Effect of Weekly Teriparatide Administration Followed by Percutaneous Balloon Kyphoplasty on Post-Menopausal Osteoporotic Compression Fracture Treatment / 대한정형외과학회잡지

Purpose@#This study examined the effect of the 3 months use of weekly teriparatide on fracture healing, complications, quality of life improvement, and change in bone turnover markers on postmenopausal osteoporotic vertebral fracture patients who received percutaneous balloon kyphoplasty. @*Materials and Methods@#Using a retrospective study design, 64 patients with osteoporotic vertebral fractures with T-scores≤-2.5, and anterior vertebral compression rates ≥30% were included in this study. 19 patients received weekly teriparatide for three months after kyphoplasty (TPTD group) and 45 patients received calcium and vitamin D supplements (control group). The changes in the anterior vertebral compression rate, rate of adjacent vertebral fracture, visual analogue scale/Oswestry Disability Index (VAS/ODI) score, and bone turnover markers were analyzed statistically. @*Results@#The changes in anterior vertebral compression rate showed significant differences at the 1-month (p=0.002) and 6-month followup (p<0.05, t-test, and two-way mixed ANOVA). The VAS scores showed a significant difference at the 3-month and 6-month followup (p<0.05). The ODI score showed a significant difference at the 3-month and 6-month period (p<0.05). An adjacent vertebral fracture occurred 18.8% (3 cases) in the TPTD group, and 21.6% (8 cases) in the control group, respectively (odds ratio=0.87). Osteocalcin showed a significant difference at 6 month (p=0.04). @*Conclusion@#Weekly teriparatide after percutaneous balloon kyphoplasty has beneficial effects on vertebral body height loss, pain, quality of life improvement, and bone formation.

Intratendinous Tophaceous Gout Mimicking Cellulitis after Achilles Tendon Repair / 대한정형외과학회잡지

A diagnosis of gout is often straightforward because gout has well known clinical presentations, laboratory analyses, and radiologic features. On the other hand, gout can mimic other diseases by showing a range of atypical clinical manifestations. This paper reports a 35-year-old male with no prior history of gout who developed tophaceous gout at his previously repaired Achilles tendon 11 years after surgery. He was initially misdiagnosed with cellulitis because of his atypical clinical features. This case is presented with a review of the relevant literature.

Minimally Invasive Spine Surgery versus Open Posterior Instrumentation Surgery for Unstable Thoracolumbar Burst Fracture

Methods@#We enrolled 40 patients who underwent either MISS (M group, 20 patients) or open posterior instrumentation surgery (O group, 20 patients) for the treatment of traumatic unstable burst fractures. Clinical outcomes were evaluated based on postoperative back pain, operation time, blood loss, hospital stay duration, and perioperative complications. For radiologic evaluation, preoperative magnetic resonance imaging and plain radiography were performed before and after the surgery to evaluate the changes in the kyphotic angle and fracture union. @*Results@#The change in the kyphotic angle was −8.2°±5.8° in the M group and −8.0°±7.8° in the O group. No significant difference was noted in terms of the change in the kyphotic angle (p=0.94, t-test) after 12 months of surgery. The Visual Analog Scale score was 1.5±0.7 points in the M group, while it was 5.2±1.4 points in the O group. In the M group, back pain has significantly decreased (p<0.01, t-test). The estimated blood loss was 195.5 mL in the M group and 1,077.5 mL in the O group; the operation time was significantly decreased in the O group from 290.7 to 120.7 minutes in the M group (p<0.05, t-test) (p=0.36, t-test). The average duration of hospital stay was 36.0 days in the M group and 41.9 days in the O group (p=0.36, t-test). @*Conclusions@#For the treatment of unstable burst fractures, MISS showed significant differences in terms of postoperative back pain, operation time, and blood loss as compared to open posterior instrumentation surgery.

Lumbar Juxtafacet Cyst Treated with Direct Needle Aspiration Under the Guidance of Image Intensifier / 대한정형외과학회잡지

A lumbar juxtafacet cyst is a rare disease that causes low back pain, radiculopathy and neurological claudication by compressing the nerve roots. A 34-year-old male complained of severe low back pain and radicular pain in the right lower extremity. Magnetic resonance images revealed a cyst at the lateral recess of the spinal canal between the L3-4 disc and posterior facet joint that extended to the L4 body level. Under the guidance of an image intensifier, needle aspiration of the cyst was performed, which extracted 1.5 ml of serous, yellowish colored fluid. After the aspiration, the symptoms subsided dramatically. The follow-up magnetic resonance images showed no recurrence of the cyst. To the best of the author’s knowledge, there are no reports of lumbar juxtafacet cyst treated with needle aspiration in Korea. This case is reported with a review of the relevant literature.

Acute Compartment Syndrome Induced by Rhabdomyolysis Due to Antipsychotic Drug Overuse / 대한정형외과학회잡지

A 49-year-old male was found unconscious at his accommodation and visited the emergency room. He was on antipsychotic and antidepressant drugs (vortioxetine hydrobromide, mirtazapine, sertraline hydrochloride, quetiapine, and alprazolam) for schizophrenia and major depression. At the time of discovery there were signs of overdose of the drugs around the patient. A physical examination revealed, pain, pallor, and edema in the left buttocks and lateral thigh. Active ankle movements below the left ankle were not possible and sensations in the tibia and peroneal nerves were lost. The pressure in the buttock compartment was measured at 42 mmHg. Magnetic resonance imaging revealed edema and high intensity signals in the left hip muscles and surrounding soft tissue. An emergency fasciotomy was performed and partial restoration of the lower extremity sensation and muscle strength were achieved after 24 hours.

