Costoclavicular Syndrome Secondary to Nonunion of a Displaced Fracture of the Clavicle, Misdiagnosed as a Simple Muscle Strain: A Case Report

Thoracic outlet syndrome is a relatively common disease. However, costoclavicular syndrome as a condition secondary to nonunion of a displaced fracture of the clavicle is very rare. Most clavicular fractures in adults are united with no or minimal persistent symptoms. Also, symptomatic nonunion of a displaced fracture of the clavicle is rare. A 55-year-old male initially presented with persistent forearm pain after slip-down was initially diagnosed with simple muscle strain. However, he was given a delayed diagnosis of costoclavicular syndrome, caused by compression of the subclavian artery due to trauma in the fibrotic nonunion of the right clavicle without apparent symptoms. We obtained satisfactory results by surgical treatment. Here we report this case with a review of the literature.

Interposition of Extensor Pollicis Longus Tendon in Smith's Fracture in a Child: A Case Report

Entrapment of the extensor pollicis longus tendon is reported rarely on Smith's fractures in children. In our case, a 15 year old boy with Smith's fracture received treatment of closed reduction at another hospital. When he visited our hospital, a wide gap at the fracture site was detected on radiograph and the thumb movement was limited. We have doubt the entrapment of the soft tissue, especially the tendon. We decided on open reduction. In the operation field, entrapment of the extensor pollicis longus tendon at the gap of the fracture site was found through dorsal approach. In addition, fracture treatment with K-wire fixation after reduction of extensonr pollicis longus tendon reduction was done. Therefore, we report this case with a review of the literatures.

Surgical Management of Comminuted Avulsion Fracture of the Proximal Fibula with Lateral Collateral Ligament Injury: Technical Note

Anteromedial force to the knee in an extended position can cause an avulsion fracture of the proximal fibula with combined injuries to the posterolateral ligaments. Avulsion fractures of the proximal fibula are rare and current management of these fractures is based on few descriptions in literature. Various surgical methods of fixation for these fractures have been reported, but there is still no standard treatment modality. Anatomic reduction of these fractures is technically difficult, and failure of reduction may cause posterolateral instability, secondary arthritis and other complications. We present our experience with two such cases of comminuted avulsion fractures of the proximal fibular with posterolateral ligament ruptures surgically fixated with a locking compression hook plate and non absorbable sutures.

Parosteal Lipoma of the Femur with Hyperostosis: A Case Report / 대한골관절종양학회지

Parosteal lipoma is a rare kind of lipoma that occurring adipous tissue around the periosteum. It has been reported most commonly in the femur, the radius, the tibia and the fibular. Treatment consists of resecting the lipomatous tumor with further exeresis of the bone and periosteal excrescence in cases with hyperostosis. The authors report a rare case of parosteal lipoma occurring at the medial portion of the femur shaft with a review of the relevant literatures.

Closed Reduction and Percutaneous K-Wire Fixation of Bony Mallet Finger Using an 18 Gauge Needle

PURPOSE: To evaluate the clinical results of the treatment of the percutaneous Kirschner wire fixation of bony mallet finger using an 18 gauge needle. MATERIALS AND METHODS: From September 2002 to September 2009, we performed closed reduction using an 18 gauge needle and percutaneous fixation with Kirschner wire for 15 cases of bony mallet finger and followed up at least 1 year. The fractures were classified by the Wehbe and Schneider's method. Indications of operative treatment were fractures involving more than 30% of articular surface, fracture fragments displaced more than 3 mm, or subluxation of the distal interphalangeal joint. The results were evaluated by the Crawford criteria. RESULTS: All the fractures united, with an average healing time of 5.3 weeks(4-6 weeks). According to Crawford criteria, 10 cases were excellent, 5 cases were fair at a mean follow-up of 13 months. There were no pin tract infections and migrations of the pin. CONCLUSION: Percutaneous Kirschner wire fixation of mallet finger using an 18 gauge needle is an easy technique which can achieve anatomical reduction and diminish operation-related complications.

