Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult: A Case Report

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

Rosai-Dorfman Disease of 4-Year-Old Girl

Rosai-Dorfman disease also known as sinus histiocytosis with massive lymphadenopathy is a benign, rare systemic disease characterized by a histiocyte proliferation which presents with lymphadenopathy. We report a case of a 4-year-old girl who presented with recurrent cervical lymphadenopathy with tenderness, without any other symptoms. After 1 month of medical treatment, her lymphadenopathy still remained, so we performed complete excision and biopsy. She was diagnosed on cytology as a case of Rosai-Dorfman disease. She responded well to become asymptomatic without recurrence by 1 month.

Surgical Treatment of Clavicle Midshaft Fractures Using a Locking Compression Plate: Conventional Open Reduction and Plating with Internal Fixation versus Minimal Invasive Plate Osteosynthesis / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to make a comparison between minimally invasive plate osteosynthesis (MIPO) and conventional open reduction and plating (COP) to treat displaced clavicle shaft fractures. MATERIALS AND METHODS: We retrospectively reviewed patients with clavicle shaft fractures, who underwent surgery by using a locking plate between May 2011 and August 2016. The inclusion criteria were: 1) displaced ≥20 mm, 2) acute fracture of less than 2 weeks from injury, 3) skeletally mature patients, and 4) follow-up of at least 6 months. The demographic data and clinical outcomes, including operation time, fracture union rate, union time, shortening of clavicle, shoulder functional score (University of California at Los Angeles score), and complications, were evaluated. The clavicle length ratio was measured to evaluate shortening. We compared the clinical outcomes between two groups: the COP group that included 21 patients treated with COP (group 1) and the MIPO group that included 19 patients treated with MIPO (group 2). RESULTS: In all cases, union of fractures was successfully achieved. The mean union time was 14.9 weeks in group 1 and 14.2 weeks in group 2 (p=0.713). Both groups had good functional scores (34.0 vs. 33.7, p=0.658). Group 2 had shorter operation time and less bleeding. There were no secondary interventions or infections. The clavicle length ratio was similar between the two groups; and all patients in both groups showed no shortening (less than 3%). There were no implant failures in either group. CONCLUSION: The clinical and radiologic outcomes were satisfactory in both groups. We suggest that MIPO may be a safe and effective method for displaced clavicle shaft fractures.

Clinical Features and Outcomes of Pelvic Insufficiency Fractures

PURPOSE: The purpose of this study was to investigate the radiological and epidemiological characteristics, as well as the clinical course of pelvic insufficiency fractures in the elderly population. MATERIALS AND METHODS: At a Haeundae Paik Hospital, we retrospectively reviewed patients with pelvic insufficiency fractures between March 2010 and May 2017. The demographic data of patients were analyzed, and bone mineral density and bone turnover markers were evaluated to estimate the metabolic status of the bone. The radiological characteristics were evaluated by comparing the simple x-ray images with the computed tomography images, and the types of fractures were classified via computed tomography images. For clinical course evaluation, we investigated comorbid complications, and compared the walking ability scale before and 6 months after the fracture. RESULTS: A total of 42 patients were included, with an average age of 76.5 years. All were female except one case. In 5 cases where the initial medical examination was from another institution, the fracture was not found in 3 cases. All cases received conservative treatment. After the diagnosis of pelvic bone fracture using a simple x-ray imaging, additional fractures were found in 81.0% of the study population using a computed tomography. Initiation of gait occurred at an average of 2.8 weeks, and every case except 1 (97.6%) fully recovered their gait ability. CONCLUSION: We concluded that there was a limitation with diagnosing pelvic insufficiency fracture using only a simple x-ray imaging technique. In general, cases in this study showed conservative treatment yielded favorable clinical outcome with relatively less critical complications.

Painful legs and moving toes syndrome in a 16-year-old girl / 소아과

Painful legs and moving toes (PLMT) syndrome is characterized by spontaneous movements of the digits and pain in one or both lower extremities. Of the reported cases, a majority of the patients was female, and the mean age of onset was 58 years. Only one pediatric case has been reported so far. Herein, we report the first adolescent case of PLMT in Korea. A 16-year-old girl complained of tingling pain in the left leg and involuntary movement of the ipsilateral great toe one month after a second untethering surgery. Three years ago, she had undergone untethering surgery to correct lipomeningomyelocele at the S2 level of the conus medullaris. At that time, she was diagnosed with polyradiculopathy at the left L5 level with axonal involvement. We diagnosed her with PLMT syndrome and prescribed gabapentin. Her symptoms diminished within a day. Complete relief from involuntary movement of the toe was achieved within four months. PLMT is a rare syndrome but it should be considered in the differential diagnosis of children and adolescents with limb pain and spontaneous movement in their toes.

Effects of Soft Tissue Surgery on Pelvic and Hip Rotation in Patients with Spastic Diplegia: A Meta-Analysis

BACKGROUND: There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia. METHODS: We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed. RESULTS: The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to -1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001). CONCLUSIONS: In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery.