Cauda Equine Syndrome Induced by Spinal Epidural Hematoma due to a Low-Energy Osteoporotic Vertebral Fracture / 대한정형외과학회잡지

Spinal epidural hematoma (SEH) can occur naturally or traumatically and is most common in patients with an underlying disease of the vascular structure or coagulation disorder. Most SEHs occur naturally for no apparent reason, and epidural hematoma caused by trauma is less common, comprising 1.0%–1.7% of total spinal injuries. Few reports of SEH induced cauda equine syndrome resulting from low-energy injury caused by osteoporotic vertebral compression fractures are available. The authors experienced a case of delayed SEH after hemorrhage due to a low-energy injury in an elderly patient. No cases in Korea have been reported; therefore, this case is reported with a review of the relevant literature.

The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

OBJECTIVES@#To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope.SUMMARY OF LITERATURE REVIEW: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6–7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration.@*MATERIALS AND METHODS@#Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25).@*RESULTS@#In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2–3, 3.00 (±0.76) in C3–4, 3.02 (±0.91) in C4–5, 3.37 (±0.95) in C5–6, and 2.95 (±0.98) in C6–7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2–3, 2.38 (±0.60) in C3–4, 2.62 (±0.60) in C4–5, 2.82 (±0.72) in C5–6, and 2.41 (±0.74) in C6–7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3–4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232–17.601; p<.001).@*CONCLUSIONS@#Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope. SUMMARY OF LITERATURE REVIEW: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6–7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration. MATERIALS AND METHODS: Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25). RESULTS: In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2–3, 3.00 (±0.76) in C3–4, 3.02 (±0.91) in C4–5, 3.37 (±0.95) in C5–6, and 2.95 (±0.98) in C6–7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2–3, 2.38 (±0.60) in C3–4, 2.62 (±0.60) in C4–5, 2.82 (±0.72) in C5–6, and 2.41 (±0.74) in C6–7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3–4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232–17.601; p<.001). CONCLUSIONS: Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

Lisfranc Joint Injuries: Diagnosis and Treatment

Injuries to the Lisfranc joint are relatively rare, but they are often misdiagnosed or inadequately treated, resulting in poor long-term outcomes. Understanding of anatomical structure and injury mechanism, careful clinical and radiographic evaluations are needed to recognize and treat Lisfranc joint injuries. In this article, we review the anatomy, biomechanics, injury mechanisms, injury classification, clinical presentation, radiographic evaluation, treatment, outcome, and complications of Lisfranc joint injuries.

Unstable Intertrochanteric Fracture Treated with ITST: A Comparative Study between Groups with and without Comminution of Greater Trochanter

PURPOSE: To evaluate whether the radiological and clinical results of treatment with intertrochanteric/subtrochanteric (ITST) nail on unstable intertrochanteric fractures are combined with comminution of the greater trochanter or not. MATERIALS AND METHODS: We reviewed the results on 210 cases of unstable intertrochanteric fractures (grouped 88 patients with comminution of greater trochanter [GT] and 122 patients without comminution of GT) treated with ITST nail from January 2007 to October 2011, which was to be followed-up for more than 12 months. RESULTS: The mean union time was 15.2 weeks in the study group (combined with comminution of GT). The mean union time was 14.7 weeks in control group (no comminution of GT). The lag screw sliding was 8.7 mm in the study group and 7.2 mm in the control group. Changes of neck-shaft angle was 4.2degrees in study group and 4.1degrees in control group. Tip-apex distance was 17.4 mm in study group and 16.4 mm in control group. The complications were 4 cases in each study group and control group. The clinical results checked by Skovron recovery scores decreased similarly in both groups, 73.7% in study group and 76.5% in control group. There were no significant differences in both groups according to radiological and clinical results. CONCLUSION: The comminution of great trochanter does not affect on the radiological and clinical results when using the ITST nail of unstable intertrochanteric fractures.

Quality of Life in Patients with Osteoporotic Vertebral Fractures

STUDY DESIGN: A case-control study. PURPOSE: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women with osteoporotic vertebral fractures, compared with a control group. OVERVIEW OF LITERATURE: Osteoporotic vertebral fractures are a major cause of morbidity among postmenopausal women. There have been many reports of a decrease in the quality of life in patients with osteoporotic vertebral fractures. However,few reports have analyzed which dimensions contribute to the decline in quality of life. METHODS: One thousand five hundred forty-five postmenopausal women aged 50 years and older from 17 study sites in nationwide hospitals were in enrolled in the study (between April 2008 and January 2009). HRQL was measured using the European Quality of Life 5 Domains (EQ-5D), and visual analogue scale (VAS). RESULTS: The average VAS of the case group was 57.80, and that of the control group was 64.10 (p=0.001). All domains of the EQ-5D score were significantly worse in the case group (p=0.001). Among the case group, the average VAS of the 559 patients (45%) who were operated on was 56.8, and that of the remaining 680 patients (55%) who were treated conservatively was 58.6 (p=0.135). Among the case group, the averages of each EQ-5D domain of the 559 patients (45%) who were operated on were: 1.87 in mobility, 1.81 in self-care, 1.99 in usual activities, 2.11 in pain, and 1.62 in anxiety or depression. Those of the 680 patients (55%) who were treated conservatively were: 1.72 in mobility, 1.60 in self-care, 1.76 in usual activities, 1.98 in pain, and 1.57 in anxiety or depression. Except for the domain of anxiety or depression, scores for the other domains were all significantly worse in the patients who were operated on (p=0.001). CONCLUSIONS: Health related quality of life in the patients with osteoporotic vertebral fractures was significantly worse in both the EQ-5D domains and VAS. Among the osteoporotic vertebral fracture patients, the patients who were operated on had a worse quality of life in EQ-5D.