Treatment of Metacarpal Shaft Fractures with Retrograde Intramedullary Kirschner-Wire Fixation

PURPOSE: The purpose of this study is to evaluate the clinical results of retrograde intramedullary fixation of metacarpal shaft fractures using two pre-bent Kirschner wires. MATERIALS AND METHODS: Between March 2006 and May 2008, 19 cases (17 patients) of metacarpal shaft fractures were treated with the retrograde intramedullary Kirschner-wire fixation and followed at least one year. The exclusion criteria were thumb metacarpal fractures, comminuted fractures and irreducible metacarpal spiral shaft fracture by closed manipulation. At final follow up all the cases were assessed with total active motion(TAM), rotational deformity, bony union and angular deformity based on the plain radiographes. RESULTS: At the last follow-up, all cases achieved bony union. Five cases showed less than 5degrees of dorsal angular deformity. The average union period was 6.3 weeks (range, 5-9weeks). Fifteen cases (79%) showed excellent results, four cases good results based on TAM. No case showed rotational deformity. Two cases had skin irritation by distal wire end, which was subsided after wire removal. CONCLUSIONS: In patients with a metacarpal shaft fracture, retrograde intramedullary fixation using two pre-bent K-wires can provide satisfactory clinical results.

Arthroscopic Repair for Traumatic Peripheral Tear of Triangular Fibrocartilage Complex

PURPOSE: To assess the results of an arthroscopic repair for traumatic peripheral tears of triangular fibrocartilage complex (TFCC, Palmer type Ib). MATERIALS AND METHODS: 10 patients with traumatic peripheral TFCC tear were treated with outside-in technique with arthroscope and evaluated with an average follow-up of 19 months (range, 15 to 28 months). The clinical outcomes were assessed with investigation of pain, range of motion, grip strength, return to job and patient's satisfaction. RESULTS: The arthroscopic repair of traumatic peripheral TFCC tear resulted in significant pain relief and increase in functional ability of wrist, that is, 8 excellent, 1 good and 1 fair results. At last follow-up, the average of flexion was 79° (range 76~86°), average of extension was 78° (range 70~84°), average pronation was 85° (range 75~91°) and average supination was 87° (range 79~92°). Nine patients except one were back to their original job. CONCLUSION: Arthroscopic repair of traumatic peripheral TFCC tear could be used for pain relief and increase in functional ability of wrist.

Arthroscopic Repair for Traumatic Peripheral Tear of Triangular Fibrocartilage Complex

PURPOSE: To assess the results of an arthroscopic repair for traumatic peripheral tears of triangular fibrocartilage complex (TFCC, Palmer type Ib). MATERIALS AND METHODS: 10 patients with traumatic peripheral TFCC tear were treated with outside-in technique with arthroscope and evaluated with an average follow-up of 19 months (range, 15 to 28 months). The clinical outcomes were assessed with investigation of pain, range of motion, grip strength, return to job and patient's satisfaction. RESULTS: The arthroscopic repair of traumatic peripheral TFCC tear resulted in significant pain relief and increase in functional ability of wrist, that is, 8 excellent, 1 good and 1 fair results. At last follow-up, the average of flexion was 79° (range 76~86°), average of extension was 78° (range 70~84°), average pronation was 85° (range 75~91°) and average supination was 87° (range 79~92°). Nine patients except one were back to their original job. CONCLUSION: Arthroscopic repair of traumatic peripheral TFCC tear could be used for pain relief and increase in functional ability of wrist.

Tumoral Calcinosis in The Knee Joint Causing Acute Symptoms : A Case Report

A sixty-eight-year-old female presented with suddenly developed pain in the left knee joint. On the first visit, there was severe tenderness on the anterolateral aspect of the knee joint with active flexion and extension limited by pain. Radiographs revealed multiple round calcific masses in the anterolateral aspect of the knee joint. Under the impression of intraarticular lesions, we performed arthroscopic examination of the knee joint, which revealed no intraarticular pathology. The masses were found in the extracapsular soft tissue and we performed excisional biopsy of the masses completely. The masses were confirmed as tumoral calcinosis by histopathologic examination. It rarely occurs around the knee joint and is usually asymptomatic. Idiopathic tumoral calcinosis with acute symptoms must be differentiated from other pathologic conditions such as gout or infection. The clinical manifestation of this case was opposed to the previous reports. So we report a rare case of idiopathic tumoral calcinosis of the knee joint with acute symptoms.

The Results of Modified Brostrom Procedure for the Treatment of Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate clinical and radiographical results of treatment of chronic lateral ankle instability with modified Brostrom procedure. MATERIALS AND METHODS: This is a retrospective study of 22 cases in 22 patients treated with modified Brostrom procedure under the diagnosis of chronic lateral ankle instability from May 2000 to August 2004. Average age was 32.3 years. Average follow-up period was 23 months. Preoperative and postoperative radiographs of ankle anteroposterior view, lateral view and varus stress view were analyzed. The clinical evaluation was performed according to the Americal Orthopaedic Foot and Ankle Society scales. RESULTS: After the modified Brostrom procedure, Americal Orthopaedic Foot and Ankle Society scales score was improved by average 28 points. Among the 22 cases, 13 cases were excellent, 3 cases good, 4 cases fair, and 2 cases poor with satisfaction of 73%. Five cases had intermittent ankle pain of whom 3 cases had difficulty during competitive sports activity. Lateral tilting of talus improved by average 5.4 degrees on varus stress view. CONCLUSIONS: The modified Brostrom procedure is one of the most effective methods for treating of chronic lateral ankle instability.

