“Locked-Lateral” Calcaneal Fracture-Dislocation Treated by Sinus Tarsi Approach / 대한정형외과학회잡지

“Locked-lateral” calcaneal fracture-dislocations are very rare. This paper reviewed the helpful radiographic and diagnostic characteristics.A 52-year-old male was treated with reduction and fixation using the sinus tarsi approach. The author reports this case with a review of the related literature.

Fracture and Bilateral Facet Dislocation after Anterior Cervical Fusion in a Patient with a Distraction-Flexion Injury at the Lower Cervical Level / 대한정형외과학회잡지

A bilateral facet dislocation after anterior cervical fusion with a plate in distraction-flexion injury without significant instability in plain radiography is very rare. This paper reports a case with a confirmed injury status (C6–7 and C7–T1) by magnetic resonance imaging and computed tomography with no visible fractures or displacement on plain radiography. Anterior cervical fusion (C6–T1) was performed with a cage and plate. On the other hand, three days later, C6–7 bilateral facet dislocation developed with severe neck and radiating pain, and posterior decompression and fusion were performed.

Multiple Periosteal Chondroma of the Fourth Toe / 대한정형외과학회잡지

Periosteal chondroma is a rare, slow-growing, benign cartilaginous tumor that develops between the periosteum and cortex, but thereare no reports of multiple periosteal chondroma of the toes. A 19-year-old male presented with a palpable mass of the right fourth toewith tenderness for one year. A radiology examination revealed multiple, radio-lucent lesions with mild cortical irregularity. The magneticresonance imaging findings were chondrogenic tumors with multiple, well-defined T1-low and T2-high signal enhanced lesions involvedin the fourth proximal, middle, and distal phalanges. The tumors were removed by a surgical resection and curettage. Histologically, thetumors were proven to be periosteal chondroma.

Early Onset Subsequent Vertebral Compression Fracture after Percutaneous Verteroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the characteristics and the risk factors of early onset subsequent vertebral compression fractures after percutaneous vertebroplasty. MATERIALS AND METHODS: A total of 44 patients, who had a new subsequent vertebral fracture after percutaneous vertebroplasty for an osteoporotic vertebral compression fracture between January 2013 and December 2015, were recruited. The patients were divided into two groups according to the onset period of subsequent fracture. The number of patients who had a fracture within 3 months following vertebroplasty were 22 cases (Group A); after 3 months were 22 cases (Group B). Variables, including age, sex, bone mineral density (BMD), body mass index (BMI), preexisting vertebral compression fracture, location of the initial fracture, intradiscal cement leakage, injected cement volume, restoration of vertebral body height, and correction of kyphosis, in the two groups were analyzed and compared retrospectively. RESULTS: The age, sex, BMD, BMI, preexisting vertebral compression fracture, location of the initial fracture, intradiscal cement leakage, and correction of kyphosis were similar in the two groups. Both a greater volume of bone cement injected and a greater degree of vertebral height restoration contributed significantly to the risk of fracture within 3 months. CONCLUSION: The cement volume and degree of height restoration are risk factors for early onset fracture at the adjacent vertebrae after percutaneous vertebroplasty and close attention is needed during the follow-up period.

A Report on Diabetic Foot and Amputation from the Korean Health Insurance Review & Assessment Service Data / 대한족부족관절학회지

PURPOSE: This study reports on limb amputations in diabetic patients according to gender, age, and region based on the data from the Korean Health Insurance Review & Assessment Service. MATERIALS AND METHODS: The number of amputations was compared by region, age, gender, and year, as well as by femoral region, lower leg, foot, and toe in diabetic patients who received limb amputation. This analysis was performed based on the data from the Korean Health Insurance Review & Assessment Service, between January 2009 and December 2014. RESULTS: The total number of amputations between the study period was 9,155. The number of patients who were treated at hospitals for diabetes in 2009 was 1.9 million, among which, 1,214 patients underwent amputation. In 2014, the incidence of diabetes was 1,747 in 2.58 million individuals. With this rising incidence of diabetes, the amputation of limbs due to diabetes is increasing every year. In particular, the following regions were amputated more often: femoral region, 2.3%; lower legs, 19.6%; feet, 18.1%; and toes 60.0%. Regarding gender differences, males showed a higher amputation rate than females for all body parts. With respect to region, Seoul was the highest with 30.2%, followed by Gyeonggi with 19.9%, and Busan with 8.8%. According to age, older age showed greater diabetic amputation rate. CONCLUSION: In accordance with the rising incidence of diabetes, the diabetic amputation is also increasing. Here, we showed that toes were amputated with the highest percentage and males had greater amputation rate than females for all body parts. Moreover, amputation rate was highest in older diabetic patients, especially for those in their seventies. Additionally, Seoul was the region with highest amputation rate.

