Comparison of Clinical Outcomes between Arthroscopic Anterior Compartment Debridement with Posterior Compartment Mini-Open Debridement and Arthroscopic Both Compartments Debridement of the Primary Elbow Osteoarthritis / 대한정형외과학회잡지

Purpose@#This study analyzed the effectiveness of arthroscopic anterior compartment debridement with posterior mini-open debridement in patients with mild or moderate primary elbow osteoarthritis (OA). The clinical results of arthroscopic anterior compartment debridement with posterior mini-open debridement were compared with that of arthroscopic both compartments debridement. @*Materials and Methods@#Between January 2010 and December 2016, 46 patients diagnosed with elbow OA underwent arthroscopic anterior compartment debridement with posterior mini-open debridement or arthroscopic anterior and posterior compartments debridement arthroscopic surgery. Of these, 27 patients were finally included in this study. The data were collected retrospectively from the medical records. The subjects were divided into two groups according to the surgical procedure: group 1 (n=16) received arthroscopic anterior compartment debridement with posterior mini-open debridement surgery, and group 2 (n=11) received arthroscopic anterior and posterior compartments debridement surgery. The elbow flexion-extension range of motion (ROM), visual analog scale (VAS), Mayo Elbow Performance Score (MEPS) were analyzed for the clinical outcome before surgery and the last follow-up visit after surgery. @*Results@#The average follow-up period was 21 months (15–32 months). All clinical outcomes (ROM, VAS, and MEPS) were improved after surgery compared to those before surgery (p<0.05) in both groups. Group 1 showed further improvement in flexion (p=0.001) and total ROM (p=0.011) than group 2. On the other hand, there was no significant difference in extension, VAS, and MEPS between the two groups. @*Conclusion@#In patients with primary elbow OA, arthroscopic anterior compartment debridement with posterior compartment mini-open technique produced an excellent clinical outcome after surgery and was particularly helpful in increasing flexion and the total ROM.

Predictors for Ambulatory Recovery after Fixation of Intertrochanteric Fracture with Proximal Femoral Nail in the Elderly / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare with general characteristics affecting ambulatory recovery at one-year after the fixation of intertrochanteric fracture with proximal femoral nail (PFN) of elderly patients over the age of 65 years. MATERIALS AND METHODS: Between September 2008 and September 2015, 152 patients were diagnosed with femoral intertrochanteric fracture in Dong-Eui Medical Center. Of these patients, 75 were available in this retrospective study. Multivariate linear regression analysis, using a stepwise selection method, were performed to identify the prognostic factors affecting one-year postoperative recovery of ambulatory status, such as pre-injury ambulatory status, gender, age, fracture type, associated underlying disease, American Society of Anesthesiologists (ASA) grade, dementia, and complication. RESULTS: A decrease in the one-year postoperative ambulatory status was 68% and pre-injury ambulatory status was regained in 32% of patients. The pre-injury ambulatory status was the most important determinant of one-year postoperative recovery of ambulatory status. The ASA grade and complication were also predictors of recovery of ambulatory status. CONCLUSION: Pre-injury ambulatory status, ASA grade and complication were prognostic factors associated with one-year postoperative recovery of ambulatory status after fixating the intertrochanteric fracture using PFN in elderly patients over the age of 65 years.

Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees

Flexion contracture deformities, as well as severe varus and valgus deformities of the knee joint, accompany osteoarthritis or rheumatoid arthritis (RA). In particular, severe flexion contracture deformity of the knee joint is often found in patients with RA, which renders them nonambulatory. This report describes a 26-year-old female patient diagnosed with RA 10 years ago. She had chronic joint pain, severe flexion contracture, valgus deformity in both knees, and limited range of motion in both knees and became nonambulatory. She underwent a total knee arthroplasty (TKA) and serial casting and physical therapy to restore stable joint movement and correct knee joint deformity. Her pain was successfully relieved, and she was able to walk after surgery. Here, we report the excellent results of TKA in this RA patient with severe flexion contracture of both knees.

Atypically Large Calcific Tendinitis of the Shoulder: A Case Report

Calcific tendinitis of the shoulder joint is common disease causing acute pain, mainly involving the supraspinatus or infraspinatus muscle, and less frequently the teres minor or subscapularis muscle. This study reports on the satisfactory arthroscopic removal of calcium deposits as well as infraspinatus and supraspinatus muscle repair without relapse via minimal incision using suture anchors. This was a case of atypically extensive calcific tendinitis involving the infraspinatus muscle, with a bursal side partial rupture of the supraspinatus muscle in a 61-year-old female whose chief complaint was chronic pain of the right shoulder exacerbated by limited movement.