Percutaneous Interlocking Intramedullary Nailing of Femoral Shaft Fracture with Retrograde Guide Wire Insertion Technique

Piriformis fossa is chosen for the entry point of the intramedullary nail insertion for the broken femoral shaft. To evaluate the correct entry point selection, the use of the usual operation table and short skin incision, we tried the percutaneous interlocking intramedullary nailing with retrograde guide wire insertion technique. The guide wire is inserted through the short skin incision on the anterior thigh and comes out through piriformis fossa easily. Through over the guide wire the femoral nail was inserted with only short skin incision. And the trick makes no difference except the convenience compared with the antegrade guide wire insertion technique. It is considered as a useful tip of the intramedullary nailing of the femoral shaft fracture.

Recurred Diffuse Pigmented Villonodular Synovitis of Ankle Joint: Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) in ankle is relatively uncommon. This disorder results in increased proliferation of synovium causing villous or nodular changes containing histiocytes, fibroblasts, multinucleated giant cell, and hemosiderin. PVNS is classified into two different type : localized and diffuse. Diffuse type of PVNS in ankle is more common than localized type. Also, recurrence of diffuse type is more frequent. We report a case of diffuse type of PVNS which was recurred soon after the excision.

Treatment of Scaphoid Nonunions with Autogenous Cancellous Bone Grafting Combined with Threaded K-wire Fixation

PURPOSE: To evaluate the results of surgical treatment of autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunions. MATERIALS AND METHODS: We retrospectively reviewed the 13 patients with scaphoid nonunion, which was follow up at least 12 months from March 1999 to June 2003. According to the Mayo classification, two cases were type P (proximal third), eight cases were type W (waist) and three cases were type D (distal third). According to the Russe classification, eight cases showed horizontal oblique type, another two cases were transverse, and last three belonged to vertical oblique type. We assessed the radiologic bony union, correction of humpback deformity and lateral intrascaphoid angle and degenerative change of radioscaphoid joint, clinical results were evaluated using assessment of Maudsley. RESULTS: Radiologic union was obtained in all cases, mean time of union was 15.4 weeks (13~17.4 weeks), and there was no radiological evidence of postoperative humpback deformity, intercarpal instability, proximal osteonecrosis and degenerative changes. According to assessment of Maudsley, there were 7 excellent cases, 4 good cases, 1 fair case and 1 poor case among these 13 cases. The final clinical results were 11 excellent cases, 2 good case in the aspect of wrist pain and tenderness. All range of motion was satisfactory to patients except 4 cases (3 fair, 1 poor) and every patients could return to work except 1 poor case. CONCLUSION: The surgical treatment using a autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunion was a relatively straightforward technique, which provides simplicity, and high union rate.

Undercorrection of the Thoracolumbar Kyphotic Deformity in the Osteoporotic Spine Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the efficiency of undercorrection and transpedicular screw fixation through a posterior approach in osteoporotic spine fractures with a thoracolumbar kyphotic deformity. SUMMARY OF LITERATURE REVIEW: The surgical treatment of osteoporotic spine fractures with a thoracolumbar kyphotic deformity requires extensive surgical procedures to obtain complete restoration of the sagittal alignment, but it has a few technical limitations due to insufficient mechanical stability at the bone-screw interface. A special strategy is essential for transpedicular screw fixation for osteoporotic spine fractures with a thoracolumbar kyphotic deformity. MATERIALS AND METHODS: We reviewed 14 osteoporotic spine fracture cases, with a thoracolumbar kyphotic deformity, which had undergone undercorrection and transpedicular screw fixation through a posterior approach, between March 2000 and June 2003, with an average follow-up period of 15. 2 months. According to the Jikei grade of the osteoporosis, 9 and 5 cases were grades 2 and 3, respectively. As a radiographic assessment, we measured the kyphotic angles of the fused segments on the preoperative, postoperative and last follow up thoracolumbar lateral views on standing using Cobb's method, and also assessed the kyphotic angle correction (KAC). The clinical results were evaluated at the last follow-up. RESULTS: The kyphotic angles at the preoperative, postoperative and last follow-up were 33.5 degrees +/- 9.3, 22.4 degrees +/- 6.9 and 24.7 degrees +/- 6.8, respectively. We obtained a mean KAC gain of 11.1 degrees postoperatively (p0.05). The clinical results were analyzed as good, fair and poor in 8, 5 and 1 case, respectively. Fusions were achieved in all cases. CONCLUSIONS: Undercorrection and transpedicular screw fixation for a thoracolumbar kyphotic deformity in osteoporotic spine fractures can be one of the alternatives to avoid fixation failure and an extensive surgical procedure.