Adjacent Segment Pathology Following Anterior Decompression and Fusion Using Cage and Plate for the Treatment of Degenerative Cervical Spinal Diseases

STUDY DESIGN: Retrospective study. PURPOSE: To analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases. OVERVIEW OF LITERATURE: No long-term data on the use of cage and plate augmentation have been reported. METHODS: The study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated. RESULTS: CASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (p<0.001). CONCLUSIONS: ACDF with cage and plate for the treatment of degenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP.

Outcomes of Treatment for Squamous Cell Carcinoma Originating as a Marjolin's Ulcer / 대한골관절종양학회지

PURPOSE: The purpose of this study was to analyze the results of treatment and prognosis of Marjolin's ulcer compared with primary squamous cell carcinoma. MATERIALS AND METHODS: Fourteen patients treated for Marjolin's ulcer were analyzed. Twenty patients with primary squamous cell carcinoma treated during the same time period was the control group. Mean age was 61.2 years. There were 24 males and 10 females. The locations, TNM stages, histological grades, recurrence, metastasis, and survival rate were analyzed and compared between two groups. RESULTS: The mean follow-up period was 54.8 months (range, 12-168 months). Local recurrences were found in 6 cases, 5 ones in Marjolin's ulcer patients, and one case in primary squamous cell carcinoma patients. The mean time interval between the initial presentation and occurrence of local recurrences was 9 months (range, 2-20 months). There were 6 metastases. 2 (14.3%) metastases were found in Marjolin's ulcer patients, and 4 (20.0%) metastases in primary squamous cell carcinoma patients. Total events (metastasis or local recurrence) were found in 10 pateients, 6 of them in Marjolin's ulcer group, and the remaining four in primary group. 5-year disease-free survival rate was 64.3% in Marjolin's ulcer group and 95.0% in primary squamous cell carcinoma group. CONCLUSION: Squamous cell carcinomas originating as Marjolin's ulcers revealed higher recurrence rate and lower survival rate despite of aggressive treatment. Therefore, new treatment modalities should be developed for improving outcomes.

Weight Bearing Study Using Digital Scales in Hemiplegic Patients

OBJECTIVE: The purpose of this study was to compare and analyze the differences between weight bearing through the plegic and nonplegic lower extremities in hemiplegic patients in various standing conditions. METHOD: We used digital scales to measure weight bearing among 13 hemiplegic patients when they performed comfortable standing, maximal weight shifting to each lower extremity, step standing with each foot on a step, and maximal weight shifting to each lower extremity again. RESULTS: 1) Patients bore significantly more weight on their nonplegic lower extremity than on their plegic one during comfortable standing (p0.05) and the weight bearing of nonplegic lower extremity was insignificantly increased (p>0.05). CONCLUSION: Step standing was a very useful training method of facilitating the weight bearing in hemiplegic lower extremity.

Conduction Study of Dorsomedial Cutaneous Nerve to the Great Toe

OBJECTIVE: The dorsomedial cutaneous nerve (DMCN) to the great toe is a branch of the medial dorsal cutaneous nerve, which originates from the superficial peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique, and to investigate the usefulness of dorsomedial cutaneous nerve (DMCN) conduction study in patients with peripheral neuropathy. METHOD: Sixty two legs in 31 normal adults and 56 legs in 28 patients with the clinical signs and symptoms as well as electrodiagnostic evidences of peripheral neuropathy were evaluated with the DMCN conduction study. The stimulating electrode was placed over the lateral 1/3 between medial and lateral malleoli and the active electrode was placed over 12 mm medial and 10 mm proximal to the extensor hallucis longus tendon over the 1st metatarsophalangeal joint. RESULTS: The mean values of DMCN conduction study in normal adults were 2.95+/-0.47 msec for onset latency, 3.58+/-0.43 msec for peak latency, 6.67+/-2.87microvolt in amplitude, and 12.96+/-1.17 cm for distance from active electrode to stimulation point. There were statistically significant differences between normal and patients groups in all parameters except the distance. CONCLUSION: A method for DMCN conduction study was introduced which could be used as a valuable technique for the early evaluation of peripheral neuropathy.

