Modified Extension Block Technique for Large Mallet Fracture

PURPOSE: To evaluate retrospectively the clinical results of modified extension block technique for large mallet fracture. MATERIALS AND METHODS: From May 2006 to August 2007, we reviewed 16 patients who got surgery with large mallet fracture. Surgical indications included fractures involving more than 33% of the articular surface or fractures associated with subluxation of the distal interphalangeal joint. The average age was 32.6 years old. The average time from injury to surgery was 10days. We performed modified extension block technique in all patients. The pins were removed between 5 to 6 weeks when we confirmed bone union by radiology. Function outcomes were determined by using the Crawford criteria. RESULTS: The average fracture fragment size was 52% of the joint surface. Average time to fracture union was 5.4weeks(4.5~7.5weeks). At a mean follow-up of 8.2months(5-13months) average extension loss was 3degrees (0-10degrees )and average flexion was 77degrees (60-85degrees ). According to Crawford classification, 81.3% of paitents had excellent or good results. There were 2 nail deformity. CONCLUSION: Modified extension block technique can make up for the weak points of traditional techique in the treatment for large mallet fracture.

Increased Activity of Insulin-like Growth Factor binding Protein-4 Protease in H-mole Patients / 대한내분비학회지

BACKGROUND: Hydatidiform mole (H-mole) is characterized by the neoplastic proliferation of trophoblasts. Only 1~10% of patients with partial H-mole will develop a trophoblastic tumor, but 18~29% of those with complete H-mole will develop a persistent trophoblastic tumor. Therefore, the early diagnosis and monitoring after operation of an H-mole disease are very important. Recently, the pregnancy associated plasma protein-A (PAPP-A) was proved to have a similar role as that of IGF binding protein-4 (IGFBP-4) protease, which has shown an increasing function in fetal growth and development by degradation of IGFBP-4 and an increase in IGF in the serum during pregnancy. Our hypothesis is "the H-mole, which shows placental hyperplasia will also have an IGFBP-4 protease activity, which may be used as in the early diagnosis and monitoring of H-mole disease". METHODS: Serum samples from 6 non-pregnant, 18 pregnant (5 in the 1st trimester, 10 in the 2nd, and 3 in the 3rd), 12 postpartum women and 3 H-mole patients(2 with complete H-mole and 1with partial H-mole) were collected and measured for the -HCG, IGF and PAPP-A levels and IGFBP-4 protease activities by a IGF-II ligand blot analysis and electrophoresis method. The IGFBP-4 protease activity of the serum during normal pregnancy was compared with that of H-mole disease. RESULTS: The results from the in vitro protease assays using recombinant IGFBP-4 determined that IGFBP-4 proteolysis was significantly increased during the first (56%) and second trimesters (90%), but reached a plateau by the third trimester (94%). In H-mole disease diagnosed 11 weeks after conception, the IGFBP-4 proteolytic activity was 97%, which was nearly the same as at terminal pregnancy. This activity gradually decreased to 75% at 1 week, 58.7% at 2 and 33% at 3 weeks after the operation. The -HCG was also decreased from 490,400 to 123,822.7, 1,352.3, and 128.5 mIU/mL at 1, 2 and 3 weeks after the operation, respectively. The PAPP-A level also gradually decreased from 34.87 to 25.5, 12.0 and 2.7 g/mL 1, 2 and 3 weeks after the operation, respectively. However, the IGF decreased from 238.3 to 172.9 ng/mL 1 week after the operation, but increased to 251.4 and 295 ng/mL at 2 and 3 weeks after the operation, respectively. CONCLUSION: These results demonstrated that the IGFBP-4 protease activity was significantly increased during pregnancy, and was extremely elevated durimg the early stages of H-mole disease, but gradually decreased after removal of molar tissue. Therefore, measuring the IGFBP-4 protease activity may play an important role in the early diagnosis and monitoring of H-mole disease