The Influence of Stroke on Postoperative Prognosis of Femoral Intertrochanteric Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the general characteristics that affect the prognosis and evaluate the influence of stroke on one-year postoperative mortality and recovery of ambulatory status in elderly patients over 65 years old with femoral intertrochanteric fracture. MATERIALS AND METHODS: This study included 80 patients who were followed-up for one year after proximal femoral nailing for femur intertrochanteric fracture between January 2008 and December 2013. We analyzed the relationship among the one-year postoperative mortality, recovery of ambulatory status and the associated factors (age, gender, associated underlying disease, American Society of Anesthesiologists [ASA] grade, comminution of the fracture, dementia). RESULTS: The one-year postoperative mortality rate in all patients and patients with stroke was 28.8% and 42.9%, respectively. The one-year postoperative mortality rate was significantly higher in patients with stroke, high ASA grade, and unstable fracture. Decrease of the one-year postoperative ambulatory status was 50.9% in all patients and was significantly associated with grade III or IV ASA rating. No significant relationships were observed between the one-year postoperative recovery of ambulatory status and stroke. CONCLUSION: Stroke, ASA grade, and unstable fracture were prognostic factors associated with one-year postoperative mortality following intertrochanteric fracture. ASA rating was the only prognostic factor affecting one-year postoperative recovery of ambulatory status.

Atypically Large Calcific Tendinitis of the Shoulder: A Case Report

Calcific tendinitis of the shoulder joint is common disease causing acute pain, mainly involving the supraspinatus or infraspinatus muscle, and less frequently the teres minor or subscapularis muscle. This study reports on the satisfactory arthroscopic removal of calcium deposits as well as infraspinatus and supraspinatus muscle repair without relapse via minimal incision using suture anchors. This was a case of atypically extensive calcific tendinitis involving the infraspinatus muscle, with a bursal side partial rupture of the supraspinatus muscle in a 61-year-old female whose chief complaint was chronic pain of the right shoulder exacerbated by limited movement.

Treatment of Avulsion Fracture of Proximal Rectus Femoris with Suture Anchor / 대한스포츠의학회지

Avulsion injuries of the anterior inferior iliac spine, which is the origin of the rectus femoris muscle, are sometimes reported in children and adolescents, but acute avulsion injuries with complete rupture of the rectus femoris are very rare in adults. We treated a case of avulsion fracture of the anterior inferior iliac spine with suture anchors in an adult and achieved a favorable outcome. Thus, we report the case with a review of literature.

An Extradural En-Plaque Meningioma Involving Thoracic Spine / 대한정형외과학회잡지

Reports of extradural spinal meningioma are rare, and differentiation from a metastatic lesion is important. We treated a case of thoracic extradural meningioma with surgical excision and obtained a favorable outcome without recurrence during one-year follow-up. Thus, we report on a case with review of the literature.

A Vessel Injury by Trocar of Closed Suction Drainage after Hip Hemiarthroplasty: A Case Report / 대한고관절학회지

Vascular complication of hip arthroplasty is relatively rare, and usually involves iatrogenic injury or thrombus formation of main vessels. No case of vascular injury associated with closed suction drainage has been reported. The current report describes an injury of a branch from the lateral circumflex femoral artery caused by a trocar of closed suction drainage in a 72-year-old man who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. We report on this case with a review of the literature in order to avoid similar complications.

Injury of the Superficial Femoral Artery Secondary to an Unstable Intertrochanteric Fracture: A Case Report / 대한고관절학회지

Injury of the femoral artery with a femoral intertrochanteric fracture is rare, and usually occurs on the deep femoral artery during surgery. We experienced a case of preoperative injury of the superficial femoral artery by a lesser trochanteric fragment. We repaired the femoral artery through an anterior approach before internal fixation.

Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The aim of this study was to analyze the clinical symptoms and function and the nerve electrophysiological changes between the pre-operative and long-term post-operative states of patients who underwent surgical treatment with endoscopic release of the carpal tunnel for idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: This study was performed in 48 patients and 88 wrists with idiopathic carpal tunnel syndrome. All patients were treated with endoscopic carpal tunnel release using a single portal. The preoperative and the 3 years 5 months long-term postoperative clinical symptoms and function were evaluated using the Boston carpal tunnel questionnaire. The nerve electrophysiological status was evaluated using the Bland grade system. RESULTS: When the preoperative Bland grade was 2, 3, 4, 5, and 6, the range of the change of the symptom severity score was 1.38, 1.68, 2.40, 1.61 and 1.28, respectively, and the range of the change of the functional status score was 0.60, 1.34, 1.58, 0.93 and 0.88, respectively, at the long-term follow-up. The clinical symptoms were signifi cantly improved at the fi nal follow-up when the preoperative Bland grade was 2, 3, 4 and 5. The function was signifi cantly improved for all the preoperative Bland grades. On the nerve electrophysiological study, there was statistical improvement of the distal motor latency of the motor nerve and the nerve conduction velocity and amplitude of the sensory nerve. When the preoperative Bland grade was 2, 3, 4, 5 and 6, the extent of improved grade was 0.60, 0.75, 2.17, 2.87 and 4.25, respectively, at the long-term follow-up, and the Bland grade was signifi cantly improved when the preoperative Bland grade was 3, 4, 5 and 6. However, there was no statistical signifi cance between the Bland grade and the clinical state at the long-term follow-up. CONCLUSION: The clinical and nerve electrophysiological states were significantly improved at the long-term follow-up after endoscopic carpal tunnel release. When the preoperative Bland grade was 3, 4 and 5, the clinical symptoms, function and the nerve electrophysiological states were signifi cantly improved at the long-term follow-up.

Treatment of a Segmental Ulnar Shaft Fracture and an Olecranon Fracture / 대한정형외과학회잡지

We would like to report a case of treating a segmental fracture of ulnar shaft, with a concomitant olecranon fracture. The patient was treated using tension band wiring and intramedullary nailing procedures. Based on the nature of the olecranon, we believe this should be a recommended treatment method that minimizes complications for the patient that has multiple fractures and a dislocation of the forearm.

Leg Length Discrepancy after Total Hip Arthroplasty

Restoration of the hip biomechanics, including the femoral offset and leg length, are the desired goals when performing total hip arthroplasty. A leg length discrepancy following total hip arthroplasty is a significant source of back pain and sciatica, gait disorders, general dissatisfaction and dislocation. Significant lengthening of the leg can be a risk factor for nerve injury and it is a relatively common cause of litigation. There is a fundamental interrelationship between leg length and stability when performing hip arthroplasty. There are a multitude of situations in which achieving both stability and perfectly equal leg lengths is simply not possible. Stability is the primary objective, and the surgeon may need to sacrifice leg length equality on the altar of stability. Although a leg length discrepancy cannot be eliminated after hip arthroplasty, it can be minimized through a series of steps, including a physical examination, radiographic evaluation, preoperative templating and intraoperative confirmation of the preoperative plan.

Intraneural Ganglion of the Tibial Nerve in the Popliteal Fossa: A Case Report

Intraneural ganglion is a relatively rare clinical entity that is commonly found in the peripheral nerves in the upper and lower extremities. It is commonly manifested by motor deficits, pain and sensory changes due to nerve entrapment and compression of the involved nerve. An intraneural ganglion of the tibial nerve is very rare. We present here a rare case of intraneural ganglion of the tibial nerve in the popliteal fossa and the patient had a neurologic deficit, and this was all treated successfully. We review the clinical course of the patient and the relevant issues are discussed together with a thorough review of the relevant literature.

Reliability of MRI findings for Symptomatic Extraforaminal Disc Herniation in Lumbar Spine

STUDY DESIGN: A retrospective study PURPOSE: This study examined the reliability of the MRI findings in detecting symptomatic extraforaminal disc herniation in the lumbar spine. OVERVIEW OF LITERATURE: There are no reports of the characteristics and reliable MRI findings of extraforaminal disc herniation. METHODS: Thirty age-and gender-matched asymptomatic volunteers and 30 patients with symptomatic extraforaminal disc herniation, who underwent surgery between March 2006 and Dec 2008, were enrolled in this study. All subjects underwent spinal MRI. The following parameters were evaluated: the presence or absence of focal eccentricity of the disc, change in the diameter of the nerve root, and displacement of the nerve root at the extraforaminal zones. Radiologic studies were reviewed blindly and independently by 3 spine surgeons. RESULTS: The overall agreement in determining the presence or absence of a symptomatic extraforaminal disc herniation between the three reviewers was 89.4% (161/180). The consensus showed focal eccentricity of the disc in 33 cases (55%), a change in diameter in the nerve root in 31 cases (51.7%), and a displacement of the nerve root in 23 cases (38.3%). An assessment of the paired intraobserver and interobserver reliability revealed mean Kappa statistics of 0.833 and 0.667 for focal eccentricity of the disc, 0.656 and 0.556 for a change in the diameter of the nerve root, and 0.669 and 0.020 for a displacement of the nerve root, respectively. CONCLUSIONS: There are three possible MRI findings that can be used to determine the presence or absence of symptomatic extraforaminal disc herniation. Among these MRI findings, focal eccentricity of the disc was found to be the most reliable.