Scedosporium prolificansInfection by Laceration with a Broken Piece of Flowerpot: A Case Report / 대한정형외과학회잡지

Scedosporium prolificans is a fungus that can be found in soil or polluted water. It is mandatory to evaluate Scedosporium prolificans infection in case of injury by soil- contaminated materials. Musculoskeletal infections by Scedosporium prolificans are extremely rare and the clinical manifestations are similar to other bacterial infections. So it is difficult to detect Scedosporium prolificans infection. We report a neglected case with bone and joint infection by Scedosporium prolificans after joint laceration with a broken piece of flowerpot in a 10-year-old boy.

Diagnostic Value of Ultrasonography for Acute Tear of Tibiofibular Syndesmosis in Ankle / 대한족부족관절학회지

PURPOSE: We studied the diagnostic value of ultrasonography to confirm the presence of the syndesmosis injuries in the ankle. MATERIALS AND METHODS: Pre-operative ultrasonography were taken in 42 cases of ankle fractures to determine injury of syndesmosis between February 2000 and August 2003. Tear of syndesmosis was confirmed when they met the following criteria; widening of distal tibiofibular clear space greater than 7 mm on pre-operative AP X-rays, leakage of contrast dye during intra-operative arthrography, and operative findings revealing syndesmosis rupture. We compared these diagnoses with those made by pre-operative ultrasonography. RESULTS: Syndesmosis injuries were confirmed in 23 cases among the total 42 cases. Ultrasonography revealed syndesmosis tear in 25 cases, with 20 cases corresponding with confirmed tear and 5 cases without tear in confirm. Syndesmoses were found to be intact in 17 cases of ultrasonograph, but 3 cases were actually confirmed tear. In ankle ultrasonography, the sensitivity was 90.9%, the specificity was 75.0%. CONCLUSION: Preoperative ultrasonography is a non-invasive and useful study to determine the syndesmosis injury in ankle fractures.

Treatment of Distal Tibial Metaphyseal Fracture Using MIPPO Technique / 대한족부족관절학회지

PURPOSE: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. MATERIALS AND METHODS: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. RESULTS: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks (2~4 weeks) and full weight bearing ambulation at average 5.2 weeks (4~8 weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks (8~18 weeks) postoperatively. Two cases showed 5 degrees limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had 6 degrees valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. CONCLUSION: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.

Distribution of Lengths of the Normal Femur and Tibia in Korean Children from Three to Sixteen Years of Age

To develop a standard growth curve of the lower extremity in Korean children from 3 to 16 yr of age, the lengths from a total of 2087 normal long bone segments (582 femurs and 645 tibias in boys, and 417 femurs and 443 tibias in girls) were measured. Children were grouped by years of bone age, which was determined by using the Korean specific bone age standard; TW2-20 method. The growth spurt occurred in girls from eight to eleven years by bone age, and in boys from eleven to thirteen years. The mean tibial length relative to the mean femoral length was 0.78 in boys and 0.79 in girls. The overall growth pattern was similar to that observed in American children in the 1960s. Korean children and adolescents appear to have a different tempo of skeletal maturation during pubertal growth from that of English and American children and adolescents. The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities. These normative growth standards can be used for leg-length equalization purposes in children with anisomelia.

Neglected Compartment Syndrome caused by Folk Remedy: Two Case Reports / 대한정형외과학회잡지

Compartment syndrome usually develops as a result of traumatic musculoskeletal injury or vascular injury. Early diagnosis and emergency fasciotomy are mandatory for the decompression of compartment pressure in the acute stage. Minor trauma or a non traumatic event can cause compartment syndrome. No report was available of the folk remedy. We report upon two cases of neglected compartment syndrome caused by a folk remedy.

Changes of Serum Alkaline Phosphatase and Osteocalcin during Fracture Healing / 대한정형외과학회잡지

PURPOSE: To investigate changes of serum osteoblastic marker during fracture healing. MATERIALS AND METHODS: The study included 22 patients with fresh fractures. Serum alkaline phosphatase (ALP), bone specific alkaline phosphatase and osteocalcin were analyzed on the first day and 1, 2, 4 and 8 weeks after injury. The bone specific-ALP was quantified by electrophoresis. Osteocalcin was quantified by enzyme linked immunosorbent assay (ELISA). RESULTS: One, 2, 4 and 8 weeks after injury, mean values of serum ALP increased 1.26, 1.45, 1.63, and 1.2 times that on the first day after injury, respectively. Similarly, during the same period, bone specific ALP increased 1.38, 1.33, 1.73 and 1.25 times, and serum osteocalcins increased 1.32, 1.2, 1.64 and 2.09 times. CONCLUSION: Serum ALP increased during the early soft callus phase. However, serum osteocalcins increased during the late hard callus phase. Serum alkaline phosphatase and osteocalcin warrant further study as useful prognostic indicators of fracture healing.

