A Broken Drill-bit Fragment Causing Severe Radiating Pain after Cervical Total Disc Replacement: A Case Report

This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits.

Modified Spring Plate for Treatment of Unstable Distal Clavicle Fractures

PURPOSE: Unstable distal clavicle fractures should be treated surgically but may be difficult in firm fixation because of small distal fragment. Although a variety of fixation methods have been currently used, none of the methods seem to be firm fixation and little pain. We present a new technique using a spring plate which was modified from one third tubular plate and report the early results. MATERIALS AND METHODS: Modified spring plate was made from one third tubular plate and the distal hole of the plate was cutting and sharpened by rasp. The sharp edge was bent just like an animal claw (C shape). Between May 2007 and June 2009, a total of six patients with distal clavicle fracture were treated using modified spring plate. A sling was applied in the immediate post operative period for six weeks and exercises were started immediately. RESULTS: Union was achieved in all cases with excellent results without complication (mean Constant score, 96). All patients had returned to ordinary daily activities but mild limitation of abduction (150 degrees ) by seven weeks after surgery. After six months, the plate was removed. CONCLUSION: The modified spring plate has provided stable fixation for unstable distal clavicle fixation without disturbance to the acromioclavicular joint, subacromial space, or rotator cuff.

Limited Wrist Fusion for Kienbock's Disease / 대한정형외과학회잡지

PURPOSE: To evaluate clinical outcomes of triscaphe (STT), scapho-capitate (SC) and scapho-capito-hamato-triquetral (SCHT) fusion in advanced Kienbock's disease. MATERIALS AND METHODS: Forty patients with Lichtman stage III and IV disease were treated with limited wrist fusion. STT & SC fusion for stage IIIa and IIIb, and SCHT fusion for IIIb and IV were done according to preoperative radiologic and intraoperative articular surface findings. The mean follow-up period was 31.6 months (range 13-108) and the mean age at the time of their surgery was 44.7 years (range 22-71). There were 13 cases of STT fusion, 19 cases of SC fusion and 8 cases of SCHT fusion. For assessment of treatment results, wrist range of motion, grip strength, VAS (visual analog pain score) and any radiologic changes of the wrist were checked at last follow-up. RESULTS: VAS score was 4.7 for STT, 3.0 for SC, 4.5 for SCHT. Grip strength, compared with the contralateral side, was 72% for STT, 78% for SC, and 54% for SCHT. Pain was more improved for the SC fusion group than for the other two groups (p=0.007). Grip strength was decreased more in the SCHT fusion group than in the other two groups (p=0.009). There were no statistically significant differences in range of motion between any of the three groups. The bone achieved union in all cases except one SC fusion. CONCLUSION: Limited wrist fusion in advanced Kienbock's disease has been regarded as a valuable method. However, SC fusion has been thought of as a more favorable technique than STT fusion with respect to pain relief. SCHT fusion is thought to be a possible salvage procedure with a limited indication for Stage IV Kienbock's disease.

Follow-up Result in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion when Associated with Shoulder Impingement Syndrome / 대한정형외과학회잡지

PURPOSE: Type II superior labral anterior posterior (SLAP) lesions can occur in the setting of impingement syndrome. The authors compared the clinical results of patients who had undergone either an isolated acromioplasty or a combined type II SLAP repair and acromioplasty. MATERIALS AND METHODS: Between 2003 and 2008, a total of 75 cases of SLAP II lesions associated with impingement syndrome were recruited. In 39 patients, the type II SLAP lesion was repaired and acromioplasty was performed. In the other 35 patients, acromioplasty was performed alone. All patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. RESULTS: At an average of 33 months postoperatively, the ASES scores significantly increased in both groups (p<0.001) but the ASES score was similar in the 2 groups (p=0.278). However, there was a significant difference in the ASES scores when the competitive sports activity of the 2 groups of patients postoperatively were compared (p=0.014). The SLAP repair patients showed limited external rotation motion compared to the acromioplasty alone patients (p=0.026). CONCLUSION: There are no advantages in repairing a type II SLAP lesion when associated with impingement syndrome. However, type II SLAP lesions should be repaired in patients involved with competitive sports activity but the competitive sports activity should be limited for a better result.

