Results and Factors Affecting Clinical Efficacy of Medial Patellofemoral Ligament Reconstruction Using a Gracilis Tendon Suture Technique

Background@#This study evaluated the outcomes of medial patellofemoral ligament (MPFL) reconstruction using a gracilis tendon suture technique for patients with patellar instability. Potential factors affecting clinical efficacy were also evaluated. @*Methods@#This study included 22 patients diagnosed with patellar instability, who underwent MPFL reconstruction using a gracilis tendon. Their mean age was 21.5 years (range, 15–48 years), and the mean follow-up period was 26.8 months (range, 12–66 months). Clinical evaluation included the determination of Kujala, Lysholm, and Tegner scores. Radiographic evaluation included changes in congruence angle and arthritic changes in the patellofemoral joint. Additionally, patients were examined for any complications, including recurrent dislocation. Factors affecting clinical efficacy were also evaluated. @*Results@#All clinical scores improved at final follow-up. The mean congruence angle improved from 23.6° before surgery to –6.5° at final follow-up. Two of 15 patients developed osteoarthritic changes in the patellofemoral joint. Dislocation recurred in 2 patients with type C trochlear dysplasia, which showed a statistically significant association with recurrent dislocation when compared to type A and B dysplasia (p = 0.026). Kujala scores were significantly lower among patients with abnormal patellar tilts (p = 0.038), and Lysholm scores were significantly lower among patients with femoral internal rotation deformity (p = 0.024). @*Conclusions@#Satisfactory results were obtained after MPFL reconstruction using a gracilis tendon suture technique for patients with patellar instability. However, dislocation recurred in patients with type C trochlear dysplasia, and clinical efficacy was lower among patients with femoral internal rotation and patellar tilt.

Treatment of Malunion / 대한정형외과학회잡지

Although current surgical techniques have reduced the incidence of malunion, it is still observed because of the complexity of the fracture or associated injuries. Osteotomy is needed when the amount of malunion is expected to result in an overload of cartilage and instability of the joint. Preoperative planning is essential when performing an osteotomy for malunion. Inadequate planning can result in serious complications, such as iatrogenic malalignment, intraoperative fracture, postoperative recurrence of deformity, or soft tissue injuries. In addition, a poor functional result can occur secondary to poor patient selection. This review article includes the surgical indications and planning to correct malunion. Various methods of corrective osteotomy are described according to the kinds of plane and fixation implants.

Comparison of Magnetic Resonance Imaging and Operation Waiting Times in Patients Having Traumatic Cervical Spinal Cord Injury; with or without Bony Lesions

PURPOSE@#To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions.@*METHODS@#Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated.@*RESULTS@#Thirty-four patients were included. Patients' mean age was 57 (range, 23–80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (±60.08) minutes in group A and 313.75 (±264.89) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (±76.03) minutes in group A and 560.5 (±372.56) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198).@*CONCLUSIONS@#If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

Etiology and Management of Nonunion / 대한정형외과학회잡지

Nonunion is caused by various factors related to fracture characteristics, patient characteristics, treatment, and infection. Aseptic nonunion, is divided into three categories in accordance with the biological activity of the fracture: atrophic nonunion, oligotrophic nonunion, and hypertrophic nonunion. Treatment of nonunion depends on the cause and classification. Here, we report our experiences and review the various causes of nonunion and treatment methods available.

Pelvis/Acetabular Fractures in the Elderly: When and How to Fix?

Owing to the increase in life expectancy, the incidence of osteoporotic fracture of the pelvis and acetabulum is increasing. Fractures in the elderly population is different from those in younger patients. Pelvic ring and acetabular fractures in geriatric patients are more likely the result of low-energy trauma, but the outcomes are generally poorer than those of the younger population. Multiple management options are available, but no intervention has become the standard of care for these fractures in the elderly. A treatment strategy should be established depending on the state of the individual patient. Regardless of whether nonsurgical or surgical treatment is selected, early ambulation should be considered to avoid the complications associated with prolonged immobilization.