"Jammed Leg" Injury of Short-Fronted Vehicle Drivers in Frontal Collision Accidents / 대한정형외과학회잡지

PURPOSE: To Investigate the patterns and to document the clinical and technical significances of the leg injuries of drivers of short-fronted vehicles in frontal collision accidents. MATERIALS AND METHODS: Twelve cases of jammed leg injury were chosen from hospitals in the Chungcheong Province area and investigated in terms of nature of the accident, distribution of injuries, methods and duration of treatment and final sequelae. RESULTS: The patients had multiple injuries on the lower extremities, such as, fractures of the femoral shaft, tibial shaft, foot and ankle and soft tissue injuries, requiring an average 8.3 surgical procedures and 7 months admission, and from which permanent sequlae resulted, though associated injuries of the head, chest, abdomen were not significant. CONCLUSION: "Jammed leg injury" seemed to be related with the design of short-fronted vehicles. As these injuries can cause considerable functional and socioeconomic loss with long treatment periods and permanent residual sequelae. Preventive measures appear to be necessary, possibly involving vehicle design modification.

Differential Diagnosis of Heel Pain in Seronegative Spondyloarthropathy from the Heel Pain Syndrome / 대한정형외과학회잡지

PURPOSE: We attempted to differentiate the heel pain in seronegative spondyloarthropathy from that in the posterior heel pain syndrome. MATERIALS AND METHODS: Forty one patients who complained of heel pain were included in this study. The evaluation consisted of history taking, physical examination, roentgenogram, bone scan, and serological tests including ESR, CRP, rheumatoid factor, and HLA-B27. The patients were classified into two groups. Group A consisted of seronegative spondyloarthropathy patients and group B consisted of plantar fasciitis, Achilles tendinitis, and retrocalcaneal bursitis patients. RESULTS: There were 14 patients in group A, and 27 patients in group B. The characteristic clinical features were the following in group A compared with those in group B. The age of patients was younger and males predominated. Also patients complained of a combined metatarsalgia or other joint pain. On the physical examination, tenderness existed on the calcaneal body rather than the bony attachment site of Achilles tendon or plantar fascia. Serologic tests revealed an elevated ESR, and a positive HLA-B27. A bone scan showed diffuse uptake in the calcaneal body and the metatarsophalangeal joint area, and an increased SIS ratio. CONCLUSION: Seronegative spondyloarthropathy should be differentiated in a patient who complains of heel pain.

Management of Deep Infection after Posterior Spinal Instrumentation with Prolonged Suction Drainage / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis about related diagnostic and therapeutic factors in postoperative deep infection cases after posterior spinal instrumentation. OBJECTIVES: Analysis of the inherent risk factors associated with deep infection and the efficacy of management with prolonged suction drainage without removal of implants. SUMMARY OF LITERATURE REVIEW: Various treatment modalities have been applied to control deep infection after spinal instrumentation. Validity of removing implants to control the infection is still controversial because it may cause loss of spinal stability. MATERIALS AND METHODS: Five cases of postoperative deep infection after posterior spinal fixation from May 1996 to May 2000 were investigated about combined general illness, features of infection, various profiles on management of the infection with surgical irrigation and debridement followed by prolonged suction drainage, and final outcomes. RESULTS: Remarkable risk factors were diabetes and obesity. Evidences of infection such as discharge from the wound, dehiscence, fever were observed since average 18.8th day postoperatively. By only one surgical procedure for each patient followed by prolonged suction drainage for mean 19.2 days and administration of IV antibiotics for average 43.6 days followed by oral antibiotics for 33.8 days, deep infections were controlled successfully without removal of implants and without any grave complications. All achieved favorable clinical results and posterolateral fusion. CONCLUSION: Irrigation and debridement accompanied by prolonged suction drainage using Hemo-vac and administration of susceptible antibiotics seemed to be one of the effective methods in controlling deep infection after posterior instrumentation and in maintaining the postoperative stability of spine.

