Breakage of Reamer during Tibia Intramedullary Nailing: A Case Report

The reamer crack, followed by breakage at its distal part occurred during intramedullary nailing of tibial shaft fracture. The broken reamer was trapped in the intramedullary canal, making it very difficult to pull out. We successfully extracted the broken reamer by retrograde impaction through the fracture site and completed intramedullary nailing procedure. Thus, we present this case with a review of the literature.

Diabetic Muscle Infarction in Thigh / 대한정형외과학회잡지

Although ischemia in the distal areas of the limbs due to vascular occlusion is a well recognized systemic condition in patients who have diabetes, infarction of skeletal muscle, not associated with gangrene, is exceedingly rare and the paucity of published cases focused on this condition makes it difficult to determine the most appropriate methods of diagnosis and treatment. The authors encountered a case of diabetic muscle infarction with exquisitely tender swelling on the anteromedial aspect of thigh and herein report the diagnostic work-up and treatment performed on the patient.

Early Surgical Repair of Acute Complete Rupture of the Proximal Hamstring Tendons

Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed.

Lumbar Posterolateral Fusion Using Demineralized Bone Matrix / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the efficacy of demineralized bone matrix as a bone graft extender in lumbar posterolateral fusion with cases using an autogenous iliac bone graft. SUMMARY OF LITERATURE REVIEW: Since demineralized bone grafts were introduced for bone graft extension in 1995, many types of demineralized bone matrices have been used with improved fusion rates. MATERIALS AND METHODS: From October 2004 to December 2005, demineralized bone matrices were used as iliac bone graft extenders in 49 cases (Group I) of lumbar posterolateral fusion, compared with 50 cases receiving autogenous grafts (Group II) similar in age, bone marrow density, and number of fusion levels. Fusion status was graded by the Lenke classification and data was analyzed using a chi-square test through SPSS v.10.0. RESULTS: Group I had Lenke A in 7 cases (14.3%), B in 21 cases (42.9%), C in 15 cases (30.6%), and D in 6 cases (12.2%). Group II had Lenke A in 9 cases (18.0%), B in 26 cases (52.0%), C in 12 cases (24.0%), and D in 3 cases (6.0%). There was no statistical difference in fusion rate. CONCLUSION: Demineralized bone matrix could be used as a bone graft extender in lumbar posterolateral fusion.

Lumbar Spinal Stenosis Accompanied by Severe Osteoarthritis of Knee: Comparison between Staged Operations and Same-day Operations / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To compare the peri-operative morbidity of patients who undergo same-day operations for lumbar spinal stenosis accompanied by severe osteoarthritis of knee with those who undergo staged operations . SUMMARY AND LITERATURE REVIEW: There is no report on the peri-operative morbidity of same-day operations for patients who have a concurrent lumbar spinal stenosis and severe osteoarthritis of the knee, even though elective surgery for lumbar spinal stenosis or total knee arthroplasty are safe procedures. MATERIALS AND METHODS: From January 1996 to December 2005, 11 patients who underwent staged operations for lumbar spinal stenosis and concomitant osteoarthritis of the knee (Group I) and 14 patients who underwent total knee arthroplasty and lumbar spinal decompression and fusion on the same-day (Group II) were compared in terms of the operative time, blood loss, perioperative complications and admission days. The data was analyzed statistically using a chi-square test through SPSS v.10.0. RESULTS: The mean surgery time in groups I and II was 266+/-34.4 minutes and 258+/-54.2 minutes, respectively. The estimated blood loss during operation of groups I and II was 1055+/-229.6 and 925+/-174.0. There was no statistical differences between the two groups. There were no life-threatening complications in any group. The admission period for group I and group II were 41.0+/-6.05 days and 30.1+/-5.10 days respectively, but there was no statistical significance. CONCLUSION: There was no difference in the surgical time, estimated blood loss, and complications between the group that underwent the staged operations and the group that underwent same-day operations. A possible surgical option is to perform both procedures on the same day.

External Fixator and External Fixator Supplemented with K-wire in the Treatment of Distal Radius Fractures