Increased Activity of Insulin-like Growth Factor binding Protein-4 Protease in H-mole Patients / 대한내분비학회지

BACKGROUND: Hydatidiform mole (H-mole) is characterized by the neoplastic proliferation of trophoblasts. Only 1~10% of patients with partial H-mole will develop a trophoblastic tumor, but 18~29% of those with complete H-mole will develop a persistent trophoblastic tumor. Therefore, the early diagnosis and monitoring after operation of an H-mole disease are very important. Recently, the pregnancy associated plasma protein-A (PAPP-A) was proved to have a similar role as that of IGF binding protein-4 (IGFBP-4) protease, which has shown an increasing function in fetal growth and development by degradation of IGFBP-4 and an increase in IGF in the serum during pregnancy. Our hypothesis is "the H-mole, which shows placental hyperplasia will also have an IGFBP-4 protease activity, which may be used as in the early diagnosis and monitoring of H-mole disease". METHODS: Serum samples from 6 non-pregnant, 18 pregnant (5 in the 1st trimester, 10 in the 2nd, and 3 in the 3rd), 12 postpartum women and 3 H-mole patients(2 with complete H-mole and 1with partial H-mole) were collected and measured for the -HCG, IGF and PAPP-A levels and IGFBP-4 protease activities by a IGF-II ligand blot analysis and electrophoresis method. The IGFBP-4 protease activity of the serum during normal pregnancy was compared with that of H-mole disease. RESULTS: The results from the in vitro protease assays using recombinant IGFBP-4 determined that IGFBP-4 proteolysis was significantly increased during the first (56%) and second trimesters (90%), but reached a plateau by the third trimester (94%). In H-mole disease diagnosed 11 weeks after conception, the IGFBP-4 proteolytic activity was 97%, which was nearly the same as at terminal pregnancy. This activity gradually decreased to 75% at 1 week, 58.7% at 2 and 33% at 3 weeks after the operation. The -HCG was also decreased from 490,400 to 123,822.7, 1,352.3, and 128.5 mIU/mL at 1, 2 and 3 weeks after the operation, respectively. The PAPP-A level also gradually decreased from 34.87 to 25.5, 12.0 and 2.7 g/mL 1, 2 and 3 weeks after the operation, respectively. However, the IGF decreased from 238.3 to 172.9 ng/mL 1 week after the operation, but increased to 251.4 and 295 ng/mL at 2 and 3 weeks after the operation, respectively. CONCLUSION: These results demonstrated that the IGFBP-4 protease activity was significantly increased during pregnancy, and was extremely elevated durimg the early stages of H-mole disease, but gradually decreased after removal of molar tissue. Therefore, measuring the IGFBP-4 protease activity may play an important role in the early diagnosis and monitoring of H-mole disease

Hypertrophy of the Patellar Tendon induced by Local Injection of TGF-beta1 in Mature Rats / 대한정형외과연구학회지

PURPOSE: The effects of local injection of TGF-beta1 on the normal patellar tendon and the characteristics of remaining tendon after the partial resection of hypertrophic one were investigated. MATERIALS AND METHODS: TGF-beta1 was injected into the right patellar tendon of mature rats weekly for 3 weeks. Histological study, biomechanical analysis and the transmission electron microscopic evaluation were done. Half of hypertrophic tendon was resected at 4 weeks after the last injection and the same analyses were RESULTS: TGF-beta1 treated tendon increased in cross sectional area but decreased significantly in maximum tensile stress. The hypertrophic tissue was mainly composed of small collagen fibrils. After the partial resection of hypertrophic tendon, there was no significant difference in maximum tensile stress between remaining and control tendons. There were relatively larger collagen fibrils in the remaining tendon tissue than in non-resected hypertrophic one. CONCLUSION: Local injection of TGF-beta1 induced the hypertrophy of normal tendon. After the partial resection of hypertrophic tendon, the remaining one showed the more similar biomechanical properties to normal one.