Pyogenic L4-5 Spondylitis Managed with Percutaneous Drainage Followed by Posterior Lumbar Interbody Fusion: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report and review of literature OBJECTIVE: Mostly operative treatment for pyogenic spondylits has been performed via anterior approach, which is often followed by greater morbidity and late sequelae. Efficacy of percutaneous drainage and posterior lumbar interbody fusion (PLIF), which are increasingly applied with favorable results, as an alternative of anterior surgery was investigated. MATERIAL AND METHOD: A case of pyogenic L4-5 spondylitis with psoas abscess but without neurologic deficit in a 66-year old lady was reviewed. Percutaneous drainage under fluoroscopic guide was performed. 7 weeks later, curettage of disc space and posterior lumbar interbody fusion using autogeous graft was performed to get rid of dead space and achieve stability. Administration of antimicrobial agents followed. RESULTS: Infection was controlled successfully. Clinical features including ambulatory function improved. Solid fusion was achieved. SUMMARY: In treating pyogenic spondylitis with moderate abscess, percutaneous drainage and posterior lumbar interbody fusion seemed to be one of alternatives of anterior surgery.

MMPI Profile in Patients with Chronic Low Back Pain / 대한정형외과학회잡지

PURPOSE: The causative pathology of chronic low back pain cannot be defined in many patients. To evaluate the relations between psychoneurotic status and chronic low back pain, the authors surveyed Minnesota Multiphasic Personal Inventory (MMPI) in the patients with chronic low back pain. MATERIALS AND METHODS: From July 1997 to December 1998, questionaire including MMPI were given to the patients who visited our Department for chronic (>6 weeks) low back pain. 50 patients (33 male, 17 female) completed MMPI. The mean age was 33.4 years (range 17-55) . MMPI scores were evaluated in two ways for each individual, mean scores of each clinical scale and two code method. Then mean scores were compared according to sex, radiating pain, radiologic abnormalities. RESULTS: In total 50 patients, three scales showed mean score over 55. Those were Hs:59.1 +/- 10.3, D:55.4 +/- 11.2 and Hy: 59.0 +/- 10.8. No significant differences were observed between the groups divided according to the sex, radiating pain, radiologic abnormalities. The two code method revealed that at least one of the neurotic triad (Hy, Hs, D) ranked within the highest two in 46 (92%) patients. CONCLUSION: It seemed that large proportion of patients with chronic low back pain had psychological tendency to hypochondriasis and/or depression and/or hysteria. MMPI seemed to be one of the useful methods in evaluation of psychogenic factors in chronic low back pain patients without definite organic pathology.

Bridge Reconstruction of Donor Iliac Crest with Resected Rib in Anterior Fusion of Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study about the efficacy of bridge reconstruction of donor iliac defect utilizing resected rib dur-ing surgical approach of thracolumbar vertebrae. OBJECTIVES: To evaluate the outcome in clinical aspect for cosmesis and pain, and radiological aspect for incorporation of rib with crest. SUMMARY OF LITERATURE REVIEW: Many iliac donor site problems were reported such as pain, deformity, fracture etc. Filling the bone defect with bone, cement, or artificial bone seems to reduce the donor site problems. MATERIALS AND METHODS: In fourteen patients who underwent anterior fusion of vertebrae, bridge reconstructions of iliac crest using resected rib for thoracoabdominal approach to vertebral body were performed. Postoperatively, donor site pain, residual deformity, and radiologic finding of the union between rib and iliac crest were evaluated. RESULTS: No patients had significant pain on donor iliac crest. Acceptable pain was complained by five patients after 1 month postoperatively and by three patients after 2 months postoperatively. After 3 months, no patients had pain problem at iliac donor site. Two patients presented palpable step-off on iliac crest, but external contours of iliac crest were satisfactory in all patients. Radi-ologic union of the rib-crest junction was confirmed within 6 months postoperatively in all cases. CONCLUSIONS: Bridge reconstruction of iliac crest defect using resected rib is a simple and effective method that can minimize residual donor site problems in anterior spinal surgeries of thoracic and upper lumbar vertebrae.

