Spontaneous Healing of Ruptured Anterior Cruciate Ligament / 대한정형외과학회잡지

The primary healing potential of anterior cruciate ligament (ACL) has been reported to be extremely poor in clinical and experimental studies. Most authors believe that the ACL does not heal spontaneously after rupture. In 1998, Kurosaka et al. reported two cases of a spontaneously healed torn ACL after non-surgical treatment; only a few cases have been reported. There are some reports of the spontaneously healed ACL or good clinical results after an ACL rupture in a conservative treatment group, but most studies were done by follow-up MRI or the clinical scores. This study experienced a case of spontaneous healing of a ruptured ACL confirmed by magnetic resonance imaging and arthroscopy. This paper reports a case with a review of the literature.

Symptomatic Calcific Deposition in Posterior Cruciate Ligament of the Knee / 대한정형외과학회잡지

Calcium deposition disease, including calcific tendinitis, rarely affects the knee joint. Only a few cases can be found in the literatures and there is no case report of symptomatic calcific deposition arising from the posterior cruciate ligament in Korea. The authors encountered a case of symptomatic calcific deposition arising from the posterior cruciate ligament, which was excised arthroscopically and confirmed pathologically. This paper reports this case with a review of the relevant literature.

A Case of Idiopathic Massive Rice Bodies in the Knee Joint without Rheumatoid Arthritis or Tuberculosis and a Literature Review

Rice bodies are materials with an amorphous nucleus and a fibrin layer found floating in the synovial space and bursa. These bodies have often been detected in patients with rheumatoid arthritis, tuberculous arthritis, and bursitis. Although the etiology and pathogenesis of rice bodies are not yet fully understood, it has been hypothesized that they might be caused by chronic inflammation originating from the synovium. However, we report on a case of idiopathic massive rice bodies in the knee joint without evidence of inflammatory articular disease or infection including rheumatoid arthritis, seronegative spondyloarthritides, tuberculosis, or bacterial or fungal infection.

Comparison of Histological and Biochemical Findings with Magnetic Resonance Imaging on the Degeneration Severity of Meniscus / 대한정형외과학회잡지

PURPOSE: The aim of this study is to determine whether degeneration severities of meniscus assessed using magnetic resonance imaging (MRI) would well estimate those assessed using histological and biochemical examinations. MATERIALS AND METHODS: Seven lateral menisci from knees with osteoarthritis undergoing total knee arthroplasty (study group) and five from normal controls (control group) were examined for this study. Degeneration severities of the menisci were graded using MRI, histologic and biochemical examinations of the menisci were then performed. Comparative analyses of MRI grading and results of histological/biochemical examinations of the menisci were performed in each group. In addition, comparative analyses of histological/biochemical conditions were performed between specimens of the study group and the control group showing grade 0 on MRI. RESULTS: All specimens from the control group showed grade 0 on MRI and their histology was also grade 0. In addition, no significant differences in biochemical results were observed among the specimens of the control group. In the lateral meniscus from the study group showing degeneration on MRI it was found that the water and proteoglycan contents increased with increasing grade of degeneration whereas the collagen content decreased. The meniscus specimens of the control group and the study group showing grade 0 on MRI had similar histologic findings but had different biochemical properties. The grade I, II degenerations on MRI were not well matched with the histologic findings in the study group. CONCLUSION: Severities of meniscus degeneration on MRI did not well reflect the histologic findings of the meniscus. This finding may be due to the water content of the meniscus. The factors of the high signal intensity of the degenerated lateral meniscus on MRI may be due to the decreased component of collagen and increased proteoglycan. Our findings suggested that caution should be taken when the severities of meniscus degeneration on MRI are attributed to histologic severities of degenerated meniscus.

Osteochondroma of the Talus: A Report of Two Cases / 대한정형외과학회잡지

An osteochondroma is one of the most common benign bone tumors. The bones of the foot are less commonly involved, and there are only a few case reports of talar osteochondroma. There are no case reports of a talar osteochondroma in Korea. We report two cases of the osteochondroma in the talus.

Malunion of the Odontoid Process Developing Cervical Myelopathy: A Case Report

Late-onset progressive myelopathy, years after odontoid fracture, is considered a rarity. Undiagnosed or untreated odontoid fractures may develop into nonunion or malunion, thereby leading to secondary delayed cervical myelopathy. We present a case of a 50-year-old man with malunion of odontoid fracture. We had a good result following one-staged posterior decompression and occipito-cervical fusion.

