Modified Transosseous Wiring Technique for Neglected Fracture–Dislocation of the Proximal Interphalangeal Joint

BACKGROUND: Fracture–dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture–dislocations of the PIP joint. METHODS: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture–dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months). RESULTS: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8). CONCLUSIONS: For chronic fracture–dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.

The Spinal Instability Neoplastic Score (SINS) as a Surgical Decision-Making Tool for the Treatment of Spine Metastasis

OBJECTIVES@#To investigate the potential clinical use of the spinal instability neoplastic score (SINS) for determining the surgical strategy, especially regarding the need for anterior support.SUMMARY OF LITERATURE REVIEW: The SINS seems to enable an improved qualitative and quantitative assessment of spinal instability in patients with spinal metastasis.@*MATERIALS AND METHODS@#We retrospectively reviewed 69 consecutive patients who underwent surgical treatment for spinal metastasis. We assessed the patients' preoperative status with respect to each component of the SINS. Multiple logistic regression was performed to calculate odds ratios (ORs) representing the associations among SINS, age, Eastern Cooperative Oncology Group performance status, modified Tokuhashi score, as well as the preoperative Nurick grade variables and reconstruction of the anterior spinal column.@*RESULTS@#Among the 6 items in the SINS, those indicating the degree of collapse and alignment had significantly higher scores in those who underwent corpectomy and anterior support (p<0.001). Multiple logistic regression revealed that the total SINS was the only factor significantly associated with predicting whether anterior support should be performed (adjusted OR=1.595). Receiver operating characteristic (ROC) curve analysis suggested that a cut-off value of 10 points on the SINS scale could be used to decide whether anterior support following corpectomy should be performed (AUC=0.706).@*CONCLUSIONS@#The SINS, insofar as it assesses the degree of collapse and alignment, is a potentially useful tool for determining the surgical strategy in patients with spinal metastasis, especially for deciding upon the necessity of additional anterior support procedures.

The Spinal Instability Neoplastic Score (SINS) as a Surgical Decision-Making Tool for the Treatment of Spine Metastasis

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To investigate the potential clinical use of the spinal instability neoplastic score (SINS) for determining the surgical strategy, especially regarding the need for anterior support. SUMMARY OF LITERATURE REVIEW: The SINS seems to enable an improved qualitative and quantitative assessment of spinal instability in patients with spinal metastasis. MATERIALS AND METHODS: We retrospectively reviewed 69 consecutive patients who underwent surgical treatment for spinal metastasis. We assessed the patients' preoperative status with respect to each component of the SINS. Multiple logistic regression was performed to calculate odds ratios (ORs) representing the associations among SINS, age, Eastern Cooperative Oncology Group performance status, modified Tokuhashi score, as well as the preoperative Nurick grade variables and reconstruction of the anterior spinal column. RESULTS: Among the 6 items in the SINS, those indicating the degree of collapse and alignment had significantly higher scores in those who underwent corpectomy and anterior support (p<0.001). Multiple logistic regression revealed that the total SINS was the only factor significantly associated with predicting whether anterior support should be performed (adjusted OR=1.595). Receiver operating characteristic (ROC) curve analysis suggested that a cut-off value of 10 points on the SINS scale could be used to decide whether anterior support following corpectomy should be performed (AUC=0.706). CONCLUSIONS: The SINS, insofar as it assesses the degree of collapse and alignment, is a potentially useful tool for determining the surgical strategy in patients with spinal metastasis, especially for deciding upon the necessity of additional anterior support procedures.

Single Stage Reduction Operation for Treatment of Toe Macrodactyly in Skeletally Immature Patients / 대한정형외과학회잡지

Macrodactyly is one of the most difficult congenital anomalies to treat. Treatment of macrodactyly requires surgical intervention because it gives rise to esthetic, social, and functional disability including difficulty in wearing shoes. A myriad of surgical techniques has been introduced to reduce the size of macrodactyly. However, treatment of toe macrodactyly has not been spotlighted due to less significant functional and social issues compared with finger macrodactyly. We treated two patients with toe macrodactyly by single stage reduction operation.

The Co-occurance of Meningitis and Para-spinal Infection after Repetitive Procedural Treatment of the Spine: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a case of meningitis combined with paraspinal infection in a patients who underwent numerous surgeries for and repetitive procedural treatment of the spine. SUMMARY OF LITERATURE REVIEW: In patients with a history surgical and repetitive procedural treatment of the spine, one symptom of infection may be a fever with localized pain or tenderness along the spine. MATERIALS AND METHODS: A 69-year-old man was hospitalized due to pyrexia and myalgia. Eight years ago, he underwented spine surgery. After that, the patient underwent spinal intervention more than once per week in another hospital due to remaining pain. One week before his visit to the emergency room, myalgia and aggravation in the lower back arose. However, a paraspinal infection was not detected in a non-enhanced MRI. One day after admission, the patient showed signs of meningeal irritation signs and the the patient's mental state suddenly deteriorated. An emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. An enhanced MRI of the brain showed pachymeningeal enhancement. An enhanced MRI of the spine showed a small abscess formation on the left paravertebral back muscle, and bilateral psoas muscle. RESULTS: Serrtia marcescens was identified on blood cultures obtained upon admission. Since antibiotics were used to treat Serratia marcescens, the fever subsided, and the patient's mental status returned to normal. CONCLUSIONS: For patients with a history of repetitive procedural treatments of the spine, a fever should be acknowledged as a symptom in meningitis or other infectious conditions.

