Vertebral Artery Compression during Roll Tilt: Is the Edge of the Foramen Magnum a Culprit?

No abstract available.

Snapping Metacarpo-Phalangeal Joint after Depressed Fracture of Metacarpal Neck: Case Report

We report one case of snapping metacarpo-phalangeal joint after depressed fracture of metacarpal neck which could be diagnosed by exploration for the snapping during extension in spite of conservative treatments.

Treatment of the Intertrochanteric Fractures of the Femur in Elderly Patients: Comparision of Wayne-County Reduction and Anatomical Reduction

PURPOSE: To compare the radiological and clinical results of Wayne-County reduction with anatomical reduction in treatment of the intertrochanteric fractures of the femur in elderly patients. MATERIALS AND METHODS: Among one hundred-three of intertrochanteric fractures treated with 135- degree angled compression hip scresw, eighty three cases treated by Wayne-County reduction (Group 1, 42 cases) and anatomical reduction (Group 2, 41 cases) with at least 1 year follow-up were reviewed. The average pateint ages were 72.4 (65~92) in group 1, 71.6 (65~89) in group 2, respectively. 33 cases (75.2%) in group 1 and 31 cases (77.5%) displayed unstable fractures by Jensen classification. The radiological observation was included neck-shaft angle, penetrating length of lag screw into head, sliding length of lag screw and time of bony union. The clinical results were evaluated by Koval criteria, Kyle's functional evaluation, leg length inequality and complications. RESULTS: There were no significant changes between group 1 and group 2 in stable fractures in the radiological and clinical results. In unstable fractures, the neck-shaft angle averaged 132.2 degree in group 1 and 129.4 degree in group 2 in the final follow-up films. The penetrating length of lag screw into head were 2.2 mm in group 1 and 3.1 mm in group 2 (p<005). But there were little differences in the sliding length of lag screw, the time of bony union and complication rates between groups. In post- operative evaluation of walking abilility by Koval, 31 patients (73.8%) in group 1 and 28 (68.3%) recovered the activity level before injury by the postoperative 1 year follow-up. Leg length discrepancy at final follow-up was 4.1+/-6 mm shortening in group 1 and 6.5+/-8 mm in group 2, respectively. CONCLUSION: Both Wayne-County reduction and anatomical reduction had a favorable results after treatment of stable intertrochanteric fractures of the femur, but Wayne-County reduction may be a better method in treatment of unstable fractures, especially in elderly patients, in which it is difficult to obtain anatomical reduction.

Partial Resection of the Sternocleidomastoid Muscle for the Congenital Muscular Torticollis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study determining the surgical result of the partial resection of the sternocleidomastoid (SCM) muscle for the congenital muscular torticollis. OBJECTIVES: To evaluate the efficacy of the partial resection of the sternocleidomastoid muscle for the correction of the congenital muscular torticollis. MATERIALS AND METHODS: We reviewed 19 patients who were treated by the partial resection of the sternocleidomastoid muscle from 1990 to 1997. The mean age at the time of the operation was 8 year 3 months. Each patient was examined the range of the motion of the neck for the functional results by the modified Ling's criteria, and the tilt of the head, facial asymmetry, presence of the lateral band, loss of the sternomastoid column and quality of the scar for the cosmetic results by the modified Ling's criteria. The over-all cosmetic and functional results were analyzed by the criteria similar to those described by Canale et al. RESULTS: Functionally, 5 patients (26.3%) were excellent, 10 (52.6%) good, 2 (10.5%) fair, and 2 (10.5%) poor. Cosmetically, 7 patients (30.8%) were excellent, 9 (47.4%) good, 1 (5.3%) fair, and 2 (10.5%) poor. The complication was one lymphatic leakage. Seven of 8 patients were good and one patient was fair under the age of 5. Six of 7 patients were good and one patient was poor between the age of 6 and 10. Two of 4 patients were good and two patients were poor over the age of 11. CONCLUSION: The partial resection of sternocleidomastoid muscle for the congenital muscular torticollis would be recommendable, because it is a simple, safe procedure and usually produces satisfactory results. All partial rescetion of the sternal and clavicular head of the sternocleidomastoid muscle may prevent the unsatisfactory cosmetic result which is lateral band due to the clavicular head of the sternocleidomastoid muscle. The good results were achieved in case of under the age 10 years.