Surgical Treatment of Intractable Lateral Epicondylitis with Nirschl Procedure / 대한정형외과학회잡지

PURPOSE: This study was performed to evaluate the results of surgical treatment of Nirschl procedure for intractable lateral epicondylitis of the elbow. MATERIALS AND METHODS: We retrospectively reviewed the functional records of surgically treated 21 cases from the 196 cases of lateral epicondylitis, which had been followed up at least 12 months from March 2000 to May 2003. Surgery was generally considered to be indicated if six months of conservative treatments since the first diagnosis had led to no improvement of the symptoms. The patients were evaluated by assessing of Pain Analog Scales (PAS) score. The objective outcomes of all patient after surgery were investigated according to the criteria by Roles and Maudsley. RESULTS: The mean PAS score followed up for 12 months postoperatively, had indicated significant improvements (p<0.001): 0.31 points (range, 0-2) at rest, 1.22 points (range, 0-3) at daily activities, and 2.25 points (range, 0-5) at sports and occupational activities. According to the Roles and Maudsley scores, there were 12 excellent, 7 good, 2 fair from the total of 21 cases; therefore, 19 (90%) cases showed the satisfactory results. CONCLUSION: The surgical treatment using the Nirschl procedure for intractable lateral epicondylitis of the elbow is considered as one of recommendable methods for the cases of no response at the conservative treatment.

Closed Reduction and External Fixation of Displaced Fractures of the Proximal Humerus

PURPOSE: This is a retrospective study to analyze the functional results of closed reduction and external fixation of unstable fractures of the proximal humerus. MATERIALS AND METHODS: Ten unstable proximal humerus fractures were managed with closed reduction and external fixation in which other operative methods are not proper due to comminution, osteoporosis or poor general condition of patients. 4 cases of 2-part and 6 cases of 3-part fracture were included. Radiologically union of fracture, malunion and the evdence of avascular necrosis of humeral head were assessed and the functional results were analyzed with Neer scoring system. RESULTS: Radiologically all fractures were healed but in 2 cases malunion was resulted because of reduction loss in proximal fragment. Pin site infection was developed in 7 cases and oral antibiotics were needed. The functional results were excellent in 4, satisfactory in 3 and unsatisfactory in 3 cases. 2 cases with malunion and one case with lack of postoperative cooperation resulted in functionally unsatisfactory. CONCLUSION: External fixation is an alternative method in the treatment of unstable proximal humerus fractures in which open reduction or percutaneous pinning are not proper due to comminution, osteoporosis or poor general condition of patient.

Mono-segment Pedicle-screw Instrumentation and Fusion following Vertebroplasty for Lumbar and Thoracolumbar Fractures / 대한척추외과학회지

STUDY DESIGN: Nineteen of 20 cases that underwent a mono-segment pedicle-screw instrumentation and fusion, following vertebroplasty for lumbar and thoracolumbar fractures, were reviewed retrospectively. OBJECTIVES: To assess the effectiveness of a mono-segment pedicle-screw instrumentation and fusion, following an anterior column reconstruction, using bone cement for a fractured lumbar and thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: With lumbar and thoracolumbar fractures, the untreated anterior instability and pre-stressing of the screws, following reduction, resulted in a high failure rate of the hardware, and posterior screw fixation alone may be not adequate. MATERIALS AND METHODS: We reviewed 19 of 20 cases that underwent a mono-segment pedicle-screw instrumentation and fusion, following vertebroplasty for lumbar and thoracolumbar fractures, between Feb. 2000 and Mar. 2002, with an average follow-up of 1.6 years. The mean age of the patients was 39.2 years, and the male female ratio as 10:9. The criteria for inclusion to the study (McAfee classification) were flexion-distraction injury, burst fracture, translational injury and burst conversion after an osteoporotic compression fracture, in 9, 7, 2 and 2 cases, respectively. We assessed the radiographic results of the local kyphotic angle correction of the fused segment and anterior body height restoration, preoperative, postoperative and at the last follow up, from the lateral views of the spine. The clinical results were evaluated according to Kumano's criteria. RESULTS: The mean local kyphotic angles of the instrumented segment, preoperatively, postoperatively and at the last follow-up were 16.5, 1.1 and 2.1 degrees, with a mean correction gain of 15.4 degrees(p0.05). The mean anterior body heights for each period were 60.4, 89.6 and 85.0%, with a mean restoration gain of 29.2% (p0.05). The clinical results were assessed as good in 18 patients (19 cases) and fair in the other one. There were 3 cases of asymptomatic leakage of the bone cement, but no fixation failures during the follow-up. CONCLUSIONS: A mono-segment pedicle-screw instrumentation and fusion, following the treatment of anterior instability, using vertebroplasty for lumbar and thoracolumbar fractures, can be an effective alternative for preserving the maximal motion segment, without fixation loss through the restoration of the immediate postoperative weight-bearing capability.