Multifocal Acute Osteomyelitis in a Mole Adolescent: A Case Report / 대한정형외과학회잡지

A 13-year-old boy developed fever and right leg pain, and multiple acupunctures were done on legs, then visited our ER for high fever, chill and painful swellings in both legs. Bone scan showed multiple hot spots on both distal femur, both proximal tibia, and left distal tibia. MRI revealed subperiosteal abscess in right proximal and left distal tibia and signal changes without abscess in other hot spot sites on bone scan. Surgical drainage of subperiosteal abscess and curettage were performed in the right proximal and the left distal tibia. Percutaneous drillings were done to other hot spot sites. All the lesions were cured after combined antibiotic chemotherapy. Multifocal osteomyelitis in a rapidly growing adolescent has been reported not rarely. It seemed that more attentions should be paid to the possibility of multifocal acute osteomyelitis in an adolescent

Temporal Bone CT Findings of Tuberculous Otitis Media: Comparison with Chronic Otitis Media

PURPOSE: To compare the differential findings of tuberculous otitis media(TOM) with those of chronic suppurative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. MATERIALS AND METHODS: We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated thepreservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the externalauditary canal, the erosion of ossicles, the tegmen tympani, scutum, bony labyr inth, facial nerve canal andsigmoid sinus, and the presence of intracranial co mplications. RESULTS: Soft tissue in the mastoid antrum wasseen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the softtissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 casesof Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM(28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM(13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%),and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%)there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculousmedication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. CONCLUSION: Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entiremiddle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells withoutsclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.

Lumbar Disc Herniation with Cauda Equina Syndrome after Self Traction Therapy: A Case Report / 대한척추외과학회지

STUDY DESIGN: A retrospective case report of lumbar disc herniation with cauda equina syndrome after self traction therapy. OBJECTIVES: Documentation of clinical significance and manifestations of disc herniation with cauda equina syndrome as one of the complications after self traction therapy. SUMMARY OF BACKGROUND DATA: Various conservative managements of acute low back pain in adults such as traction, spine manipulation therapy(SMT), and exercise therapy may produce harmful complications, especially when performed by non-professional therapists. Recently, reports of complication from SMT are increasing, however, understanding of biomechanism and natural history of traction, SMT, and exercise therapy are still poor. Therefore background information on the possible complications from their management is essential for physicians. METHOD: A case of acute cauda equina syndrome after self traction therapy in a 41 year-old man. Magnetic resonance imaging revealed severe compression of cauda equina by a huge mass. Emergency lumbar laminectomy was performed and all the compressing mass was removed. The mass was proven to be prolapsed disc of nearly whole nucleus amount and scanty nucleus was found within the disc space. RESULT: Acute low back pain and radiating pain disappeared immediately after operation. And neurologic deficits began to improve after postoperative 1 week. At the 15 month follow-up, the patient had recovered fully except minimal paresthesia on the right foot. CONCLUSION: More attentions to the possibility and clinical features of this complication seemed to be needed to the clinicians and therapists who do conservative management for the low back problems, especially SMT, traction, exercise therapy etc.

Analysis of Tensile Strength of Double Helix Wires / 대한정형외과학회잡지

PURPOSE: To compare the tensile properties of double helical twisting. MATERIALS AND METHODS: 21G and 18G stainless steel wires were used. Monostrand, untwisted double strand and manually twisted double helix wires were tested under gradually increasing tension force until the wires break. Data were analyzed by using a computer system to get force-strain curves. RESULTS: Forces at the break point showed no significant differences between untwisted double strand wires and helically twisted double strand wires. Forces at the yield point deformation were proportionally increased to the degree of helical twisting until the wires were twisted 20 times (piptch number: 24/10 cm) with no more increase after then. Final strain at break point decreased by helical twisting, which means the range of plastic deformation decreased. CONCLUSION: By helical twisting, the wires increase in elastic range and decrease in plastic deformation. Therefore, double helix wiring seemed to be a more effective method of fixation compared to the untwisted double strand wires.

Morphological Difference of Polyethylene Section in Knee Arthroplasty

The purpose of this study is to see the value of transsectional morphology of polyethylene for evaluation of wear and characteristics of ultra-high molecular weight polyethylene. Retrieved nineteen polyeth- ylene tibial components were examined for this study. Ten components were the directly molded 1900 Himont polyethylene, and 9 components were the machined GUR 415 polyethylene. Transsection of polyethylene(thickness: 60 - 150 micron) was obtained by microtome and was examined microscopical- ly for the fusion defects, subsurface white bands, and delamination as a mode of wear. Significant differ- ences between two groups of polyethylene were found. Fusion defects greater than 100 micron were observed in 5 among 9 GUR 415 polyethylene. Subsurface white band were observed in 7 among 9 GUR 415 polyethylene. Delamination was found in 6 arnong 9 GUR 415 polyethylene. Neither fusion defects greater than 100 micron, nor delamination were observed in 1900 Himont polyethylene. Morphological examination of polyethylene section is an efficient way to differentiate the polyethylene and to evaluate the wear behavior of retrieved polyethylene. This study suggests that delamination of polyethylene tibial components is influenced by resin type and / or manufacturing method.