Safety and Efficacy of the Endeavor Resolute® Stent in Patients with Multivessel Disease: The HEART (Honam EndeAvor ResoluTe) Prospective, Multicenter Trial / 전남의대학술지

The Endeavor Resolute® (ER) is a zotarolimus-eluting stent (ZES) with a biocompatible BioLinx polymer. This study prospectively compared the clinical outcomes of 2 versions of ZES, ER and Endeavor Sprint® (ES), in patients with multivessel disease. A total of 488 patients who underwent multivessel percutaneous coronary intervention (PCI) were divided into 2 groups the ER group (n=288) and the ES group (n=200). The primary endpoint was a composite of major adverse cardiac events (MACE) consisting of death, myocardial infarction, and target vessel revascularization after 12 months. In all patients, the prevalence of diabetes was higher in the ER group (42.7% vs. 31.0%, p=0.009). The rate of post-PCI Thrombolysis in Myocardial Infarction flow grade 3 was higher in the ER group (100.0% vs. 98.0%, p=0.028). There were no between-group differences in the in-hospital, 1-month and 12-month clinical outcomes. In the propensity score matched cohort (n=200 in each group), no differences were observed in the baseline and procedural characteristics. There were no statistical differences in the rates of in-hospital, 1-month and 12-month events (12-month MACE in the ER and ES groups: 6.0% vs. 3.5%, p=0.240, respectively). The safety and efficacy of both versions of ZES were comparable in patients with multivessel disease during a 12-month clinical follow-up.

An Irreducible Hip Dislocation with Femoral Head Fracture

Urgent reduction is required in cases of traumatic hip dislocation to reduce the risk of avascular necrosis of the femoral head. However, in cases of femoral head fractures, the dislocated hip cannot be reduced easily, and in some cases, it can even be irreducible. This irreducibility may provoke further incidental iatrogenic fractures of the femoral neck. In an irreducible hip dislocation, without further attempting for closed reduction, an immediate open reduction is recommended. This can prevent iatrogenic femoral neck fracture or avascular necrosis of the femoral head, and save the natural hip joint.

Pulmonary Thromboembolism during Acetabular Fracture Operation

Acetabular and Pelvic ring fractures are major high-energy trauma injuries and are often combined with other injuries. In particular, cause of long duration of immobilization and combined injuries, venous thromboembolism is a common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism during the acetabulum fracture operation in a 62-year-old male patient.

Bone Transport over the Plate for the Segmental Bone Defect of Tibia

Segmental bone defects of the tibia present a challenging problem for the orthopedic trauma surgeon. These injuries are often complicated by soft tissue defects and infection. Many techniques are reported, from bone graft to bone transport. To our knowledge, bone transport over the plate in the distraction site has not been described for the treatment of tibial bone defect. We report an instance including procedure and subsequent complications after bone transport over the plate, to restore a tibial bone defect.

Calcaneal Fractures: A Soft Tissue Emergency

Calcaneal fractures are quite often seen in patients with axial loading injury. In the tongue-type of calcaneusal fractures or tuberosity avulsion fractures, bone fragments are often superiorly and posteriorly displaced, because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. The Ddisplaced bone fragment compresses the soft tissues, leading tothat makes skin necrosis. To prevent further soft tissue injury, early recognition of the injury by the emergency physician and immediate orthopedic consultation is needed.

Extensor Pollicis Longus Tendon Rupture with Concomitant Rupture of the Extensor Digitorum Communis II Tendon and Extensor Indicis Proprius after Volar Plating for Distal Radius Fracture

Extensor tendon rupture is well known complication following distal radius fracture after either conservative treatment or volar plating. However, there are not many reports in literature about concomitant ruptures of other extensor tendons. We report a case of delayed rupture of extensor pollicis longus (EPL), second extensor digitorum communis (EDC II), and extensor indicis proprius (EIP) tendons 4 weeks after volar plating for distal radius fracture. Due to the absence of EIP, EIP transfer was discouraged for EPL reconstruction. Thumb and index finger extension was restored by palmaris longus tendon graft for EPL and EDC II.

A Correction of Malunion or Deformity in the Lower Extremity

The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.

A Correction of Malunion or Deformity in the Lower Extremity

The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.

A Case of Pheochromocytoma Initially Manifesting as Acute Myocardial Infarction

Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors arising from chromaffin cells in the adrenal medulla. Typical classic triad are consisted of headaches, palpitations, and profuse diaphoresis. But some patients with pheochromocytomas have other cardiovascular manifestations such as left ventricular hypertrophy, congestive heart failure, and cardiac arrhythmia. Rarely, pheochromocytomas manifest as acute myocardial infarction leading to delayed diagnosis and treatment. We experienced one case of pheochromocytoma initially manifesting as acute myocardial infarction which showed normal coronary artery on coronary angiography. Pheochromocytoma should be suspected and evaluated in patients with acute myocardial infarction whose coronary angiography shows normal coronary without definite thrombosis.

Surgical Timing of Treating Pediatric Trauma: Urgencies/Emergencies

No abstract available.