Two Cases of Callosal Disconnection Syndrome: Impaired Body Cognition of Nondominant Limbs

Callosal disconnection results in the functional independence of each hemisphere and usually produces characteristic signs including alien hand, left-sided apraxia, left agraphia and left tactile anomia. Our two patients; a 75-year-old right-handed woman with hypertension and a 71-year-old right-handed woman with diabetes mellitus, showed impairments in the identification of body parts with their left hands in addition to characteristic symptoms such as left ideomotor apraxia, agraphia, tactile anomia, and right alien hand signs with groping and grasping. Brain MRIs of these patients upon admission demonstrated infarcts in the medial portion of the left frontal lobes and in the corpus callosum supplied by the left anterior cerebral artery. The impairment of body parts cognition in our patients can be attributed to the failure of the patient's left hand to communicate with the body schema stored in the left hemisphere.

The Effect of Femoral Lengthening on Mechanoreceptors of Anterior Cruciate Ligament in the Rabbit / 대한정형외과학회잡지

PURPOSE: This study aimed to observe the effect of femoral lengthening on proprioceptive nerve endings of the anterior cruciate ligament in rabbits and to evaluate the relationship between changes in the number of mechanoreceptors and electrophysiologic abnormalities, and histomorphological changes in the ligament, according to the length gain. MATERIAL AND METHODS: Forty rabbits were divided into two groups, such as 10% and 20% lengthening. Each ipsilateral femur was distracted by gradual method and the contralateral side was used for the sham group. Distraction at a rate of 1 mm per day was started on the 5th day postoperatively. The frequency of distraction was 2 steps per day. At the end of the experiment, nerve conduction studies including amplitude, latency and area of compound muscle action potential (CMAP) were measured. Modified gold-chloride stain was used for detection of proprioceptive nerve endings of the anterior cruciate ligament and hematoxylin-eosin stain was used for light microscopic examinations of the anterior cruciate ligament. Among 40 animals, 7 were excluded in our study due to experimental faults which were 3 inadequate osteotomy, 2 premature consolidation and 2 sepsis. Three types of mechanoreceptors were identified by Freeman and Wyke criteria. RESULT: There was a statistically significant reduced number of three morphological kinds of corpuscles in anterior cruciate ligaments in the 20% lengthening group than in the sham group (p<0.03) . Morphological changes of synovium on the anterior cruciate ligaments were more evident in the lengthened groups rather than in the ligament itself. However, there was little relationship between abnormalities of nerve conduction velocity and the change in number of proprioceptive nerve endings. CONCLUSION: This study provided morphological evidence of the harmful effects on proprioceptive function of adjacent joints due to lengthening, and that femoral lengthening may alter the neurophysiological function of the knee joint by decreasing the number of mechanoreceptors in the anterior cruciate ligament. As well, this morphological change by limb lengthening did not seem to be related to distraction neuropathy.

A Case of Marchiafava-Bignami Disease with Abnormal SPECT Findings

Marchiafa-Bignami disease(MBD) is a rare complication of chronic alcoholism and is pathologically characterized by a symmetrical primary demyelination of the corpus callosum with or without focal necrosis. The clinical features of the disease are quite variable, and the course is usually progressive and fatal. We present a case with characteristic clinical features and imaging findings, including SPECT, of MBD. A 51-year-old man was admitted due to mental confusion, violent behavior, and slowness of motion for 2 months. He had been a heavy alcoholic for about 20 years. He was in a stuporous state for 1 week beginning 2 weeks after his admission.. He then showed alertness but was still in a mute state. His cooperation and responses to noxious stimuli were very poor. A brain MRI showed focal cystic change in the enlarged corpus callosum and diffused high-signal intensity in the subcortical white matter, thalamus, and corpus callosum in T2WI. 99mTc-ECD SPECT revealed diffusely decreased cerebral perfusion in both frontal, temporal and pari-eto-occipital lobes.