Arthroscopic Treatment of Displaced tibial Intercondylar Eminence Fractures: A Comparison of K-wires vs. Screw Fixation / 대한정형외과학회잡지

OBJECTIVES: To assess and compare the degree of reduction and clinical results following arthroscopic cannulated screw and K-wire fixation for type III displaced tibial intercondylar eminence fractures. METHODS: From 1991 to 1997, 20 patients with type III of intercondylar eminence fractures were arthroscopically treated (K-wire in 12 and screw in 8) and followed up 31 mo. in average. Degrees of reduction, extension loss and residual joint laxity were checked. And statistical analysis was done (Mann Whitney U-test) . Functional results were recorded by Meyers & McKeever's criteria. RESULTS: Degrees of reduction showed +2.1mm in K-wire group, and -1.3mm in screw group (avg., p<0.05) . Anterior displacements were 2.2mm and 1.7mm in stress x-rays and 3.5mm and 1.2mm in KT-1000 arthrometer, respectively (avg.,p<0.05) . Average loss of extension was 7 in K-wire group and 3 in screw group. There were excellent 9, good 3 in K-wire group and excellent 7, good 1 in screw group. CONCLUSION: Because of arthroscopic screw fixation able to compress and sink the fragment, it may showed less extension loss and residual laxity than K-wire fixtion. It is recommendable for the first choice to the treatment of type III tibial intercondylar eminence fractures with relatively large fragment.

Clinical Analysis Between Surgically Proven Contained and Ruptured HIVD / 대한척추외과학회지

STUDY DESIGN: The authors retrospectively analysed the difference of clinical natures in contained vs. ruptured HIVD. OBJECTIVE: To compare contained HIVD with ruptured HIVD in respect of clinical symptoms, signs and the result after surgery. SUMMARY OF LITERATURE REVIEW: In contained disc herniation, the disc material remains beneath tile intact outer annulus. But, once disc material penetrates through the limit of posterior annulus, it is a ruptured herniation or disc extrusion/sequestration. There is few report concerning the clinical characteristics related to type of herniation. MATERIALS AND METHODS: Forty-six patients, treated by open discectomy from March 1990 to December 1994, were followed up for minimum two years. The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR, and severity of radiating pain were periodically followed up on the predesigned protocol. Result: Twenty patients had contained disc and remaining 26 had ruptured disc. The mean age of contained disc was 31.4 years and that of ruptured disc was 43.3 years. In preoperative examination, 18/26 cases of patients with ruptured discs, developed pain in less than 3 months, compared with 7/20 cases of does with contained ones. Motor deficit was positive in 25/26 cases (96.2%) of ruptured discs and 12/20 cases (60%) of contained ones. 23/26 cases (80.8%) of patients with ruptured discs, had sensory deficit compared with 12/20 cases (60%) of those with contained ones. There was no significant difference in SLR and DTR change between ruptured and contained disc. CONCLUSIONS: Factors such as age, motor and sensory deficits and duration of symptoms had correlation with the type of herniation, but SLR and DTR change showed no statistical difference in this study. Clinical outcome showed no significant difference between two groups, but in ruptured group, the results were getting worse with the time goes. On the basis of this study, we concluded that the clinical symptoms and signs were different between the two groups, but surgical results showed no statistical difference.

Experimental Observation of Pedicle Screws in Postoperative CT scan - Stainless steel vs. Titanium / 대한정형외과학회잡지