Brain Tumor Mimicking Cervical Spinal Disease: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of cerebellar tumor mimicking cervical spinal disease with neck pain for one year. SUMMARY OF LITERATURE REVIEW: Neck pain is one of the most common symptoms of cervical spinal disease. Neck pain in the cervical spine is usually accompanied by radiculopathic or myelopathic symptoms. Pain aggravated with neck motion is another point of differentiation. However, the differential diagnosis of neck pain is not always easy. MATERIALS AND METHODS: A 47-year-old woman presented with neck pain, without other symptoms of radiculopathy or myelopathy. The neck pain was not position-dependent and had exacerbated 1 week previously. Cervical magnetic resonance imaging (MRI) revealed a brain tumor in the cerebellum. RESULTS: The patient underwent surgical craniotomy and tumor resection. The neck pain improved after surgery. CONCLUSIONS: If neck pain cannot be explained by cervical pathological conditions, the possibility of other causes, including brain pathology, should be considered.

Results of Abductor Pollicis Longus Suspension Ligamentoplasty for Treatment of Advanced First Carpometacarpal Arthritis

BACKGROUND: Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty. METHODS: The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs. RESULTS: The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71degrees preoperatively to 82degrees postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously. CONCLUSIONS: The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.

Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty

PURPOSE: To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA). MATERIALS AND METHODS: We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed. RESULTS: Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05). CONCLUSIONS: The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.

Effectiveness of Selective Nerve Root Block for the Treatment of Radiculopathy in Degenerative Lumbar Scoliosis

STUDY DESIGN: Level III, Retrospective studies. OBJECTIVES: This study was conducted to evaluate the effects and usefulness of the selective nerve root block in advance for the Degenerative Lumbar Scoliosis patients, with radiating pain, who were scheduled for an operation. SUMMARY OF LITERATURE REVIEW: Selective nerve root block was introduced in 1971, by Macnab and it was used to make improvements for radiating pain, as a treatment of multiple lesions or a tool to help making a surgical decision, and to predict the result. After an introduction by Cooper, selective root block on degenerative sclerosis, with lower leg radiating pain, showed fine results on a short term follow-up and moderate to good results on long term follow-up. MATERIALS AND METHODS: Between January 2005 to December 2009, 47 cases were selected from the patients, who underwent selective nerve root block, before the operation. The mean follow-up period was 38.4 months and the mean age was 67.1 years. The patients were divided into the operation group and the only selective nerve root block group. The treatment results in the SNRB group and the operation group were analyzed using Kim's criteria and the Visual Analog Scale score. The groups were radiologically evaluated for the neural compression rate. RESULTS: Among the 47 cases that were scheduled for an operation, 30 cases did not proceed to the operation. The average VAS score for the selective root block group and the operation group were 7.56 and 8.12, at the preoperative state and the preinjection state, respectively. After the selective nerve root block and surgical treatment, the scores were 3.71 and 2.64 at 1year follow up, respectively. There was no correlation with statistical significance between the initial VAS score and the degree of stenosis noted in the MRI (P>0.05). There was no statistical significant correlation between the initial relief from selective nerve root injections and the degree of stenosis noted in the MRI (P>0.05). However, there was a correlation with statistical significance between the operation rate and the degree of stenosis noted in the MRI (P<0.05). CONCLUSION: Selective nerve root block is considered to be an effective treatment for the Degenerative Lumbar Scoliosis patients with radiating pain, who are scheduled for an operation.

Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

STUDY DESIGN: Level III, retrospective studies. OBJECTIVES: This study is conducted to evaluate the effect and usefulness of ultrasound guided facet block for the outpatients who complained of chronic lower back pain. SUMMARY OF THE LITERATURE REVIEW: Facet joint syndrome was introduced in 1976, by Mooney V. It was considered to be one of the major causes of low back pain. MATERIALS AND METHODS: Between October 2009 to March 2011, 98 cases were selected from the outpatients who complained of chronic lower back pain for more than 3 months. The patients had no surgery history and did not complain of neuromuscular symptoms, and they had more than three times outpatient care at least and could be followed up for 1 year. The patients were divided into three groups; first was the ultrasound guided facet block group (27 cases), second was the Fluoroscopy guided facet block group (39cases) and third was the conservative group (32 cases).The clinical results were analyzed using Kim's criteria and the Visual Analog Scale score, ODI score, Physician's global assessment (subjective), Patient's global assessment (Objective). RESULTS: The VAS score was improved from an average of 7.75+/-1.5 to 4.47+/-2.4 in the ultrasound guided facet block group, and from 7.81+/-1.4 to 4.39+/-2.6 in the Fluoroscopy guided facet block group, and from 7.87+/-1.3 to 6.24+/-2.1 in the conservative group. The VAS score, Kim's criteria, ODI score, Physician's global assessment (subjective), and Patient's global assessment (Objective) showed statistically significant improvement in the ultrasound guided facet block group and Fluoroscopy guided facet block group. CONCLUSION: In the outpatient clinics, comparing with the group that underwent conservative treatment with medication, the group treated with ultrasound for block could have better results in clinical improvement.