Prognostic Factors of Septic Arthritis of Hip in Infants and Neonates: Minimum 5-Year Follow-up

BACKGROUND: The authors conducted the present study to identify clinical and radiological prognostic factors in infants and neonates with septic arthritis of the hip. METHODS: The authors retrospectively reviewed the records of 31 patients with septic arthritis of the hip. All of the patients were younger than 18 months old. Follow-up periods ranged from 5 to 17 years. The following potential variables for predicting the prognosis were included in the assessment: gender, age, underlying diseases, duration of symptoms, changes of hip joint in X-ray, concomitant osteomyelitis, elevation of erythrocyte sedimentation rate and C-reactive protein, sepsis, pus drainage, synovial fluid culture, and infecting organisms. Clinical and radiological prognoses were analyzed at the final follow-up. RESULTS: Univariate analysis demonstrated that radiological prognoses were poorer in patients who had underlying diseases, a longer duration of symptoms, and pus drainage. However, on multivariate analysis, only the variable-duration of symptoms-was found to be statistically related with a poor radiological prognosis. CONCLUSIONS: Although poor prognosis for patients with several underlying diseases and radiological changes has already been established, a favorable outcome might be expected with prompt surgical drainage and appropriate antibiotics.

Lateral Supramalleolar Flap for Reconstruction of Soft Tissue Defect around the Ankle Joint

PURPOSE: Soft tissue defect on foot and ankle is vulnerable and requires a thin flap for improvement of aesthetic and functional results. Lateral supramalleolar flap is a simple and fast procedure, which can preserve and supply reliable constant blood flow, and causes fewer donor site complications. The authors reviewed our cases and report the clinical results. MATERIALS AND METHODS: Ten cases of soft tissue defects on the lower leg, around the ankle were treated with lateral supramalleolar flap. There were seven males and three females with a mean age of 54.8 years. The mean size of flaps was 5.9x6.3 cm and the mean follow-up period was 23 months. Flap survival and postoperative complications were evaluated. RESULTS: Nine flaps survived completely without loss of flap. There was one case of partial wound dehiscence requiring debridement and repair, and another case of necrotic flap change requiring partial bone resection and closure. All patients were capable of weight bearing ambulation at the last follow up. CONCLUSION: The authors suggest that the lateral supramalleolar flap could be a useful option for treatment of soft tissue defect around the ankle joint.

Convalescence from Saturday Night Palsy

PURPOSE: Saturday night palsy is a transient form of nerve palsy that occurs after a prolonged period of direct pressure on the course of radial nerve by one's own or spouse's head. Although commonly encountered, there have been only few studies concerning its convalescence. The purpose of this study is to predict the prognosis of Saturday night palsy based on the causes, time to recovery and degree of recovery. MATERIALS AND METHODS: Retrospective study of 20 patients who were diagnosed compression radial nerve palsy was performed. The average age was 36.7 years old and the mean follow-up period was 19.6 months. We investigated sleeping hours as an indirect measure of nerve compression time, recovery of wrist and finger extension, DASH score on the monthly based follow up. RESULTS: The mean sleeping hours was 5.8 hours and all patients showed full recovery of wrist and fingers extension with the mean duration of symptom for 3.2 months. DASH score was an average 1.53 at the last follow up and we found no statistical significance between the time to recovery and the sleeping hours. CONCLUSION: Complete natural recovery can be expected in compression radial nerve palsy in this study without correlation with sleeping time. Accurate diagnosis is important in order to avoid unnecessary therapeutic intervention and further study should be accomplished for clarifying the related prognostic factors in larger scale of the cases.

Reverse Superficial Sural artery flap for the Reconstruction of Soft Tissue Defect on Posterior side of heel exposing Achilles tendon

PURPOSE: Soft tissue defect on posterior side of heel exposing Achilles tendon is vulnerable and require thin flap to improve aesthetic and functional results. Reverse superficial sural artery flap is simple and fast procedure, and it can preserves major arteries, supplies reliable constant blood, causes less donor site complication. Authors reviewed our cases and report the clinical results. MATERIALS AND METHODS: Nine cases of soft tissue defects on the posterior side of heel exposing Achilles tendon were treated with distally based superficial sural artery flap. There were 6 male and 3 female and mean age was 48.4 years. The size of flap was from 4x4 cm to 10x15 cm and mean follow-up period was 23 months. Flap survival, postoperative complications were evaluated. RESULTS: All flaps were survived completely without necrosis. There was one case of partial wound dehiscence that needed debridement and repair, and other one case had recurrent discharge that was healed after removal of calcaneal plate. All patient showed acceptable range of ankle motion. CONCLUSION: Authors suggest that the reverse superficial sural artery flap could be one of the useful treatment options for the soft tissue defect on posterior side of heel exposing Achilles tendon.

Recent Trends in Treatment of Supracondylar Fracture of Distal Humerus in Children

No abstract available.

Percutaneous Transphyseal Intramedullary Kirschner Wire Fixation for Pediatric Diaphyseal Forearm Fractures

PURPOSE: Percutaneous pin fixation is commonly applied for pediatric diaphyseal forearm fractures. We analyzed the results of percutaneous transphyseal intramedullary K-wires fixation for pediatric forearm fractures and evaluated the safety of this procedure in terms of growth. MATERIALS AND METHODS: Thirty-six pediatric patients with forearm diaphyseal fractures treated with transphyseal intramedullary K-wire fixation were reviewed retrospectively. Authors analyzed size and number of fixed K-wires and evaluated postoperative complications, bone length discrepancy and any deformity at the last follow-up. We also evaluated range of motion of wrist and forearm as a functional result. RESULTS: The mean age was 9.5 years old and the average period of follow-up was 53 months (range: 23-85 months). Single wire was applied in each bone, and 1.6 mm sized K-wire was most commonly used for radius fractures and 1.1 mm K-wire for ulnar fractures. There was one superficial pin site infection which was healed by conservative treatment. There were no other complications such as premature epiphyseal closure, discrepancy of forearm length or any deformity. All patients showed no significant difference in range of motion compared to opposite side at the last follow-up. CONCLUSION: Percutaneous transphyseal intramedulaary K-wire fixation is one of the effective and safe operative treatment for pediatric forearm fractures without any deleterious effects on subsequent growth of radius and ulna.