Vertebral pedicle screws have been widely used for secure posterior spinal fixation. When postoperative CT scan films were made, the blurring of pedicle screws were observed and we could not figure nut the exact diameter of screw and canal encroachment. There is no information in the difference hetween actual diameter and measured diameter of pedcile screws in CT yet. In this study, we try to find out partial voiume averaging artifact of pedicle screws made of stainless steel and titanium. Partial volume averaging artifact occurs when the shape of an object changes within the thickness of the CT slice or when a relatively small object is only partially included within the slice. Four pig cadaveric spinal column including 6 vertebrae each were prepared and CT scans were performed after insertion of C-D screws(stainless steel) to the left and TSRH screws(titanium) to the right pedicle. Another CT scans were performed after insertion of C-D screws to the right and TSRH screws to the left pedicle. The third CT scans were made after removal of all the pedicle screws. Actual C-D screw diameter was 6mm and CT scanned diameter was 8. I 6+/-0.66mm. Actual TSRH diameter was 6.5 mm and CT scanned diameter was 6.59+/-0.34mm. In conclusion, stainless steel has more partial volume averaging artifact than titanium. Safety margin of pedicle screw made of stainless steel is about 2mm and that of titanium is about 1 mm.

Cauda Equina Syndrome after Laminectomy of Lumbar Spine with Application of Autogenous Free Fat Graft: A Case Report / 대한정형외과학회잡지

Although epidural fibrosis after laminectomy is considered to be the cause of pain in a number of patients, the exact relationship of postoperative scar tissue and symptoms remains controversial. However it is generally accepted that epidural fibrosis after surgical decompression of neural tissue has to be avoided. To diminish the likelihooa that such a scar will form, fat grafts have been used to create an interpositional membrane. Compression of a nerve after the use of a fat graft is rare; postoperative cauda equina syndrome, resulting from compression by a grafted fat. We report the case of a patient who had this complication.

Lumbar Intradural Lipomatosis: A case Report / 대한정형외과학회잡지

Intradural lipomatosis is a rare clinical entity characterized by excessive fat deposition in the intradural space. And they occur slightly more frequently in males. It may lead compression of the spinl cord or lumbargo, radiating pain, paresthesia, intermittent claudication and if they involve the cervical and thoracic region, the patients with tumours in these regions most frequently present with a slow ascending monoparesis or paraparesis, cutaneous sensory loss and defective deep sensation. Only 3% of tumours have been reported in the thoraco-lumbar region. The diagnosis should be based on a combination of clinical, imaging, surgical, and histological findings, and especially the diagnostic procedure of choice in patients with progressive myelopathy is MRI scan as it produces accurate imaging without exposure to ionizing radiation. He was treated surgically-removal of excessive fat tissue and decompressive laminectomy. We report a case of intradural lipomatosis that we had removed by surgically.

Differences of Fracture Patterns by the Level of the Thoracolumbar and Lumbar Burst Fractures / 대한척추외과학회지

STUDY DESIGN: Surgically treated thirty-five Denis type B thoracolumbar and lumbar burst fractures were assessed to compare the differences of fracture patterns by the level of fracture. OBJECTIVE: To know the major surgical indications according to the level of fracture. SUMMARY OF BACKGROUND DATA: General operative indications of thoracolumbar and lumbar burst fractures were collapse of anterior body height more than 40-50%, kyphotic deformity more than 30 degrees, canal encroachment more than 50% and neurologic deficit. But we could not apply the same surgical indications to the whole thoraco]embar and lumbar burst fractures because their fracture patterns are different. METHODS: We compared the collapse of anterior body height, collapse of posterior body height, Cobb angle, wedge angle, canal encroachment and incidence of posterior injury according to the level of fracture. RESULTS: The higher the level of fracture, the more the collapse of anterior body height, Cobb angle, wedge angle and incidence of posterior injury But the lower the level of fracture, the more the canal encroachment. CONCLUSIONS: These results mean that the primary surgical indications for thoracolumbar junction are collapse of anterior body height, possibility of posterior injury and increased kyphosis, while for the lower lumbar fractures, amount of canal encroachment is an important factor to make decision for surgery.