Distal Radioulnar Joint Injuries Associated with Intra-articular Fracture of Distal Radius

PURPOSE: To evaluate the significance of distal radioulnar joint injury which may affect the postoperative radiologic and clinical results of AO classification, type C distal radius fractures. MATERIALS AND METHODS: From October 2000 to October 2005, 58 patients of AO classification, type C distal radius fracture, who had been treated with operative methods were studied. They are thirty-six men and twenty-two women. The average follow up period was 14 months. The patients were divided into five groups. In the first group (13 cases), there was no distal radioulnar joint injuries. In the second group (20 cases), there were ulnar styloid fractures. In the third group (11 cases), there were separation of distal radioulnar joint. In the fourth group (9 cases), there were ulnar styloid fractures with separation of distal radioulnar joint. In the fifth group (5 cases), there were displacement of ulna in sagittal plane. We measured the radial length, radial inclination and volar tilt in plain radiograph in each group and analyzed the results through Scheck's methods. To analyzed the clinical results, we used the Demerit Point System by Sarmiento. RESULTS: There was no significant differences in radiologic and clinical results among the five groups. CONCLUSION: According to compairing the radiologic results of each group which was suspicious of distal radioulnar joint injuries, in the intraarticular comminuted fractures of distal radius, the distal radioulnar joint injuries did not affect the results of treatment when anatomical reduction of distal radius was achieved.

Bilateral Bipartite Carpal Scaphoid: A Case Report / 대한정형외과학회잡지

Bipartite scaphoid is a rare anomaly and it has been questioned as whether it is of congenital origin or traumatic. However, many authors have reported that congenital origin is more probable. There was no case report in Korea about bipartite scaphoid, but this article reports a case of a 38-year-old male with bilateral bipartite scaphoid.

Subacute Epiphyseal Osteomyelitis in a Child: A Case Report / 대한정형외과학회잡지

Primary subacute osteomyelitis is an infection of the bone that continues for several weeks without any acute infectious manifestations such as fever, local pain and swelling. A diagnosis is often delayed because of the slow onset, the subtle radiological changes and the absence of infectious clinical and laboratory manifestations. Primary subacute osteomyelitis in 35% of primary osteomyelitis cases, almost developed in the metaphysis, but there is no report of subacute epiphyseal osteomyelitis in Korea. We report a case of primary subacute epiphyseal osteomyelitis in the distal femur which was treated conservatively with a satisfactory outcome.

Instability of Knee Associated with Ipsilateral Femoral and Tibial Shaft Fractures

PURPOSE: To establish the incidence, type and significance of knee instability in patients with ipsilateral femoral and tibial shaft fracture, comparing with the patients with femoral shaft or tibial shaft fracture alone. MATERIALS AND METHODS: Two hundreds and seventy-nine consecutive patients were retrospectively reviewed from February 2000 to April 2004. They were composed of 80 patients with femoral shaft fracture alone, 176 patients with tibial shaft fracture alone and 23 patient with ipsilateral femoral and tibial shaft fracture. We evaluate the instability of knee based on physical examinations, plain stress films and MRI. We analyze incidence and period to diagnosis of instability, period to complete bony union and Hospital for Special Surgery (HSS) knee score respectively. RESULTS: There were 6.3% of knee instability in femoral shaft fracture alone, 9.7% in tibial shaft fracture alone and 30.4% in ipsilateral femoral and tibial shaft fracture. The average period to diagnosis of instability, average period to complete bony union and average HSS knee score were 9.2 months, 4.7 months and 65 points in femoral shaft fracture alone, 9.1 months, 4.2 months and 69 points in tibial shaft fracture alone, 8.7 months, 5.3 months (femur), 4.7 months (tibia) and 57 points in ipsilateral femoral and tibial shaft fracture respectively. CONCLUSION: We should consider MRI to evaluate the knee instability in patient with ipsilateral femoral and tibial shaft fracture at the time of injury and make a plan early about the treatment of knee instability.

Operative Treatment for Avulsion Fracture of Base of the Fifth Metatarsal / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological results of the operative treatment in the avulsion fracture on the base of the fifth metatarsal. MATERIALS AND METHODS: We studied retrospectively, 11 patients of avulsion fracture on the base of the fifth metatarsal operated and followed over 1 year, from February 2000 to May 2002. There were eight men and three women and the average age was 39 years old. The mean follow up period was 14 months. Ten cases were slip-down and one case was fall from a height injuries. We used the modified Foot Score by Wiener for the clinical evaluation, and analyzed the time of union and state of reduction radiologically. RESULTS: In clinical results, we had ten excellent and one good cases by the modified Foot Score at last follow-up. In radiologic results, the complete bony union was achieved in all cases and the duration of the bony union was 37 days in average. CONCLUSION: We had good result for the avulsion fractures on the base of the fifth metatarsal treated by the operation. This study shows the operation was recommended for the moderate and severe displacement of the avulsion fractures on the base of the fifth metatarsal.