Periprosthetic Fractures after Total Elbow Replacement

PURPOSE: To analyze clinical presentation and results of the treatment of periprosthetic fractures occurring after total elbow replacement (TER). MATERIALS AND METHODS: Eleven patients who had periprosthetic fractures after TER were examined. The locations and the causes of periprosthetic fractures were evaluated. The periprosthetic fractures were classified using Mayo classification. Stable fractures were treated conservatively, and unstable fractures were treated by open reduction and internal fixation. Revision operation was conducted if implant loosening was observed. End results after treatment were evaluated based on Mayo elbow performance score (MEPS) and radiologic examinations. RESULTS: Most fractures occurred at the humeral site(82%), and Type B2 periprosthetic fracture was most frequently observed(64%). Radiographic union was observed at a mean of 26 weeks after the treatment. No statistically significant differences were observed between preoperative and postoperative elbow active motions. According to the MEPS, the results were rated as excellent in three patients, good in five, fair in one and poor in two. CONCLUSION: A periprosthetic fracture after TER likely occurrs at humeral site and it is highly related with loosening of the implant. Although union tends to be delayed and complications occur frequently, relatively fair results can be obtained with appropriate treatment.

Complications and Revision Rate as the Type of Prosthesis of Total Elbow Replacement: Long-term Follow-up in Korea / 대한정형외과학회잡지

PURPOSE: Few studies have compared the outcomes, complications and revision rate of a total elbow replacement (TER) prosthetic design. This study examined a series of patients with semiconstrained and unconstrained total elbow replacements (TER) and evaluated them for any functional differences, complications and revision rates that might be attributable to the prosthetic design. MATERIALS AND METHODS: A total 78 cases of primary TER was performed in 71 patients. Their mean age at TER was 54 years. The causes of TER were rheumatoid arthritis in 42, post-traumatic arthritis and osteoarthritis 24 and 5 patients, respectively. Unconstrained and semiconstrained TER was employed in 35 and 43 cases, respectively. The end results of TER by the Mayo elbow performance score (MEPS), their elbow range of motion before and after surgery, their complications and revision rates after an average 13 year follow-up were evaluated. RESULTS: The MEPS was improved from 33 points pre-operatively to 87 points post-operatively (p<0.001). Active flexion-extension elbow motions were also improved markedly from 27degrees-86degrees pre-operatively to 16degrees-128degrees postoperatively (p<0.001). There was no significant difference between the semiconstrained and unconstrained TER in the post-operative MEPS (p=0.764) and range of motion (p=0.728). The complication rate was much higher in the unconstrained groups than in the semiconstrained group (p=0.014). The mean total revision rate was 29.5%. There was no significant difference in revision rate between the unconstrained and semiconstrained groups (p=0.402). Loosening was found in a total of 12 cases (15.4%). There was also no significant difference in loosening between the semiconstrained and unconstrained groups (p=0.382). CONCLUSION: Favorable results of MEPS and elbow motion were obtained in both the unconstrained and semiconstrained types after an average 13 year follow up after TER. However, the semiconstrained type of TER showed a lower complication rate than the unconstrained type of TER.

Short-Term Follow-up Results of Periacetabular Osteotomy for Hip Dysplasia

PURPOSE: To evaluate the clinical and radiologic results of periacetabular osteotomy for the treatment of hip dysplasia. MATERIALS AND METHODS: We performed a clinical and radiological assessment of 20 periacetabular osteotomies (19 patients), which had been followed up for > 1 year. The mean age of the patients at the time of surgery was 34.2 years (range, 18~50 years). The average follow-up period was 26.7 months (range, 12~85 months). The Harris hip score and range of motion were used for clinical evaluation. The radiologic measurements were evaluated using the acetabular angle, center-edge angle, acetabular depth, femoral head coverage, and medialization. RESULTS: The mean Harris hip score improved from 59.6 points to 96.4 points. The mean acetabular angle improved from 47.9 degrees to 26.4degrees. The mean center-edge angle increased from 14.2degreesto 41degrees. The acetabular depth increased from 176 to 242.7 The mean femoral head coverage increased from 63.3% to 95.4%. The following complications were noted: hematoma in 2 cases, temporary lateral femoral cutaneous nerve palsy in 3 cases, and superficial wound infection in 1 case. CONCLUSION: Periacetabular osteotomy is an effective surgical treatment for hip dysplasia.