Effect of Bone Cement Augmentation of Pedicular Screwing for Osteoporotic Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: Eighteen patients undergoing bone cement augmentation of pedicular screwing for osteoporotic lumbar spine were reviewed retropectively. OBJECTIVES: To assess the effectiveness of bone cement augmentation of pedicular screwing for osteoporotic lumbar spine. SUMMARY OF LITERATURE REVIEW: For the technical limit obtaining the dynamic stability in the bone-screw interface for osteoporotic lumbar spine, the additional device to enhance pedicular screw fixation strength needs. MATERIALS AND METHODS: We reviewed 18 cases undergoing pedicular screwing and fusion for the osteoporotic (Jikei grade I, II, III/III) lumbar spine from Feb. 2000 to Mar. 2001 with an average follow-up of 1.5 years. Mean age was 69.5 years with 6 male and 12 female. Inclusion criteria was 9 degenerative spinal stenosis, 5 spinal stenosis associated with compression fracture, 2 Kummel's disease, 1 spondylolisthesis and 1 internal disc disruption. We performed bone cement injection around the screws showing significantly low insertion torque, screw pullout or cut-up during surgery. We asssessed the radiographic results of sagittal angle correction (SAC) of the fused segment and disc height restoration (DHR) on the preoperative, postoperative and last follow up lumbar lateral views. Clinical results were evaluated according to the Kumano's criteria. RESULTS: Mean sagittal angle at preoperative, postoperative and last follow-up was 11.6-21.6-19.6 degrees with mean SAC gain 10 degrees (p0.05). Mean disc height of each period was 33.3-49.8-43.5% with mean DHR gain 16.5% (p0.05). The clinical result was analyzed as 14 good, 3 fair and 1 poor. Fusion success was achieved in all. There were 2 perioperative complications of 1 superficial surgical site infection and 1 incomplete L4 root injury, and 6 complications during follow up of 3 compression fractures above fused segment, 1 screw pullout, 1 screw cut-up, and 1 bone cement extrava-sation into canal. CONCLUSIONS: The bone cement augmentation of pedicular screwing for osteoporotic lumbar spine can be an alternative to enhance screw fixation strength.

Closed Reduction and Percutaneous Pinning in Fracture-Dislocations of Carpometacarpal Joints / 대한정형외과학회잡지

PURPOSE: There is little information about the treatment of carpometacarpal (CMC) fracture-dislocations. The purpose of this study was to investigate treatment methods and times between diagnosis and surgery in CMC fracture-dislocations. MATERIALS AND METHODS: In 18 cases treated by surgery, the 4, 5th CMC joints were found to be the most frequently involved in 13 cases. Comminution of the carpal or metacarpal bone was present in 8 cases. The time to surgery was within 3 days in 10 patients, within 5 days in 6, within 9 days in one patient and more than 4 weeks in one. All the injuries were managed by closed reduction and K-wire fixation except for one which was detected after 4 weeks since initial trauma. RESULTS: A painless full hand function was restored in 13 cases. Intermittent pain was present in 5 cases in which there was comminution in 4. However, clinically full hand function was restored in 4 cases except for one in whom the treatment was delayed. CONCLUSION: If the treatment of CMC fracture-dislocation is not delayed a successful result can be gained using the closed method even though comminution occurs.

Vertebral Actinomycosis: Two Case Report / 대한정형외과학회잡지

The lack of familiarity with vertebral actinomycosis by both clinicians and radiologists, may contribute to its frequent omission from the differential diagnosis of suspicious lesions, therefore the condition can be difficult to diagnose. We now present the first report of two cases of thoracic and lumbar vertebral actinomycosis resulting in a paraparesis due to epidural abscess which necessifated surgery.