The Natural History of Kienböck’s Disease Diagnosed at More than 50 Years of Age

Background@#Previous literatures suggest that the prognosis of Kienböck’s disease might be favorable despite no surgery if it is diagnosed in late age, but the evidence is not clear. The aim of this study was to determine the radiographic and clinical progression of Kienböck’s disease diagnosed at more than 50 years of age. @*Methods@#Data of 27 patients diagnosed with Kienböck’s disease at more than 50 years of age between 2000 and 2016 were investigated. During the study period, no treatment, either surgical or nonsurgical, was applied. We explained to the patients that the affected lunate was not expected to collapse further if found late in age. Annual visits were recommended, through which radiographic and clinical observation was made. We assessed changes in Stahl index and radioscaphoid angle between the initial assessment and the final follow-up, and clinical assessment was made using pain in visual analog scale (VAS) and Dornan’s criteria. @*Results@#Initially, 2 patients were in Lichtman stage 1, 6 in stage 2, 5 in stage 3A, 11 in stage 3B, and 3 in stage 4. Radiographic follow-up of at least 5 years (mean, 7.8 years) was made in 14 patients, whose Stahl index and radioscaphoid angle did not differ significantly from their initial measurements. Arthritic appearance was not found, and progression in the Lichtman stage was detected in 1 lunate, from 3A to 3B. Despite no surgical treatment for an average of 7.5 years (range, 5.0–15.7 years) of observation period in the 27 patients, average pain in VAS improved from 3.5 (range, 1–7) to 0.8 (range, 0–2), with excellent or good clinical status by Dornan’s criteria. @*Conclusions@#Our study suggests that Kienböck’s disease diagnosed at more than 50 years of age can follow a benign natural course in radiographic and clinical aspects. Therefore, surgical interventions should be considered carefully in this age group.

The Wear Rate and Survivorship in Total Hip Arthroplasty Using a Third-generation Ceramic Head on a Conventional Polyethylene Liner: A Minimum of 15-year Follow-up / 대한고관절학회지

Purpose@#The purpose of this study was to evaluate the wear and survival rates of third-generation ceramic heads on a conventional ultra-high molecular weight polyethylene liner. @*Materials and Methods@#A total of 160 hips (147 patients with a mean age of 55.9 years) who underwent total hip arthroplasty using the third-generation ceramic head on a conventional polyethylene liner from March 1998 to August 2003 were reviewed retrospectively. Evaluation of the wear rate for 56 hips (49 patients) followed-up for at least 15 years was performed using the PolyWare program version 8 (Draftware Developers, USA). The Kaplan–Meier survivorship was also evaluated. @*Results@#Linear wear and volumetric wear rates were 0.11±0.47 mm/year and 32.75±24.50 mm 3 /year, respectively. Nine revisions were performed during the follow-up period because of cup or stem loosening. The Kaplan–Meier survival rate, using cup revision or total revision total hip arthroplasty (THA) as the endpoint of analysis, was 93.7% at 15 years and 73.6% at 20 years. @*Conclusion@#Because all revisions were performed between 15 and 20 years in our study, surgeons should pay greater attention to patients who underwent THA with ceramic-on-polyethylene bearing from 15 years postoperatively. Contemporary alumina ceramic on highly cross-linked polyethylene could certainly be a good alternative bearing couple providing better longevity.

Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

Extensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE. Methods: Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments. Results: Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]). Conclusions: PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists / 대한신경손상학회지

Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.

Treatment of Spinal Infection Following Bilateral Total Knee Replacement Postoperative Infection / 대한정형외과학회잡지

Postoperative infection from total knee arthroplasty (TKA) is an issue drawing great attention, which can manifest as a local or general infection. Its development into sepsis has also occasionally been reported. Such sepsis is a critical complication that can spread to various parts of the body, which can ultimately lead to mortality. However, the cases where infection has spread to the spine do not have clear clinical signs, making diagnosis difficult. These cases are not found in the literature. Therefore, this is a case study on both postoperative infection from TKA that has developed into sepsis and spread to the spine.

Comparative Study of Clinical and Radiographic Outcomes of High Tibial Osteotomy in Patients with Kissing Lesions and Non-Kissing Lesions

PURPOSE: High Outerbridge grade lesions of the articular cartilage have been associated with poor outcomes of high tibial osteotomy (HTO). However, there has been no report on the efficacy of HTO in the presence of kissing lesions. The purpose of this study was to compare clinical and radiographic outcomes of HTO between kissing lesion and non-kissing lesion groups. MATERIALS AND METHODS: Of the patients with medial compartment osteoarthritis and varus deformity treated with HTO between 2007 and 2012, 21 cases with kissing lesions and 22 cases without kissing lesions were selected. Clinical outcomes were assessed using the Lysholm knee scoring scale score, visual analogue scale score, Hospital for Special Surgery score, Western Ontario and McMaster Universities score, and Tegner activity score. Radiographic outcomes were assessed using the femoral-tibial angle, mechanical axis deviation, medial proximal tibial angle, posterior tibial slope angle, and joint space width. RESULTS: Clinical outcomes were improved in both groups from the postoperative assessment to the final follow-up, which showed no statistically significant difference between groups at the final follow-up. No statistically significant differences were observed with regard to radiographic assessment. CONCLUSIONS: Since both groups showed favorable short-term clinical and radiographic outcomes, HTO might be an alternative treatment option for degenerative osteoarthritis with kissing lesions in relatively young patients.

