Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

Peroneus Tendon Dislocation Associated with Fracture of Lateral Process of Talus: A Case Report

Traumatic peroneal tendon dislocation in association with fracture of the lateral process of the talus is a rare injury, which is difficult to diagnose. As a result, early detection is often delayed, which in turn leads to ankle pain and dysfunction. We treated a patient by open reduction and screw fixation in fracture of the lateral process of talus and primary repair of the superior peroneal retinaculum. We report this case with a brief review of the literature.

Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis

PURPOSE: To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail. MATERIALS AND METHODS: Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score. RESULTS: All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points. CONCLUSION: The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.

Complications of Hook-Plate Fixation for Distal Clavicle Fractures

PURPOSE: To report on the complications of hook-plate fixation for distal clavicle fractures. MATERIALS AND METHODS: Eighteen patients who underwent surgery for distal clavicle fracture with a hook-plate from April 2008 to April 2011 were enrolled with a minimum of 4 months follow-up. The reduction was qualified and evaluated according to the radiologic findings. We analyzed the results by UCLA score, Kona's functional evaluation, and VAS pain score. RESULTS: By radiologic evaluation, 17 of 18 cases showed anatomical reduction and solid unions. Although satisfactory results were found in the clinical study as shown by the UCLA score, Kona's functional evaluation, and VAS pain score, complications arose in 7 cases, including osteolysis of the acromion in 2 cases, nonunion in 1 case, periprosthetic fracture in 2 cases, subacromial pain in 1 case, and skin irritation in 1 case. 2 cases of all required reoperation. CONCLUSION: To reduce the complications of the hook-plate, a precise surgical technique and the choice of an appropriate size for the hook-plate are needed. We suggest that early removal of the plate is necessary to decrease the risk of subacromial impingement and erosion in hook-plate fixation.

Treatment of Distal Clavicle Fracture Using Hook Plate

PURPOSE: To evaluate the result of distal clavicle fracture treated by Hook plate (LCP clavicle hook plate, Synthes(R), Paoli, Switzerland). MATERIALS AND METHODS: 10 patients with distal clavicle fracture treated by Hook plate from April 2008 to March 2010 were analyzed. The average follow-up period was 10 (range 4 to 26) months. The reduction was qualified and evaluated according to the immediate post-operative, final radiographs. We analyze the result by UCLA score and Kona's functional evaluation. RESULTS: By radiologic evaluation, all cases showed anatomical reduction and solid union. By Kona's functional evaluation, there are 7 cases with excellent results, 3 cases with good results. The UCLA score was average 33.3 (range 29 to 35) points followed by 6 excellent cases, 4 good cases. As complication, 1 case showed post-operative clavicle shaft fracture and 1 case showed acromial osteolysis on X-rays. We found no complications such as skin irritation, infection, loosening of screws, and plate failure. CONCLUSION: The Hook plate fixation for distal clavicle fracture is considered effective method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result.

Acroosteolysis of Scleroderma Associated with a Felon / 대한정형외과학회잡지

The Scleroderma is a chronic inflammatory disease of the connective tissue with involvement of the skin and other organs. It can be a manifestation of various disorders and occasionally acroosteolysis in the phalanges. Acroosteolysis is characterized by bone resorption or destruction in the phalanges, while the base is preserved. The pathogenesis of acroosteolysis in patients with scleroderma is a blood-flow disorder that is mainly associated with an abnormal accumulation of collagen in all tissues, microangiopathy and infections in the phalanges. The phalanges in patients with scleroderma are prone to continuous infections as a felon or skin ulcers due to atrophy of the subcutaneous tissue, dry and sclerotic skin, or a disorder of the immune system. We experienced a patient who had acroosteolysis with scleroderma of the phalanges, and this was associated with a felon. We report on this case along with a brief review of the literature.