PURPOSE: To evaluate the differences of the outcome between external fixator and external fixator supplemented with K-wire in the treatment of distal radius fractures. MATERIALS AND METHODS: Twenty-one cases which underwent external fixation (external fixation group) and 28 cases, external fixation supplemented with K-wire (external fixation with K-wire group), were analyzed. Radial length, radial inclination and volar tilt were compared in preoperative, immediate postoperative radiographs, and radiographs after removal of external fixator between two groups. And functional outcome including flexion, extension, pronation and supination of wrist were compared between two groups and wrist pain, as well. RESULT: Radial length and radial inclination in the postoperative radiographs and radiographs after removal of external fixator showed no difference between two groups, but volar tilt of external fixation group measured 2.1+/-4.2 degrees, 1.3+/-3.8 degrees and external fixation with K-wire group, 8.8+/-2.3 degrees, 8.5+/-2.4 degrees respectively, so that external fixation with K-wire group showed better reduction and maintenance. Wrist flexion and extension about postoperative 6 months measured 25.6+/-8.2 degrees, 25.1+/-10.2 degrees, respectively, in external fixation group and 42.5+/-15.2 degrees, 33.6+/-9.5 degrees in external fixation with K-wire group, so that external fixation with K-wire group showed better functional results. CONCLUSION: In the treatment of distal radius fractures, to obtain better reduction and function result, external fixations supplemented with K-wire need to be taken into consideration.

Radiolucent Zones Surrounding Transpedicular Screws After Lumbar Spinal Instrumented Fusion / 대한척추외과학회지

STUDY DESIGNS: A retrospective study for radiographic and clinical assessment. OBJECTIVES: To clarify the clinical significance of the radiolucent zones surrounding transpedicular screws that occasionally appears following lumbar spinal instrumented fusion. SUMMARY OF LITERATURE REVIEW: that the formation of radiolucent zones surrounding pedicular screws are significantly frequent after transpedicular fixation. MATERIALS AND METHOD: 88 cases, age 50 or older, which underwent lumbar spinal fusion with transpedicular screws, between January 1999 and December 2002, were included in this investigation. The postoperative radiographs of all patients were analyzed for radiolucent zones around the transpedicular screws. These radiolucent zones were evaluated in relation the number of fusion levels, the existence of osteoporosis, and the fusion status and satisfaction rates. RESULTS: Radiolucent zones were observed in 30 cases (34%, 30/88), 13 (43%, 13/30) of which disappeared during the follow-up period. The average number of fixation levels in the cases with and without radiolucent zones were 2.33 (range 1-4, SD 0.94) and 1.74 (range 1-4, SD 0.82), respectively. Osteoporosis was found to accompany 43.3 and 20.7% of the cases with and without radiolucent zones, with the latter cases showing a statistically significant higher fusion rate and greater patient satisfaction. CONCLUSION: Radiolucent zones, a frequent finding following pedicle screw fixation, resulted in less favorable outcomes. Surgeons should be alert to radiolucent zones and their transformation during follow-up. Methods for improving the stability of the interface between the pedicle screw and vertebral bone will require further research.

Operative Treatment of Diaphyseal Forearm Fracture in Children / 대한정형외과학회잡지

PURPOSE: This article presents a retrospective study of treatment modality for children's diaphyseal forearm fractures. MATERIALS AND METHODS: A total 148 forearm fractures (October. 1997-October. 2001) were examined, of which 19 required operation, a teenager whose growth plate had closed was excluded from the study. 17 patients required intramedullary K-wire fixation, 2 patients required open reduction and plate fixation. Time to radiologic union, complications at the last follow up were evaluated. RESULTS: In 17 intramedullary K-wire fixation patients, the average time to union was 6 weeks and complications including 1 ulnar shortening, 1 pin infection, 1 osteomyelitis, which developed due to a patient's mistake. In 2 plating patients, average union time was 6 weeks with no complications. CONCLUSION: We think that the treatment method of pediatric forearm fracture should be decided upon based on the fracture site and type of fracture. Intramedullary K-wiring for diaphyseal forearm fracture is an effective method and we recommend that the wire is inserted across the physis in cases of diaphyseal fractures of the forearm bone close to the metaphysis. If the diaphyseal forearm fracture is refracture or a bony gap is shown at the fracture site, open reduction and plate fixation is needed. If reduction and fixation of the bone alone in a diaphyseal fracture of both forearm bones restores the stability of other fracture, fixation of the other bone can be avoided.

Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus / 대한척추외과학회지

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. SUMMARY OF LITERATURE REVIEW: There are controversies in the treatment results of diabetic patients. OBJECTIVE: To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. MATERIALS AND METHODS: We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, 1998. In all patients, duration of symtoms, sensory and motor deficits, comorbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. RESULTS: Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. CONCLUSION: The outcome of surgery was similary successful in the two groups.

Patellar metastasis from Squamous Cell Carcinoma of the Larynx: A Case Report / 대한정형외과학회잡지

Metastatic tumors of the patella are rare, espicially metastasis of the head and neck carcinoma to the patella is exceedingly rarer still. We experienced a case of patellar metastatic cancer from laryngeal squamous cell carcinoma and report the clinical, radiographic and pathologic findings in detail.

Clinical Implications of Bone Bruises on MRI in Acute Traumatic ACL or PCL Injury / 대한정형외과학회잡지

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.