Effects of Soft Tissue Surgery on Pelvic and Hip Rotation in Patients with Spastic Diplegia: A Meta-Analysis

BACKGROUND: There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia. METHODS: We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed. RESULTS: The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to -1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001). CONCLUSIONS: In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery.

Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome

PURPOSE: The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome. MATERIALS AND METHODS: Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection. RESULTS: According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection. CONCLUSION: Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.

Modified Stoppa Approach in Acetabular Fractures

PURPOSE: The purpose of this study is to evaluate the clinical results of modified Stoppa approach in acetabular fractures. MATERIALS AND METHODS: Twelve patients who underwent surgery using the modified Stoppa approach for acetabular fractures were enrolled. There were 10 cases of isolated acetabular fracture, two cases of acetabular fracture combined with pelvic ring injury. There were two cases of anterior column fracture, nine cases of both column fracture, and one case of T-type fracture according to Letournel classification. The clinical outcomes were evaluated from Harris hip score (HHS) at postoperative one year and complications. The radiologic result was evaluated according to Matta criteria; anatomical, imperfect, and poor. RESULTS: According to the radiological results, there were eight cases of anatomical, three cases of imperfect, and one case of poor reduction. The average HHS was 82.5 and 10 patients had excellent or good results. The other two patients had poor results due to lumbosacral plexopathy and poor reduction, respectively. The complication included one case of incomplete sciatic nerve palsy, which was recovered at postoperative three months. CONCLUSION: Internal fixation of acetabular fractures using the modified Stoppa approach had satisfactory clinical and radiological outcomes. The modified Stoppa approach can be a useful option for acetabular fractures with appropriate indication and anatomical information.

Neurologic Injury within Pelvic Ring Injuries

PURPOSE: To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures. MATERIALS AND METHODS: Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury. RESULTS: There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048). CONCLUSION: The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.

Ankle Fracture Associated with Tibia Shaft Fractures

PURPOSE: The purpose of this study is to evaluate the incidence of ankle injury in ipsilateral tibial shaft fractures and to assess the risk factors for ankle injury associated with tibial shaft fractures. MATERIALS AND METHODS: Sixty patients with tibial shaft fractures were enrolled in this retrospective study. The incidence and characteristics of ankle injury were evaluated, and fracture classification, fracture site, and fracture pattern of the tibial shaft fractures were analyzed for assessment of the risk factors for ankle injury combined with tibial shaft fractures. RESULTS: Ankle injury occurred in 20 cases (33%). There were four cases of lateral malleolar fracture, four cases of posterior malleolar fracture, two cases of distal tibiofibular ligament avulsion fracture, and 10 cases of complex injury. Fourteen cases (70%) of 20 cases of ankle injury were diagnosed from x-ray films, and the other six cases were recognized in ankle computed tomography (CT). Ankle injury occurred in 45.1% of distal tibial shaft fractures and found in 41.4% of A type, but there was no statistical significance. Ankle injury was observed in 54% of cases of spiral pattern of tibial shaft fracture and the incidence was statistically higher than 19% of cases of non-spiral pattern tibial shaft fracture. CONCLUSION: Ankle injury was observed in 33% of tibial shaft fractures; however, only 70% could be diagnosed by x-ray. Ankle injury occurred frequently in cases of spiral pattern of tibial shaft fracture, and evaluation of ankle injury with CT is recommended in these cases.

Hip Arthroplasty in Intertrochanteric Fractures: Is It Acceptable Treatment?

No abstract available.

Gastrocnemius Architecture in Patients with Spastic Cerebral Palsy / 대한정형외과연구학회지

PURPOSE: Gastrocnemius muscle spasticity is a common finding in children with cerebral palsy (CP). However, the differences between spastic hemiplegic CP (SHCP) and spastic diplegic CP (SDCP) have not been compared. The purpose of this study was to compare the gastrocnemius architecture between the two CP groups and a control group, by using ultrasonography. MATERIALS AND METHODS: We enrolled 18 children with CP and 10 healthy controls. Patients with CP were categorized into two groups: 10 patients with SHCP and eight patients with SDCP. Ultrasonography images of the gastrocnemius were acquired at rest and with the knee at 0degrees with full ankle dorsiflexion. Fascicle lengths, pennation angles, and muscle widths were compared. RESULTS: SHCP demonstrated the most limited ankle dorsiflexion, and there were no significant differences in joint positions between the two CP groups at rest. Compared to healthy controls, fascicle lengths were diverse, but pennation angles and muscle width were similar or decreased in the two CP groups. There were no significant differences between SHCP and SDCP in fascicle length, pennation angle, and muscle width with the knee at 0degrees with ankle full dorsiflexion. At rest, the fascicle length of SHCP was longer than SDCP and the lateral gastrocnemius muscle width of SDCP was smaller than SHCP. CONCLUSION: A decreased pennation angle and muscle width are characteristic features of the gastrocnemius in patients with CP. There was little difference in the architecture of the gastrocnemius between SHCP and SDCP, despite different spasticity. A decreased pennation angle would be expected to decrease the excursion of the muscle during ankle dorsiflexion.