Occlusion of Vertebral Artery and Cerebral Infarction after Cervical Spine Fracture: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case of brain infarction due to occlusion of vertebral artery after cervical spine fracture is reported. OBJECTIVES: Documentation of possibility and clinical significances of brain infarction as one of grave complications after cervical spine injury. SUMMARY OF LITERATURE REVIEW: Occlusion of vertebral artery and consequent brain infarction can be associated with cervical spine injuries because vertebral arteries course through the transverse foramina from sixth to second corvical vertebrae. Infarction of vertebrobasilar system may cause impairment of cerebral, cerebellar, or brain stem function and can occasionally bring grave functional loss, even death. MATERIALS AND METHODS: A case of occlusion of vertebral artery and consequent cerebral infarction after cervical spine fracture in a 66 year-old man. Brain CT and angiogram were performed. He was managed with anticoagulants. RESULTS: Neurologic deficits from brain infarction disappeared after 2 weeks. CONCLUSIONS: Attention to the possibility of these complications and awareness of their clinical features seem to be mandatory in managing cervical spine injury patients.

Clinical Evaluation of Blunt Renal Trauma / 대한비뇨기과학회지

PURPOSE: The evaluation of patients with suspected blunt renal trauma relies mainly on clinical assessment, urinalysis and imaging studies. For the evaluation of the effects of various factors in patients with blunt renal trauma, we performed this study. MATERIALS AND METHOD: We retrospectively reviewed the medical records of 103 patients who presented to our hospital with blunt renal trauma between 1991 and 1996. RESULTS: A total of 103 patients presented to our hospital with suspected blunt renal trauma. There were 72 male and 31 female between 8 and 82 years old (mean 35.7). Traffic accident was the most common cause of injury, accounting for 54.4%(56 cases). The remaining injuries were caused by falls in 30 cases (29.1%), assault in 15(14.6%) and sports-related trauma in 2(1.9%). Renal injuries were classified as established by the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma in 1989. There were 61 cases(59.2%) grade I, 15(14.6%) grade II, 8(7.8%) grade III, II(10.6%) grade IV and 8(7.8%) grade V. Of the 103 patients 58 had microscopic hematuria and 40 had gross hematuria. We found that the degree of hematuria does not correlate with the severity of renal injury. 54 patients(52.4%) had a total of 69 associated injuries, including extremity fracture In 21, rib fracture in 14, pelvic fracture in 14, liver injury in 6, closed head injury in 6, spinal fracture in 3, bowel injury in 3 and spleen injury in 2. Surgical exploration was required in 15 patients(14.6%) for renal or associated injuries. CONCLUSIONS: We should be managed blunt renal injuries with a consistent approach based on accurate injury definition from clinical, radiographic, and sometimes surgical staging. Accurate renal injury staging was essential to successful management of traumatized patients.

Bone SPECT, Simple Radiography , and Operative Findings in Osteoarthritic Knee with or without Anterior Cruciate Ligament Injury / 대한정형외과학회잡지

In so-called primary osteoarthritic knees, there may be secondary osteoarthritis due to the instability from chronic cruciate ligament and/or meniscal tear. The purpose of this study is to compare the findings of bone single-photon emission computed tomography(SPECT) and those of simple radiography in osteoarthritic knees which we consider as primary on the status of anterior cruciate ligament(ACL). We reviewed the preoperative bone SPECT and simple radiography of forty-three osteoarthritic knees in 23 patients who underwent total knee arthroplasty between 1995 and l996. We divided the cases into two groups on the status of ACL: thirty intact ACLs(Group I), thirteen insufficient ACLs(Group II). Meniscal tear and/or ACL insufficiency were found in 38 of 43 knees, As regards with presence of osteophytes and sclerotic changes on simple radiograph, there was no significant differences between group I and II. Joint space narrowing was more prominent and diffuse in group I(medial 29, lateral 24) than group II(medial 7, lateral 6). Bone SPECT showed diffuse uptake in group I(medial 30, lateral 23), but less uptake on the lateral compartment(medial 13, lateral 3) in group II. In ACL-intact osteoarthritic knees, joint space narrowing on simple radiograph and hot uptake on bone SPECT were more prominent and diffuse than in ACL-insufficient knees. Clinical relevance is still uncertain and further investigation is needed.