Biplanar Open Wedge High Tibial Osteotomy in the Medial Compartment Osteoarthritis of the Knee Joint: Comparison between the Aescula and TomoFix Plate

BACKGROUND: The purpose of this study was to compare the results of Aescula and TomoFix plates used for biplanar open wedge high tibial osteotomy in medial osteoarthritis of the knee joint with varus deformity. METHODS: A consecutive series of 50 cases of biplanar open wedge high tibial osteotomy were evaluated retrospectively. Group A contained 25 cases treated by using the Aescula plate, and group T contained 25 cases treated by using the TomoFix plate. Full weight-bearing was permitted at 6 weeks after surgery in group A and at 2 weeks in group T. Clinical evaluations were performed at the final follow-up by using postoperative knee scores and functional scores. Radiographic analysis included postoperative mechanical femur-tibia angle, change in posterior tibial slope angle, and complications related to implants. The mean follow-up periods were 30 months in group A and 26 months in group T. RESULTS: The knee and functional scores were improved at the final follow-up in both groups (p 0.05). An acceptable correction angle was obtained in 52% of group A and in 84% of group T (p = 0.015). Change in posterior tibial slope angle was larger in group A than in group T (p < 0.001), showing better maintenance of posterior tibial slope in group T. In group A, there were 3 cases of screw loosening and 4 cases of delayed union. In addition, there were residual varus deformities in 7 cases (6 in group A and 1 in group T). CONCLUSIONS: This study shows that firm fixation using a TomoFix plate for open wedge high tibial osteotomy produces better radiologic results and a low complication rate than those of the Aescula spacer plate.

Biomechanical Analysis of Operative Methods in the Treatment of Extra-Articular Fracture of the Proximal Tibia

BACKGROUND: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. METHODS: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. RESULTS: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. CONCLUSIONS: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.

A Case of Lemierre's Syndrome in Young Patient with Acute Peritonsillar Abscess

Lemierre's syndrome is very rare and is characterized by previous oropharyngeal infections, such as pharyngitis or peritonsillar abscess, leading to high fever, internal jugular venous thrombosis, and metastatic infections to multiple internal organs. Prompt and accurate diagnosis followed by early treatment with antibiotics is very important because its mortality is high if treatment is delayed. We report on the case of a 23-year-old female who was transferred to our hospital with a left peritonsillar abscess combined with left jugular venous thrombosis, complaining of a sore throat and left submandibular swelling, and diagnosed as Lemierre's syndrome. Finally, she was treated successfully without anticoagulants.

An Analytical Comparison of Short-term Effectiveness and Safety Between Thulium:YAG Laser Vaporesection of the Prostate and Bipolar Transurethral Resection of the Prostate in Patients With Benign Prostatic Hyperplasia

PURPOSE: In recent years, laser surgery has been widely used to treat benign prostatic hyperplasia (BPH). A thulium:yttrium-aluminium-garnet (Tm:YAG) laser was recently introduced for BPH surgery. We compared the effectiveness and safety of Tm:YAG laser vaporesection of the prostate (ThuVaRP) with that of bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS: From January 2010 to December 2012, 86 patients underwent surgical treatment for symptomatic BPH by a single surgeon. We retrospectively analyzed and compared the medical records of 43 patients who underwent ThuVaRP and 43 patients who underwent bipolar TURP. All patients were assessed by using the International Prostate Symptom Score, transrectal ultrasonography, the serum prostate-specific antigen (PSA) level, uroflowmetry, and postvoid residual volume before and 1 month after surgery. All complications were compared between the two groups. RESULTS: ThuVaRP was superior to TURP in catheterization time (p50 g), operation time was much longer with ThuVaRP. One month after surgery, the decrease in PSA was greater (p=0.045) with ThuVaRP than with TURP, and the increase in maximal urine flow rate was greater (p<0.001) with ThuVaRP than with TURP. The postoperative complication transient urinary incontinence was significantly different between the ThuVaRP group (nine cases, 20.9%) and the TURP group (two cases, 4.7%). Other complications were comparable between groups. CONCLUSIONS: The effectiveness and safety of ThuVaRP and TURP were comparable. ThuVaRP is a promising alternative surgical technique to TURP for BPH.

Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture

PURPOSE: To report our early experience with thermo-expandable urethral stents (Memokath) for the management of recurrent urethral stricture and to assess the efficacy of urethral stents. MATERIALS AND METHODS: Between March 2012 and February 2013, 13 patients with recurrent urethral stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. RESULTS: The mean patient age was 47.7 years (range, 18 to 74 years). The mean urethral stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile urethral strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with urethral hyperplasia. The mean follow-up duration was 8.4 months. CONCLUSIONS: Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent urethral stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile urethral stricture can be factors predicting poor results.