Avulsion Fracture of Medial Cuneiform by Tibialis Anterior Tendon (A Case Report) / 대한족부족관절학회지

Avulsion fracture of medial cuneiform by tibialis anterior tendon is quite rare. It has been reported about the avulsion fracture and surgical repair of tibialis anterior tendon rupture at distal insertion site of medial cuneiform in Korea. We report a case of right foot medial cuneiform avulsion fracture by tibialis anterior tendon after autobike accident and describe this case with a review of literature.

Peroneus Longus Dislocation associated with Trimalleolar Fracture: A Case Report / 대한족부족관절학회지

Traumatic dislocation of the peroneus longus tendon is an often unrecognized injury which has been reported to occur most commonly during sports activity. Most acute cases with early detection can be treated by simple repair of the tendon or retinaculum using one of several procedures available. Accurate treatment through a comprehensive evaluation of the ankle injury prevents suboptimal and sometimes unrecorrectable outcomes. The authors experienced concomitantly the peroneus longus tendon dislocation associated with a trimalleolar fracture of the ankle. We report this case a brief review of the literature.

Usefulness of MRI in Distal Femoral Intra-articular Fracture

PURPOSE: Preoperative recognition of an associated injuries including ligament disruptions of the knee and Hoffa fracture in the cases of the intra-articular distal femoral fractures affects surgical planning. The purpose of this study is to identify the usefulness of MRI in distal femoral intraarticular fracture. MATERIALS AND METHODS: Over a 7 years period from January 1995 to December 2001, all patients with an intra-articular fracture of the distal femur were collected from a prospectively designed orthopaedic database and reviewed. Seventy five patients with intra-articular distal femoral fractures were collected. There were 49 male and 26 female patients ranging from 15 to 91 in age. Because these injuries usually result from high-energy trauma, we should also exclude associated injuries of pelvis, hip, patella, tibial plateau fractures, popliteal vessel injuries, and ligament disruptions of the knee. So we checked knee MRI of patients with distal femoral fractures to rule out associated knee injuries. RESULTS: There were 12 Hoffa's fractures, 6 anterior cruciate ligament injuries, 6 posterior cruciate ligament injuries, 10 medial collateral ligament injuries and 3 lateral collateral ligament injuries. Five patients of 12 Hoffa's fractures associated with intra-articular distal femoral fractures that were not diagnosed in patients with conventional radiographs were confirmed after MRI evaluation. CONCLUSION: Knee MRI for intra-articular distal femoral fracture is necessary to rule out associated ligament injuries and Hoffa fractures in case of high-energy trauma patients.

Relationship between Gb3 Expression and Cytotoxicity of Shiga-like Toxin I

PURPOSE: Infection with Shiga-like toxin (SLT)-producing Escherichia coli, an emerging human pathogen found particularly in young children under 5 years of age, causes a spectrum of illnesses with high morbidity and mortality, ranging from diarrhea to hemorrhagic colitis and hemolytic uremic syndrome. Host mediators play an important role in the pathogenesis of SLT-I toxicity. The experiments described here were designed to investigate the effect of SLT-I on TNF- alpha production and to understand the effect of TNF-alpha on GB3 expression. We also further examine the relationship between the Gb3 level and the differential susceptibility of cells to the cytotoxic action of SLT-I. METHODS: The effect of purified SLT-1 from E. coli O157 : H7 (ATCC 43890) on tumor necrosis factor-alpha (TNF- alpha) production in Raw264.7 cells was investigated. Many mediators regulate endothelial cell membrane expression of the glycolipid globotriaosyleramide (Gb3), which serves as the toxin receptor, suggesting that the host response to the toxin or other bacterial products may contribute to pathogenesis by regulating target cell sensitivity to the toxins. Therefore, the relationships between Gb3 expression and cytotoxicity against SLT-I on three types of cells were evaluated. RESULTS: Detectable levels of TNF-alpha were produced as early as six hours after induction and continued to increase during 48 hours by SLT-I. It was also found that Vero cells and dendritic cells (DC2.4 cells) expressed high levels of Gb3, 83% and 68%, respectively, and that Raw264.7 cells had a low level of Gb3 (29%) and appeared refractory to cytotoxicity against SLT-I. Vero cells and DC2.4 cells expressing high levels of Gb3 were highly susceptible to SLT-I. Furthermore, macrophages showed a resistance to SLT-I cytotoxicity, despite the fact that Gb3 expression was enhanced. CONCLUSION: These results strongly suggest that the expression of Gb3 is necessary but not sufficient to confer sensitivity of macrophages to SLT-I and further underpin the important role of SLT-I and its Gb3 receptors in the pathogenesis of E. coli O157 infection.