Results of PLIF using Laminar Chips in Spinal Lesions / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analyzing the results of chip PLIF with pedicle screw instrumentation for various spinal lesions. OBJECTIVES: To analyze the clinical and radiologic results of chip PLIF and to compare the amount of blood loss and transfusion and operation time with the ordinary PLIF. SUMMARY OF LITERATURE REVIEW: The ordinary PLIF has 86-95% of radiologic union rate and 80% of clinical satisfactory rate. The problems of ordinary PLIF were donor site morbidity, limited bone resources, prolonged operation time and excessive blood loss. MATERIALS AND METHODS: Forty patients were treated by chip PLIF utilizing cubical chip bone obtained from spinous process, facets and lamina from October 1995 to October 1997. Twenty-four patients, followed up over 12 months, were included in this study. Radiologic union, disc space collapse and change of kyphotic angle were assessed by simple X-ray and clinical results by improvement of back pain, radicular pain and change of neurological deficits. Twenty-nine patients treated by ordinary PLIF were compared concerning the operation time, amount of blood loss and transfusion. RESULTS: The mean age was 51.5 years(27-68 years) and mean follow-up was 20.7 months(12-30 months). Complete radiologic union rate was 47.6%, which was lower than ordinary PLlf. Satisfactory clinical result rate was 79%, which was similar with other fusion methods. Operation time, amount of blood loss and transfusion were less than the ordinary PLIF. There were three complications that were one dural tear ailed two pedicle screw breakages. CONCLUSION: There was no relationship between radiologic union rate and clinical satisfactory result after chip PLIF. Although operation time is relatively short and blood loss is less, it's not a good method to obtain nice bony union in spinal lesions.

A Clinical Study of Dupuytren's Contracture / 대한정형외과학회잡지

Dupuytren's contracture is characterized by a proliferative fibroplasia and contracture of the palmar fascia with resultant deformity of hand and finger. It is most common in those of Scandinavian and Celtic origin but it is very rare in the orientals. We experienced 30 hands of 21 patients from January 1985 to December 1995 in Soonchunhyang University Hospital. Among 21 patients, operative treatment was done in 28 hands of 19 patients. Partial fasciectomy was done in 24 hands and complete fasciectomy was done in 4 hands. The longitudinal straight skin incision was done in 14 cases and the transverse or Zig-Zag incision was done in 12 cases. Average follow-up period was 24 months. The results of the operative treatment were classified by Honner's classification. Excellent result was obtained in 16 cases (57%), good in 8 (29%), fair in 3 (11%), poor in 1 (3%). The complications were 5 cases as follows; recurrence 2, skin defect 1, hypoesthesia 2. In conclusion, partial fasciectomy utilizing longitudinal straight incisions overlying diseased area is suggested as one of the good method for the treatment of Dupuytren s contracture.

Pull - out Strength of Different Multiple Suturing Method of the Cruciate Ligament / 대한정형외과학회잡지

The aim of this study was to measure the immediate pull-out strengths by increasing the number of suture loops and to compare the immediate pull-out strengths of three different suturing techniques. In one group, the number of suture loops increased from 2 to 9 and the suturing technique of multiple loops through the proximal ligament stumps was used. The other group, the three different techniques were transverse, vertical, and criss-cross suture. The ultimate strength for the 2 loops was 16.62 (+/-6.7)N, for the 3 loops was 34.45 (+/-12.5)N, for the 4 loops was 54.80 (+/-17.7)N, for the 5 loops was 74.30 (+/-21.4)N, for the 6 loops was 102.49 (+/-13.5)N, for the 7 loops was 105.05 (+/-24.8)N, for the 8 loops was 129.50 (+/-76.1)N, for the 9 loops was 229.50 (+/-48.7)N. The transverse suture had a mean ultimate strength of 47.38 (+/-14.8)N, where-as the vertical suture failed at 76.94 (+/-26.4)N and the criss-cross suture at 101.82 (+/-25.7)N. Consequently, their strength can be improved by increasing the number of loops and we suggest that the criss-cross suture technique is reliable method for clinical use, because of high failure strength and wider apposition area of bone to ligament.

