Revisional Percutaneous Full Endoscopic Disc Surgery for Recurrent Herniation of Previous Open Lumbar Discectomy

STUDY DESIGN: A retrospective study. PURPOSE: To determine the feasibility and effectiveness of revisional percutaneous full endoscopic discectomy for recurrent herniation after conventional open disc surgery. OVERVIEW OF THE LITERATURE: Repeated open discectomy with or without fusion has been the most common procedure for recurrent lumbar disc herniation. Percutaneous endoscopic lumbar discectomy for recurrent herniation has been thought of as an impossible procedure. Despite good results with open revisional surgery, major problems may be caused by injuries to the posterior stabilized structures. Our team did revisional full endoscopic lumbar disc surgery on the basis of our experience doing primary full endoscopic disc surgery. METHODS: Between February 2004 and August 2009 a total of 41 patients in our hospital underwent revisional percutaneous endoscopic lumbar discectomy using a YESS endoscopic system and a micro-osteotome (designed by the authors). Indications for surgery were recurrent disc herniation following conventional open discectomy; with compression of the nerve root revealed by Gadolinium-enhanced magnetic resonance imaging; corresponding radiating pain which was not alleviated after conservative management over 6 weeks. Patients with severe neurologic deficits and isolated back pain were excluded. RESULTS: The mean follow-up period was 16 months (range, 13 to 42 months). The visual analog scale for pain in the leg and back showed significant post-treatment improvement (p < 0.001). Based on a modified version of MacNab's criteria, 90.2% showed excellent or good outcomes. There was no measurable blood loss. There were two cases of recurrence of and four cases with complications. CONCLUSIONS: Percutaneous full-endoscopic revisional disc surgery without additional structural damage is feasible and effective in terms of there being less chance of fusion and bleeding. This technique can be an alternative to conventional repeated discectomy.

Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing: A Case Report

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

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 of Arthroscopy and Routine MRI About Cartilage Lesion in Knee Joint

PURPOSE: The cartilage lesions of routine MRI (no cartilage-specific image sequences) compared with those of arthroscopy for detecting how much we can predict. MATERIALS AND METHODS: We made a retrospective study of 53 patients with cartilage lesions of medial femoral condyle in the knee arthroscopy from Nov. 2003 to Jan. 2006. We analyzed the extent of agreement in cartilage lesions between arthroscopy and routine MRI using modified Outerbridge classification. RESULTS: All patients were categorized by modified Outerbridge Grade I~IV. In arthroscopy, 3, 4, 24, 22 cases were reported in each category: on routine MRI, 3, 10, 12, 23 cases were reported in each category and there were 5 normal cases. The sensitivity of cartilage lesions on MRI was high (90.6%), however, the agreement of those was low (K=0.24). We found 24 cases (45.2%) that MRI levels and arthroscopy levels were matched. We found 29 cases (54.7%) that those two levels were not matched. CONCLUSION: It is important to make a close inspection of chondral surfaces even in routine MRI. And cartilage lesions in routine MRI should be considered as those of higher grade in arthroscopy.

Medial Plantar Nerve Injury after Screw Fixation of the Calcaneus Fracture

We present a case of medial plantar nerve injury by screw tip after open reduction and internal fixation of intraarticular calcaneus fracture. We reviewed the risk and prevention technique of medial plantar nerve injury in fixing the calcaneus fracture.