Carpal Tunnel Decompression with Limited One-Incision Technique / 대한정형외과학회잡지

PURPOSE: Carpal tunnel decompression with limited one-incision technique has been reported that it is possible to achieve a sufficient decompression without significant complications. We evaluated the clinical effectiveness of this method. MATERIALS AND METHODS: Forty-two cases of twenty-eight patients of carpal tunnel syndrome were retrospectively evaluated, which were treated with limited one-incision technique less than 2 cm in length, from January 1997 to September 1999. RESULTS: According to Cseuz's criteria, 36 cases (85.7%) were excellent or good. CONCLUSION: Carpal tunnel decompression with limited one-incision technique can provide sufficient decompression with small skin incision. It is not necessary of special eqipment. It has less copmplications and no difference of clinical results comparing with classic open method or endoscopic method. Therefore, this method can be a good method in the surgical treatment of carpal tunnel syndrome. But this method can't be performed in the patient with abnormal anatomical structure or tumorous conditions in carpal tunnel and complication rates are not zero. Therefore operator should pay attention to the selection of patients and the technique.

Meralgia Paresthetica Secondary to soft Tissue tuberculosis: a case report / 대한정형외과학회잡지

Meralgia paresthetica is a syndrome of pain or dysesthesia, or both, of the anterolateral thigh caused by entrapment or metabolic neuropathy of the lateral femoral cutaneous nerve. Many cases of meralgia paresthetica have been presented for a century. We have experienced a case of meralgia paresthetica which was misdiagnosed as lumbar radicu- lopathy at other hospital, of a 53-year-old man who had developed painful paresthesia and dysesthe- sia of the anterolateral thigh caused by soft tissue tuberculosis of oblique abdominal muscles just proximal to the lateral inguinal ligament where the lateral femoral cutaneous nerve passes. We report a case of unilateral meralgia paresthetica secondary to soft tissue tuberculosis with review of literatures because it has not previously been reported.

Flexibility and Graf / 대한척추외과학회지

STUDY DESIGN: The lumbar segmental motions were analysed in asymptomatic volunteers. OBJECTIVES: To obtain normative data on flexibility and Graf's instability degree in sagittal plan of the normal lumbar spine. SUMMARY OF LITERATURE REVIEW: Although several clinical and radiological measurement tech niques are available, little is known about the normal range of lumbar spine motion. As a consequence, the diagnostic evaluation of radiographs are frequently based on subject opinions rather than object reality. MATERIALS AND METHODS: The authors have checked lumbar flexion-extension Yiews of 95asymptomatic volunteers who were divided into 5 groups by the age, and then their flexibility and Graf's instability degree were calculated by Graf's method with using Graf/Bar Mark II(digitalizing table) and personal computer program(RachisR). Evaluation of the sexual difference and comparison of the difference of each age group in spine level were done RESULTS: 1. There were significant differences in flexibility among age groups(p0.05). 3. Graf's instability degree was not different among 5 age groups(p>0.05), and between male and female(p>0.05). 4. The mean Craf's instability degree was below 8o in L2-3, L3-4, and L4-5 segment, but above 8 in L5-S1 segment(male: 11.62+/-9.27 , female. 11.11+/-8.70). CONCLUSIONS: Although we observed small subjects, these results are the basic steps toward more objective and careful interpretation of flexibilty and Graf's instability degree.