Intraosseous Lipoma in Long tubular bone: 3 cases report / 대한정형외과학회잡지

Intraosseous lipoma is one of the rarest primary benign tumors of bone and it is characterised by a neoplastic overgrowth of univacuolar fat cells. The incidence is less than one per 1,000 bone tumors. Most commonly, long bones are affected, with a tendency for metaphyseal involvement. Because of its rarity and nonspecific clinicopathologic findings, biopsy is needed for accurate diagnosis. Currettage and bone-grafting is the treatment of choice if the lesion is painful or if structural stability is threatened. We report 3 cases of intraosseous lipoma in long tubular bones with review of literatures. Two cases were treated by surgical intervention and the other case by conservative management.

Comparative Study of Fusion Rate in the Thoracolumbar and lumbar Posterolateral Fusion using Autograft or Xenograft(Lubboc) / 대한척추외과학회지

No abstract available.

Posterior Column Injuries in Thoracolumbar and Lumbar burst Fractures / 대한척추외과학회지

No abstract available.

Dural Tear and Root Entrapment in Lumbar Burst Fractures / 대한척추외과학회지

No abstract available.

Bilateral Fractured of the Fabella / 대한정형외과학회잡지

The fabella is the seasmoid bone occurring in about 10–30% of individuals and is located in the head of the lateral tendon of the Gastrocnemius muscle. Fracture of the fabella is a very rare condition. Since first reported by Jacob Sagel in 1932, only 5 cases of fabella fracture had been reported. However, there has been no bilateral case. We report a first case of bilateral fracture of the fabella with review of literature. This case was combined with rupture of anterior cruciate ligament and lateral collateral ligament on the right knee.

Tendon Transfer for Radial Nerve Paralysis and Multiple Extensors Rupture / 대한정형외과학회잡지

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.

Biomechanical Study of the Pull-Out Strength of Interference Screw Fixation in Anterior Cruciate Ligament Reconstruction: Comparison Between Endoscopic and Arthroscopic Assisted Technique / 대한정형외과학회잡지

Surgical reconstruction of the anterior cruciate ligament is undergoing constant evolution. The variable success of these procedures can be attributed to many factors including graft selection, graft placement, graft tensioning, graft remodelling and rehabilitation program. Rigid fixation is probably the most important factor in the success of these procedures during the initial stages of healing. Arthroscopically assisted reconstruction of the ACL-deficient knee using a bone-patellar tendon-bone graft(two-incision technique) is a reliable and evolving technique. Rosenberg et al, described a one-incision technique that allows endosteal fixation of bone plugs within their femoral tunnels intraarticularly via the intercondylar notch. These two techniques are different from their femoral tunnel direction and bone plug placement. The present study was designed to develop a swine model for in vitro biomechanical testing of the bone-patellar tendon-bone ACL autograft to compare the pull-out strength of Outside-In technique and Inside-Out technique. The result were as follows: 1. Normal ACL(N=10 knees) pull-out tensile strength tests showed a maximum tensile strength of 1295.34(N), a stiffness of 120.95(N/mm), and a linear load of 1104.26(N). The failure sites were all tibial attachments. 2. Femoral and Tibial interference fit pull-out tensile strength tests(N=10 knees) showed a maximum tensile strength of 463.23±42.27(N), a stiffness of 33.62±3.18(N/mm), and a linear load of 392.51±95.42(N). The failure sites were all in the tibial tunnel area(N=9 knees), except for one which femoral tunnel area. 3. Inside-Out technique(N=15 knees) showed a maximum tensile strength of 1250.64±75.67(N), a stiffness of 94.31±26.44(N/mm), and a linear load of 1046.92±367.55(N), but the Outside-In tech-nique(N=15 knees) showed a maximum tensile strength of 805.35±54.61(N), a stiffness of 83.33±10.98(N/mm), and a linear load of 685.99±86.32(N)(p < 0.0001). The failure sites were all in the femoral tunnel area. 4. Tensile testing demonstrated that the Inside-Out technique was significantlly stronger than Outside-In technique for maximum tensile strength, stiffness and a linear load.