Rehabilitation of Torticollis in Children

The primary treatment goal of torticollis is to prevent the craniofacial deformities, limitation of neck movements and long-term postural changes. In order to offer precise guidelines for the treatment of torticollis regarding the cosmetic and functional results, we analyzed 99 torticollis children retrospectively for the ages at diagnosis and the start of treatment, the duration of treatment, the problems at first visitation, and the size of sternocleidomastoid mass. These patients visited the department of rehabilitation medicine, Holy Family Hospital from April 1991 to June 1997. The results showed that there was no relation between the number of problems at first visitation and the age at the start of treatment, but the group with 1 problem had a significantly shorter duration of treatment than the groups with more than 4 problems. The ages at diagnosis and at the start of treatment for the patients with a palpable neck mass were younger than those of the patients without a neck mass. The duration of treatment was longer for the patients with a larger size of mass by the ultrasonography of the neck. The ages at diagnosis and at the start of treatment, and the duration of treatment were all younger and shorter in the cosmetically satisfactory group than those of the cosmeticlly unsatisfactory group. However there was no significant difference between the functionally satisfactory group and unsatisfactory group in the ages at diagnosis and at the start of treatment, and the duration of treatment. In conclusion, when the treatment of torticollis was started early, especially at less than 3 months old, better cosmetic results were obtained, even though functional results were relatively satisfactory by the proper rehabilitation treatments. We want to emphasize that it is important to detect and treat the torticollis as early as possible for the better cosmetic results.

Cartilage-Perichondrium Tympanoplasty for Pediatric Atelectatic Ears / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pediatric atlectasis of the pars tensa occurs fairly commonly in patients with previous ear disease, especially otitis media with effusion. The atelectatic ears have been classified into four grades. For grades 3 and 4 atlectasis, for which it is difficult to manage by conservative treatment, some surgeons suggest fascia and perichondrium grafts to reinforce thin atrophic tympanic membranes. In such situations, fascia and perichondrium are often shown to undergo atrophy and subsequent failure in the postoperative period. In this study, we attempted to assess the efficacy of cartilage-perichondrium tympanoplasty for pediatric atelectatic. We used cartilage-perichondrium for graft because it was more rigid and it tended to resist resorption and retraction even in the face of continued eustachian tube dysfunction. MATERIALS AND METHOD: Twenty one patients who underwent cartilage-perichondrium tympanoplasty were assessed retrospectively. RESULTS: The atelectatic ears were elevated and everted in all patients. The air-bone gap was less than 10 dB in 57%, and less than 20 dB in 33% of the patients observed. The postoperative CT showed a well placed graft with good ventilated middle ear cavity and mastoid cavity. CONCLUSION: It can be suggested from this study that the cartilage-perichondrium tympanoplasty offers the possibility of rigorous drum reconstruction with excellent postoperative hearing results.

Relationship between Recovery of Vestibuloocular Reflex and c-Fos Protein Expression in Medial Vestibular Nuclei Following Unilateral Labyrinthectomy in Rats / 대한이비인후과학회지

Relationships between recovery of vestibuloocular reflex and expression of c-fos immunoreactive cells in the medial vestibular nuclei following unilateral labyrinthectomy(ULX) were investigated in rats. Frequency of spontaneous nystagmus, velocity of eye movement induced by sinusoidal rotation of the whole body at frequencies of 0.1, 0.2, 0.5Hz, and the number of c-fos immunoreactive cells in the medial vestibular nuclei were measured for 72 hours after ULX. Frequency of spontaneous nystagmus was 3.9+/-0.5 beats/sec(M+/-SD) immediately after ULX and disappeared completely within 48 hours. On sinusoidal rotation, eye movement induced by rotation toward the lesioned side recovered normal pattern within 24 hours at 0.1Hz rotation, and 12 hours at 0.2, 0.5Hz. Directional preponderance which represents the symmetry of bilateral vestibular functions decreased to less than 20% at 72 hours, but did not recover normal limit. The number of c-fos immunoreactive cells in the bilateral medial vestibular nuclei was severe asymmetry till 24 hours of ULX. However, the symmetry was recovered after 48 hours. These results indicate that the recovery of vestibuloocular reflex correlates with the expression of c-Fos immunoreactive cells of the medial vestibular nuclei in the early stage of vestibular compensation following ULX. Therefore, the vestibular nuclei may play a key role in vestibular compensation.