

Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis of The Cervical Spine: A Case Report / 대한척추외과학회지

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and ankylosing hyperostosis, is a relatively common disease that predominantly affects middle-aged and elderly men. It is often asymptomatic; especially dysphagia is a rather frequent and prominent symptom, particularly when the cervical spine is involved with the hyperostotic state. A case of DISH, with dysphagia, was experienced, which was treated by excision of the bony spur, with an anterior approach.

Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis of The Cervical Spine: A Case Report / 대한척추외과학회지

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and ankylosing hyperostosis, is a relatively common disease that predominantly affects middle-aged and elderly men. It is often asymptomatic; especially dysphagia is a rather frequent and prominent symptom, particularly when the cervical spine is involved with the hyperostotic state. A case of DISH, with dysphagia, was experienced, which was treated by excision of the bony spur, with an anterior approach.

A case of antacid-associated osteomalacia / 대한내과학회지

Chronic heavy use of phosphate-binding antacids has been known to cause osteomalacia. However, in spite of widespread use of antacids without prescription, there was no case report of osteomalacia associated with antacids in Korea. We report a case of osteomalacia diagnosed in a 36-year-old woman who had ingested large amounts of aluminum-containing antacids due to epigastric soreness. She had consumed about 4.2 kg of aluminum hydroxide over 10 years until she had withdrawn antacids 3 months before she was admitted with non-traumatic fractures of bilateral femur necks. Biochemical tests revealed normal levels of serum calcium and iPTH, increased level of serum alkaline phosphatase, and normal renal function. Bone mineral density (BMD) values of lumbar spines were decreased (T-score=-3.99~-3.11). Bone biopsy showed abundant unmineralized osteoid indicating osteomalacia. She was treated with bilateral total hip replacement arthroplasty and recommended not to restart the ingestion of antacids. After thirty months' withdrawal of antacids, BMD values of lumbar spines were found to be improved (T-score=-2.3~-1.4).

Role of IVIR in Limb Fracture

PURPOSE: In evaluation of the limb fracture, MR scan has been used in limited roles as evaluating the associated soft tissue injury not the fracture itself. This study aims at understanding the possible role of MR in fracture. METHODS AND MATERIALS: thirty three sets of MR scans in twenty nine patients were retrospectively analyzed. They included twelve tibial plateau fractures, four pateliar fractures, four distal femur fractures, five epiphyseal fractures and four others. RESULTS: All MRs except two showed better image and more information about the extent of the injury (93.9%). Evaluation of cartilage (which was impossible on other modalities) was possible in 28 MR scans (84.8%). Surrounding marrow change associated with fracture was also able to be evaluated. Associated soft tissue injury or other abnormality could be evaluated-cruciate or collateral ligament injury, meniscus tear, chodromalacia or osteonecrosis. In epiphyseal injury, direct demonstrability of premature bony fusion on MR took a critical role in making a management plan. CONCLUSION: MR scan in fracture has its value in evaluating the extent and degree of the injury and it is especially advantageous in detecting cartilage injury and early complication of growth plate injury.

Direct repair of spondylolysis using screw / 대한정형외과학회잡지

No abstract available.