Operative Treatment of the Clavicular Fracture with Reconstruction Plate / 대한정형외과학회잡지

It had been reported by many authors that the incidence of delayed or nonunion in fracture of clavicle was higher in open reduction and internal fixation than conservative treatment. The purpose of this study is to verify the gratification of the reconstruction plate in fracture of clavicle which needed internal fixation. From March 1993 to September 1995, 32 clavicular fractures were underwent open reduction and internal fixation with reconstruction plate for the wide gap, soft tissue interposition and comminuted fracture etc. The results were as follows 1. The range of motion of the shoulder was returned to normal range within 1.5 weeks except one case who had brachial plexus injury. 2. All cases had bony union. Average time to clinical union was 2.9 weeks and the bony union 7.8 weeks. 3. By functional evaluation of shoulder by Weitzman, final results were excellent in 27, good in 4 and fair in l. 4.Fixation and maintenance of clavicular fragment by reconstruction plate was recommendable for wide separated, soft tissue interposed, comminuted fracture of the clavicle. We concluded that reconstruction plate in fracture of clavicle could be recommended as one of the device for internal fixation.

Treatment of the Open Tibial shaft Fracture using Unreamed Intramedullary Nailing / 대한정형외과학회잡지

We have treated the open tibia shaft fractures, especially Gustilo type II, with unreamed interlocking intramedullary nail. In cases combined with soft tissue damage around fracture site, maintaining rigid internal fixation and preserving endoosteal blood supply is important in union of fracture and soft tissue healing. We have analyzed 18 cases of Gustilo type II open tibial shaft fractures managed with intramedullary nailing without reaming since 1991, the follow-up period was average 22 months. Most of the fractures were the result of moderate to high-energy trauma. In all 18 cases, nails were inserted via closed method. Static interlocking nailing was used in all cases. In 16 cases, union of the fracture was achieved from 16 to 25 weeks(average 23 weeks). In the other 2 cases, union was achieved in 7 months. There was no serious postoperative complication except one skin infection with skin defect managed by skin flap and one failure of the interlocking screw. These results are comparable with those obtained from other forms of fixation, including immobilization with a cast, reamed intramedullary nailing, and external fixation.

Immunohistochemical and biochemical mechanism of selenium effects on antioxidant system in putative preneoplastic lesion in rat liver / 대한암학회지

No abstract available.

A Case of Congenital Biliary Atresia associated with Ectopic Pancreatic Tissue

Congenital biliary atresia is the commonest cause of prolonged obstructive jaundice in the neonatal period, and is due to the pathologic closure of a major portion or segment of the biliary tree. The neonate with prolonged obstructive jaundice poses a diagnostic dilemma that may be insoluble by routine clinical and laboratory studies. This applies particularly to the most common entities, neonatal hepatitis and biliary atresia. We esperienced one case of congenital biliary atresia associated with ectopic pancreatic tissue in 23 day-old female which was confirmed by autospy. Literature about congenital biliary atresia were reviewed.

Effects of the Cyclophosphamide and 6-Mercaptopurine on the RES Function in Rats

To study the effect of anticancer drugs on the RESFunction, cyclophosphamide and 6-mercaptopurine were intramuscularly injected and evaluated the reticuloendotherial phagocytic activity by the carbon clearence method in rats. Experimental groups were subdivided by the dosage, into the small and large dosage groups, and by the duration of treatment, into the 1, 3, 5 days and 8days (3 days cessation after 5 days treatment) groups. The results obtained were as follow. 1. Cyclophosphamide-treated groups showed the splenic atrophy which was in proportion to duration of treatment. RES phagocytic activities seemed to be slightly increased in large groups, but to be within normal ranges in ranges in small dosage groups, which were normalized in the 8 days groups. 2. 6-Mercaptopurine-treated groups didn't show the hepatic and splenic alterations significantly. RES phagocytic activities were variably changed as in triphagic curve fashion in both small and large dosage subgroups of 1, 3, 5 days treated groups, which were normalized in the 8 days groups.