Etanercept Treatment in Ankylosing Spondylitis Hip Lesions / 대한고관절학회지

PURPOSE: To evaluate the efficacy of etanercept in patients with an ankylosing spondylitis hip lesion. MATERIALS AND METHODS: Between March 2008 and December 2011, this study evaluated 13 patients with hip lesions who were refractory to conventional therapy. The general improvement was evaluated by the Harris hip score, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), ESR, CRP, and complications. RESULTS: The mean Harris hip score changed from 55.6+/-3.4 to 87.2+/-4.3(P=0.01). The mean BASDAI/ BASFI decreased from 6.8+/-1.7/6.8+/-1.6 before treatment to 4.4+/-1.8(P=0.02)/4.3+/-1.1(P=0.02) after treatment. The mean ESR/CRP changed from 48.4+/-31.5/5.8+/-5.1 to 20.8+/-19.7(P=0.06)/3.1+/-4.2(P=0.03). No complications were encountered. CONCLUSION: These results suggest that etanercept can induce significant pain improvement in most ankylosing spondylitis hip lesions.

A Clinical Study of Pediatric Bacterial Meningitis in Daejeon and Chungcheong area : 2006-2010

PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.

Can Serum Sodium Level Affect Seizure Features of Benign Convulsions with Mild Gastroenteritis?

PURPOSE: The aim of this study is to evaluate the effect of serum sodium level on seizure features of benign convulsions with mild gastroenteritis. METHODS: We assessed 31 patients with benign convulsions with gastroenteritis at Soonchunhyang University Cheonan Hospital, from March 2010 to December 2012. The patients' data including sex, age on visit, semiology, frequency and duration of seizure, laboratory findings, seizure onset after gastroenteritis, EEG findings and brain MRI findings were retrospectively reviewed. RESULTS: Thirteen boys and 18 girls were involved in the study. Their mean age was 19.7+/-12.7 months. Twenty two patients (71.0%) visited hospital from November to March in terms of monthly distribution. The seizure types were generalized tonic clonic seizures (61.3 %), generalized tonic (29.0%), atonic (6.5%) and partial seizures (3.2%). The duration of seizures was mostly within 5 minutes. The onset of seizures from gastroenteritis was 1 to 3 days. Stool rotavirus antigen test were positive in 3 of 20 patients. Electroencephalography was performed in 22 patients, in which only four patients showed generalized delta activities without sharp wave/spike discharge. Brain MRI was performed in 16 patients and only one patient had small venous malformation in the right frontal lobe. Seven out of 31 patients had mild hyponatremia. There were no significant differences in the semiology, frequency and duration of seizures between the group with mild hyponatremia and normal group. CONCLUSION: The study showed that mild hyponatremia did not affect seizure features of benign convulsions with mild gastroenteritis. However, further studies are needed.

Traumatic Femoral Head Fracture without Hip Dislocation: A Case Report / 대한고관절학회지

The incidence of femoral head fracturesafter posteriorhip dislocation is approximately 5-15%, and femoral head fractures are highly associated with posterior dislocation. Femoral head fractures can cause avascular necrosis of the femoral head or post-traumatic osteoarthritis; therefore, diagnosis and appropriate treatment is important. We present a case of femoral head fracture without hip dislocation, as well as a literature review.

Parathyroid Hormone 1-34(Teriparatide) Treatment in Pelvic Insufficiency Fractures: A Report of Two Cases

As a result of aging population, the incidence of pelvic insufficiency fracture has been increasing. Pain-related immobility caused by pelvic insufficiency fractures may result in a serious dependency and high mortality with preexisting comorbidities. We present two cases of pelvic insufficiency fracture in elderly patients which had good clinical outcome by parathyroid hormone 1-34(teriparatide) treatment as well as a literature review.

The Incidence of Venous Thromboembolism in Trauma Patients with Pelvic or Acetabular Fracture

PURPOSE: To evaluate the incidence of venous thromboembolism (VTE) in trauma patients with pelvic or acetabular fracture and determine high risk factors. MATERIALS AND METHODS: Twenty-three patients who had a pelvic or acetabular fracture were enrolled between March 2011 and February 2012. All patients had mechanical and chemical prophylaxis and underwent deep vein thrombosis (DVT) computed tomography around 2 weeks after injury for evaluation of VTE. The relationships between VTE and each of sex, age, body mass index, injury severity score, intensive care unit stay, transfusion, operation time, coagulopathy, and associated injury were analyzed. RESULTS: A total of 8 patients developed VTE (34.8%), of which 5 had DVT, 2 had pulmonary embolism (PE), and one had both DVT and PE. The group with a VTE risk score of 14 or more had a significantly higher incidence of VTE. CONCLUSION: Careful attention is needed in management of patients with pelvic or acetabular fracture.

A Case of Gitelman Syndrome

Gitelman's syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria that has recently been reported to be linked to thiazide-sensitive Na-Cl cotransporter gene mutation. We have experienced one patient whose initial complaint was paresthesia of hand and feet, who had hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. We report the case of Gitelman's syndrome with a brief review of related literature.