Acute Compartment Syndrome Which Causes Rhabdomyolysis by Carbon Monoxide Poisoning and Sciatic Nerve Injury Associated with It: A Case Report / 대한고관절학회지

Rhabdomyolysis is most frequently caused by soft tissue injury with trauma to the extremities. Non-traumatic rhabdomyolysis may be caused by alcohol or drug abuse, infection, collagen disease, or intensive exercise, but incidence is low. In particular, rhabdomyolysis resulting from carbon monoxide poisoning is especially rare. If caught before death, carbon monoxide poisoning has been shown to cause severe muscle necrosis and severe muscle damage leading to acute renal failure. In cases of carbon-monoxide-induced rhabdomyolsis leading to acute compartment syndrome in the buttocks and sciatic nerve injury are rare. We have experience treating patients with acute compartment syndrome due to rhabdomyolysis following carbon monoxide poisoning. We report the characteristic features of muscle necrosis observed during a decompression operation and magnetic resonance imaging findings with a one-year follow-up in addition to a review of the literature.

Acute Compartment Syndrome Which Causes Rhabdomyolysis by Carbon Monoxide Poisoning and Sciatic Nerve Injury Associated with It: A Case Report / 대한고관절학회지

Rhabdomyolysis is most frequently caused by soft tissue injury with trauma to the extremities. Non-traumatic rhabdomyolysis may be caused by alcohol or drug abuse, infection, collagen disease, or intensive exercise, but incidence is low. In particular, rhabdomyolysis resulting from carbon monoxide poisoning is especially rare. If caught before death, carbon monoxide poisoning has been shown to cause severe muscle necrosis and severe muscle damage leading to acute renal failure. In cases of carbon-monoxide-induced rhabdomyolsis leading to acute compartment syndrome in the buttocks and sciatic nerve injury are rare. We have experience treating patients with acute compartment syndrome due to rhabdomyolysis following carbon monoxide poisoning. We report the characteristic features of muscle necrosis observed during a decompression operation and magnetic resonance imaging findings with a one-year follow-up in addition to a review of the literature.

Spinal Canal Migration of a K-Wire Used for Fixation of a Distal Clavicular Fracture / 대한정형외과학회잡지

We report on migration of the K-wire, which is used in fixation of a distal clavicular fracture, to the spinal canal. A 39-year-old male was admitted to our hospital with pain in his right shoulder. He had undergone surgery for a right distal clavicular fracture (in another hospital) ten years ago. Plain radiographs showed an old right distal clavicle fracture fixed with three K-wires. One of the three K-wires had broken, and the broken K-wire had migrated to the spinal canal. Fortunately, the patient exhibited no neurological symptoms, however, there was a possibility of fatal complications, such as spinal cord injury. Therefore, we recommend close follow-up for patients who undergo repair of a distal clavicular fracture is fixed using a K-wire, with use of x-ray until the K-wire has been removed.

Useful Method for Neutral Positioning of the Femoral Stem in Cementless Total Hip Arthroplasty / 대한고관절학회지

PURPOSE: The aim of this study was to evaluate the usefulness of a method for positioning the femoral stem in neutral position refer to the measured value of "lateral distance" in pre-operative templating and the femoral stem position post-operatively. MATERIALS AND METHODS: A total of 81 hips in 76 patients underwent cementless total hip arthroplasty between March 2008 and April 2012 using the C2 stem (Lima Corporate S.P.A, Udine, Italy). We measured the perpendicular distance from the lateral outermost part of the greater trochanter to the lateral outermost part of the femoral stem (lateral distance, LD) in pre-operative templating. We aimed to insert the femoral stem in neutral position by comparing LD measured intra-operatively. We evaluated the position of the femoral stem on post-operative plain radiography. We compared the result of post-operative re-measurement of the LD with that of pre-operative measurement. RESULTS: In all of the 81 cases, the femoral stem was inserted in neutral position, defined as the femoral stem position within 3degreesvalgus or varus. The average angle of the inserted femoral stem was 1.20degrees(0.003-2.85degrees). LD measured in preoperative templating was 15.6 mm(10-21.5 mm), and it showed no correlation ratio with LD; LD re-measured post-operatively was 15.9 mm(10.3-23.5 mm) (P=0.781). CONCLUSION: Measuring LD pre-operatively and using the value intra-operatively is an effective method for insertion of the femoral stem in neutral position.

Clinical Outcome after Surgical Treatment of the Central Disc Herniation / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVE: We wanted to to assess the clinical features of central disc herniation and the differences in the clinical outcome between discectomy and fusion. Summary of the literature REVIEW: Central disc herniation appears to have poorer results than does posterolateral herniation in the literature. In most reports, persistent back pain was often found after discectomy and it may be related to the anatomical characteristics of the posterior longitudinal ligament in the lower lumbar region. MATERIALS AND METHOD: Central disc herniation was defined as a herniated mass that occupied more than 50% of the spinal canal and the maximal deviation of the apex was within 2 mm from the midline. 27 patients were operated on with using these criteria and they were subdivided by the operation methods. Laminotomy and discectomy was done in 20 patients. Posterior lumbar interbody fusions were performed on the other 7 patients with significant back pain. We compared the neurological improvement and the clinical outcomes. RESULTS: Preoperative back pain was significantly more frequent in the PLIF group. The other clinical features were significantly improved in the both groups, but the differences were not statistically significant. Satisfactory clinical outcomes were obtained in 70 percent of the discectomy group and in 100 percent of the PLIF group, respectively, but this was not significantly different. CONCLUSION: The presence of significant back pain was considered as an indication for performing fusion in our series. The clinical outcome of central disc herniation after PLIF was slightly better than that of discectomy in spite of the preoperative back pain in the PLIF group, but the difference was not statistically significant.