Percutaneous Transphyseal Intramedullary Kirschner Wire Fixation for Pediatric Diaphyseal Forearm Fractures

PURPOSE: Percutaneous pin fixation is commonly applied for pediatric diaphyseal forearm fractures. We analyzed the results of percutaneous transphyseal intramedullary K-wires fixation for pediatric forearm fractures and evaluated the safety of this procedure in terms of growth. MATERIALS AND METHODS: Thirty-six pediatric patients with forearm diaphyseal fractures treated with transphyseal intramedullary K-wire fixation were reviewed retrospectively. Authors analyzed size and number of fixed K-wires and evaluated postoperative complications, bone length discrepancy and any deformity at the last follow-up. We also evaluated range of motion of wrist and forearm as a functional result. RESULTS: The mean age was 9.5 years old and the average period of follow-up was 53 months (range: 23-85 months). Single wire was applied in each bone, and 1.6 mm sized K-wire was most commonly used for radius fractures and 1.1 mm K-wire for ulnar fractures. There was one superficial pin site infection which was healed by conservative treatment. There were no other complications such as premature epiphyseal closure, discrepancy of forearm length or any deformity. All patients showed no significant difference in range of motion compared to opposite side at the last follow-up. CONCLUSION: Percutaneous transphyseal intramedulaary K-wire fixation is one of the effective and safe operative treatment for pediatric forearm fractures without any deleterious effects on subsequent growth of radius and ulna.

Anterior Debridement and Strut Graft with Pedicle Screw Fixation for Pyogenic Spondylitis

STUDY DESIGN: A retrospective study. PURPOSE: We evaluated the results of the use of anterior debridement and interbody fusion followed by posterior spinal instrumentation. OVERVIEW OF LITERATURE: An early diagnosis of pyogenic spondylitis is difficult to obtain. The disease can be treated with various surgical methods (such as anterior debridement and bone graft, anterior instrumentation, and posterior instrumentation). METHODS: This study included 20 patients who received anterior debridement and interbody fusion with strut bone graft followed by posterior spinal fusion for pyogenic spondylitis between 1996 and 2005. We analyzed the culture studies, the correction of the kyphotic angle, blood chemistry, the bony union period, and the amount of symptom relief. RESULTS: In terms of clinical symptoms relief, eight patients were grouped as "excellent", eleven patients as "good", and one patient as "fair". The vertebral body cultures were positive in 14 patients showing coagulase (-) streptococcus and S. aureus. The average times for normalization of the erythrocyte sedimentation rate and C-reactive protein level were 3.3 and 1.9 months, respectively. Four months was required for bony union. For complications, meralgia paresthetica was found in two cases. CONCLUSIONS: Due to early ambulation and the correction of the kyphotic angle, anterior interbody fusion with strut bone graft and posterior instrumentation could be another favorable method for the treatment of pyogenic spondyulitis.

Reconstruction of Iliac Crest Donor Site Using 1/3 Tubular Plate / 대한척추외과학회지

STUDY DESIGN: This is a prospective study OBJECTIVES: The purpose of this study is to describe the technique for reconstruction of the iliac crest graft donor site and to determine the clinical results of its application. Summary of literature REVIEW: An iliac crest tricortical bone graft is frequently used for anterior interbody fusion of the spine. For preventing iliac crest graft donor site morbidity (pain, skin dimpling, etc), various graft materials have been used, for example, rib, cement, ceramic and so on. However, the rib needs another incision for lumbar or cervical fusion, the cement sometimes causes the wound infection, and the bioactive ceramic spacer has not had its long term results confirmed. MATERIALS AND METHODS: We prospectively analyzed 28 patients who underwent iliac crest reconstruction with a 1/3 tubular plate after bone harvesting between 1998 and 2004. Pain at postoperative 1 month, 6 months and 1 year was checked by the visual analogue scale (VAS). The cosmetic appearance, foreign body sense, overall satisfaction (according to the methods of Ito et al), complications and the radiologic evaluations were all analyzed as indicators of the outcome. RESULTS: The mean visual analogue scale was 3.5 and 0.1 at postoperative 1 and 12 months, respectively. For the cosmetic appearance, among the 28 patients, 24 patients felt a smooth and satisfactory outline (Excellent). 25 patients couldn't feel any foreign body sense. One patient experienced wound infection. No plate breakage or screw loosening were observed. CONCLUSIONS: Reconstruction of the iliac crest with a one-third tubular plate after tricortical bone graft harvest could be a favorable method. the screws during the consolidation of PMMA.

Superior Gluteal Artery Pseudoaneurysm without Pelvic Bone Fracture: A Case Report

Pseudoaneurysm is defined as the aneurysmal cyst resulted from partial or total rupture of vessel membrane, and it can be caused by fracture, operation, laceration, blunt trauma, osteochondroma and so on. When the displaced pelvic bone fracture is diagnosed, the traumatic pseudoaneurysm, which is frequently related by the direct injury of vessel, is one of the common complications, and it can result the massive hemorrhage even death. In case of the displaced pelvic bone fracture, surgeon should check the hemoglobin level and vital sign carefully for the possibility of vascular injury. Authors report the rare case of superior gluteal artery pseudoaneurysm without pelvic bone fractrure.