Results of Clinical and Oncological Outcomes in Treatment of the Humerus Malignant Bone Tumor: Comparison according to the Treatment Methods / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and oncological outcomes between the primary and metastatic malignant tumor of humerus. MATERIALS AND METHODS: Between May 2005 and May 2014, 42 cases of malignant tumor in humerus that were followed-up for at least 1 year were entered into the study and analyzed retrospectively. Cases were divided into two groups, the primary (group 1, 15 cases) and metastatic (group 2, 27 cases), according to the origin of the tumor. The clinical and oncological outcomes between the primary and metastatic malignant tumor of humerus were analyzed and compared. RESULTS: In the group 1, nine cases were osteosarcoma and six cases were chondrosarcoma. The tumor lesions were distributed in the proximal area of the humerus. In the group 2, 12 cases originated from lung cancer, six cases from liver cancer, and two cases from bladder cancer. The lesions were usually distributed in the midshaft area. The patients underwent various surgical treatments, including wide excision with tumor prosthesis, curettage with bone grafting, intramedullary nailing, open reduction, and internal fixation with plate. Kaplan-Meier 5-year survival estimates were 87.5% for group 1, and 1-year survival estimates were 70.1% and 2-year survival estimates were 40.1% for group 2. The mean Musculoskeletal Tumor Society score was high in both groups. However group 1 showed a higher score on the functional index compared to group 2. CONCLUSION: Primary malignant bone tumors of the humerus usually involve the proximal site and tumor prosthesis is the main treatment. The metastatic malignant bone tumor usually involves the midshaft area and intramedullary nailing and radiation therapy is the main therapy. Although treatment of the primary malignant tumor increases the survival rate, treatment of metastatic malignant tumor does not affect the survival rate, though it helps in relieving pain.

Effects of Teriparatide Administration on Fracture Healing after Intramedullary Nailing in Atypical Femoral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the effects of teriparatide administration on fracture healing after intramedullary nailing in atypical femoral fractures. MATERIALS AND METHODS: We retrospectively reviewed 26 patients (26 cases) with atypical femoral fracture who were treated using intramedullary nailing between January 2009 and December 2013. Teriparatide was not administered to 15 patients (non-injection group) and was administered to 11 patients after surgery (injection group). Clinical results were assessed using the Nakajima score and the visual analogue scale (VAS). Radiographic results were compared for the time of callus formation, callus bridge formation, and bone union between the groups. RESULTS: Time to recover walking ability and to decrease pain in the surgery region (VAS≤2) were significantly shorter in the injection group than in the non-injection group. The time of callus formation, callus bridge formation, and bone union was significantly shorter in the injection group than in the non-injection group. There were 5 cases of delayed bone union (33.3%) and 1 case of none union (6.7%) in the non-injection group and all cases obtained bone union in injection group. CONCLUSION: The injection group showed better clinical and radiographic results than the non-injection group after intramedullary nailing in atypical femoral fracture. Therefore, we think that teriparatide administration after intramedullary nailing could be a useful treatment option to promote bone union.

A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the results of treatment of distal tibial fractures between intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO). MATERIALS AND METHODS: Between January 2007 and February 2012, 57 patients (57 cases) were treated for distal tibial fractures. Thirty-two patients (32 cases) were treated with IM nailing (nail group) and the 25 patients (25 feet) were treated with MIPO (plate group). Clinical results were compared using range of motion (ROM) of the ankle joint, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Olerud-Molander score between nail group and plate group. Radiographic results were compared using mean bony union time, coronal and sagittal malunions, and shortening between the groups. RESULTS: Mean ROM of the ankle joint was significantly larger in nail group until 6 months after surgery; however, it was not different between two groups at the last follow-up. AOFAS score and Olerud-Molander score were not different between two groups at the last follow-up. In the nail group, two malunions more than 5 degrees were observed in coronal and sagittal planes, respectively. One case showed non-union in the plate group, however, bone union was obtained after autogeneous bone graft. CONCLUSION: Treatment using IM nailing is more advantageous in terms of postoperative rehabilitation than MIPO in distal tibial fractures.