Intercondylar Fracture of Distal Humerus in Children

Intercondylar fractures of the distal humerus are very rare in children. The pattern of the fracture would suggest that the mechanism of injury involves a fall directly on the flexed elbow. Most agree that the undisplaced fracture can be managed conservatively. With increasing displacement and comminution, the opinions tend to differ. We suggest that closed reduction with percutaneous K wire pinning and open reduction with percutaneous K wire pinning offer a satisfactory methods by which to treat displaced intercondylar fracture in children.

Anterolateral Approach for the Distal Metaphyseal Fracture of the Tibia

PURPOSE: The purpose of this study is to evaluate the effectiveness of anterolateral approach of the ankle for the distal tibial fracture in aspect of preventing complication and acquiring union. MATERIALS AND METHODS: Authors reviewed 21 patients of distal metaphyseal fracture of the tibia treated by anterolateral approach and lateral plating method from February, 2000 to May, 2002. Mean follow-up period was 17 months (12~29 months). There were twelve type A, two type B, and four type C patients according to AO/OTA classification. We have analyzed the bone union rate and Ovadia`s functional scale. We also reviewed the complication rate, such as soft tissue problem and postoperative infection. RESULTS: In all cases union was achieved and mean time to union were 16 weeks. The functional result by Ovadia's scale were 17 excellent cases and 4 good cases in objective evaluation, and 19 excellent cases and 2 good cases in subjective evaluation. Wound infection occurred in one case, but the infection was controlled after plate removal and the union was acquired through cast immobilization. There was no other complication, such as soft tissue necrosis. CONCLUSION: The anterolateral approach is a safe and worthwhile method for distal tibia fracture while avoiding some of the complication associated with standard anteromedial approach and plating method.

Postoperative Evaluation of Displaced Intra-articular Calcaneal Fractures by Computed Tomography

PURPOSE: The purpose of the present study was to define the factors that affect the treatment and clinical result of displaced calcaneal fracture with use of the pre- operative and final follow-up computed tomography scanning. MATERIALS AND METHODS: Present study included the 17 patients(18 feet) whom we performed surgery for displaced intra-articular calcaneal fracture at our institution between March 2000 and March 2002 and had a minimum follow-up of 12 months. For all patients, the Bohler's angle and posterior facet incongruity were measured with computed tomography pre- and post-operatively. The Creighton-Nebraska Health Foundation Assessment Scale for Fractures of the Calcaneus (CN scale) was used to evaluate the clinical results. RESULTS: Of all eighteen fractures, the clinical results were excellent in three (16.6%), good in six (33.3%), fair in six (33.3%), and poor in three (16.6%). The Bohler's angle averaged 21degrees, 15degrees, 27degrees, 25degrees at final follow-up in each above clinical result group. The step-off averaged 1.0, 1.6, 3.9 and 6.0 mm and the average range of motion of the subtalar joint at final follow-up were 85, 76, 60 and 45% of normal. CT evaluation showed intra-articular screws in the posterior subtalar joint in three (16.6%) of the eighteen fractures but their average clinical result was good (80.3 points). CONCLUSION: The restoration of the congruity and range of motion of posterior subtalar joint are considered important factor that affect clinical result.

Spinal Epidural Hematoma Associated with Cervical Fracture in Ankylosing Spondylitis / 대한척추외과학회지

A spinal epidural hematoma is a very rare condition, but it is a neurological emergency that requires urgent investigation and treatment, as it can lead to neurological sequelae, such as quadriplegia, in many cases. With a traumatic epidural hematoma associated with ankylosing spondylitis, the clinical course progresses more rapidly, and the prognosis is thought to be worse than that without ankylosing spondylitis. The mainstay of treatment is an urgent surgical decompression and evacuation of the hematoma, via a laminectomy, in the patients' that develop progressive neurological deterioration. However, there have only been a few reports on the successful conservative treatment of selective patients, with incomplete and nonprogressing deficits, where the symptoms and signs have resolved without surgery. We report on a patient with a traumatic epidural hematoma, associated with cervical fracture in ankylosing spondylitis, treated conservatively with an excellent neurological outcome.