Conservative Treatment of Nondisplaced Fifth Metatarsal Base Zone I and II Fractures / 대한족부족관절학회지

PURPOSE: Zone I fractures of the fifth metatarsal bone can generally be treated by conservative methods while both surgical and conservative methods are used for zone II fractures. However, the clinical results of conservative treatment have been rarely reported. The purpose of this study is to report the clinical results of conservative treatment for zone I and II nondisplaced fractures. MATERIALS AND METHODS: Between July 2007 and August 2008, consecutive thirty seven patients (38 fractures) with zone I and II fractures of the fifth metatarsal bone were treated with tolerable weight bearing and minimum duration of immobilization based on pain on weight bearing. We evaluated the duration of immobilization, time to clinical and radiographic union, and time to pre-injury activity level. RESULTS: Clinical and radiological union were achieved in all patients without any complications including malunion or nonunion. The mean duration of immobilization was 28.7 days. The mean 33.1 days and 48.9 days were required for clinical union and radiographic union respectively, after the initial injury. The mean time to pre-injury activity level was 4.8 months. CONCLUSION: Our study shows that the acute nondisplaced zone I, II fracture of fifth metatarsal bone can be treated effectively using tolerable weight bearing and minimum duration of immobilization, which is based on the pain on weight bearing.

Changes of Sagittal Alignment and Mobility of Lumbar Spine After Artificial Disc Replacement / 대한정형외과학회잡지

PURPOSE: To evaluate clinical outcomes of patients treated with artificial disc replacement (ADR) and to assess the capacity of this artificial disc replacement for preserving sagittal alignment and motion in the lumbar spine. MATERIALS AND METHODS: 24 patients (10 men and 14 women, with a mean age of 46.7 (range 37-65) years) who underwent ADR in one or two segments of lumbar spine and followed up more than 12 months (range, 12-23 months) were reviewed. The level of pain was evaluated using visual analog scale (VAS) for low back and gluteal pain and functional outcome was evaluated using Oswestry Disability Index (ODI). Sagittal alignment and mobility of the lumbar spine were assessed in standing radiographs and dynamic flexion-extension radiographs. RESULTS: The ODI improved from a mean of 33 (25-47) preoperatively to a mean of 11 (0-24) at the final follow-up. The VAS for lower back pain improved from 74 (50-100) to 23 (0-70) and for gluteal pain, the level improved from 52 (0-100) to 14 (0-60). The mean lordosis of the surgical segments was 16.7degrees preoperatively, 20.3degrees postoperatively, and 25.9degrees at final follow-up (p<0.05). The mean lordosis of the whole lumbar spine was 43.4degrees preoperatively, 36.9degrees postoperatively, and 49.4degrees at final follow-up (p<0.05). Range of motion of the operation segments was 13degrees preoperatively and 16.2degrees at the final follow-up, and that of the whole lumbar spine was 46.9degrees preoperatively and 48.1degrees at the final follow-up. CONCLUSION: These clinical results showed significantly less pain (VAS) and disability (ODI) after the ADR in the short term. In addition, the physiologic sagittal alignment and range of motion could be restored with ADR. The data from more patients and a longer follow-up will be needed to determine if these results can be maintained over the long term.

Three Cases of Primary Ovarian Pregnancy / 대한산부인과학회잡지

Primary ovarian pregnacy is a rare form of ectopic pregnacy of which an estimated overall incidence is highly variable, but improved diagnosis of acute hemoperitoneum of ovarian may reveal a higher incidence than reported earlier. Ovarian pregnancy is uaually accompanied with the rupture of the ovary and massive hemoperitoneum. It usually presents with abdominal pain, menstural irregularities, vaginal bleeding, a palpable adnexal mass and other symptoms which are very similar to those of tubal ectopic pregnacy and hemorrhgic corpus luteum cysts. Risk factors to ovarian pregnancy include a history of pelvic inflammatory disease (PID), prior pelvic surgery, and use of an intrauterine contraceptive devices (IUD). We have experienced three cases of ovarian pregnancy, which are presented with a brief review of the literature.

Three Cases of Primary Ovarian Pregnancy / 대한산부인과학회잡지

Primary ovarian pregnacy is a rare form of ectopic pregnacy of which an estimated overall incidence is highly variable, but improved diagnosis of acute hemoperitoneum of ovarian may reveal a higher incidence than reported earlier. Ovarian pregnancy is uaually accompanied with the rupture of the ovary and massive hemoperitoneum. It usually presents with abdominal pain, menstural irregularities, vaginal bleeding, a palpable adnexal mass and other symptoms which are very similar to those of tubal ectopic pregnacy and hemorrhgic corpus luteum cysts. Risk factors to ovarian pregnancy include a history of pelvic inflammatory disease (PID), prior pelvic surgery, and use of an intrauterine contraceptive devices (IUD). We have experienced three cases of ovarian pregnancy, which are presented with a brief review of the literature.