Partial Fibulectomy for Non / 대한정형외과학회잡지

One may sometimes complicated with non-union of the tibia with intact fibula or comparatively early united fibular fracture during the cause of treatment of crural fractures. So that the fibula is to strut the tibial fragment preventing effective contact. Several authors have sporadically reported the removal of a portion of fibula may increase potential compression force across the tibial fracture site and promote bony union of non-delayed union of the tibia. Partial fibulectomy was performed in 9 patients with established nonunion of the tibia at National Medical Center from 1975 to 1982. The results were as follows: 1. Healing occurred in 8 of the 9 cases, and average time to union was 7.4months after fibulectomy. 2. In one case performed B-K amputation due to intractable infection after partial fibulectomy. 3. The average shortening of the involved lower limb was about 1.9cm. 4. All cases did not have significant symptoms at the fibulectomy site after union. 5. Partial fibulectomy proved to be a relatively effective method for the treatment of nonunion of the tibia.

A Clinical Study of Conservative Treatment on the Tibial Shaft Fracture / 대한정형외과학회잡지

One hundred and two patients with fracture of the tibial shaft were treated conservatively at the Department of Orthopaedic Surgery, National Medical Center from 1977 to 1982. In this article, we have analyzed early and late influencing factors upon healing process of the tibial shaft fractures treated with conservative methods. Early factors: Age, fracture type, initial displacement, comminution, open fracture, ipsilateral fibular fracture and associated injuries. Late factors: Interval between accident & final manipulation, distraction of fracture site after skeletal traction, and condition of final apposition. Also, we had the result that the mean healing time of tibial shaft fx. was 17.9 weeks by conservative treatment.

Multifocal Eosinophilic Granuloma without Extraskeletal Involvement: A Case Report / 대한정형외과학회잡지

A very rare case of multifocal eosinophilic granuloma without extraskeletal involvement in 35 year-old ma was experienced. The patient was admitted for the painful swelling of the right clavicular region and was treati with curettage and autograft of iliac bone. Five months later newly developed the pain in the trochanteric lesion left femur without fever, and also was confirmed as the same lesion. Both lesions were treated with curettage and iliac bone graft, and were followed by radiotheraphy. According to the pathological study, those lesions were confirmed as the multifocal eosinophilic granuloma.

Extraskeletal Neoplasm Resembling Ewing's Sarcoma: Case Report / 대한정형외과학회잡지

Ewing's sarcoma had never been described as a primary tumor outside bone, although other malignant skeletal tumors, such as osteogenic sarcoma & chondrosarcoma, are known to arise from extraskeletal soft tissues. In 1975, Angervall & F.M. Enzinger reported 39 cases of small, round or oval cell sarcomas occuring in the soft tissues and considered histologically indistinguishable from Ewing's sarcoma of bone. Recently, We experienced one case of extraskeletal neoplasm resembling Ewing's sarcoma of bone which it was located deeply in the calf area of young female patient and the case review has been followed until the death, approxlmately 10.5 months after removal.

The Result of Compression-Plate Fixation in Forearm Fractures / 대한정형외과학회잡지

We meet much difficult problem to solve in the treatment of the forearm fractures which are not encountered in the treatment of fractures of the other long bone and there are many reports on the results of treatment of forearm fractures and many methods have been introduced. In the late 1950's ASIF compression plate was invented and developed by Muller, Allgower, and Willenegger and it has shown excellent union rate and functional results in the treatment of forearm fractures. From Jan. 1971 to Dec. 1979, we have experienced 71 cases of fresh or old forearm fractures treated by different methods and devices and among them, 53 patients, those were treated with compression plate and other various internal fixation devices, were possible to trace for more than 3 months. The Author divided the traceable patients into two groups, the one was the group treated with compression plate and the othtr one was the group treated with other various internal fixations, and compared the results in the aspect of healing time and functional results. The results were as follows; 1. Among 71 patients, 45 patients (36.6%) were fresh and 26 were old cases. Of 61 adult patients 21 cases (34.4%) exhibited severe soft tissue injury due to crushing machinary injury. 2. There was 24 (33.8%) cases of open fractures and the most common fracture site was middle one-third of both radius and ulna. 3. The period between operation and exercise was 7.3 weeks in fresh cases which were treated with compression-plate fixation and 10.3 weeks in old cases with other fixation devices. 4. The time of radlological union was comparatively rapid in compression-plate fixation group, acute cases and radial fractures when compared it with those treated with other fixation devices, old cases and ulnar fractures, respectively. Radiological union time in average was as follows; Radius, compression-plate fixation: 12.1 weeks ulna, compression-plate fixation: 12.4 weeks redius, other fixation devices 14.9 weeks ulna, other fixation devices 15.5 weeks 5. By Anderson's functional criteria, the ratio of excellent or good results was as follows, Acute compression-plate fixation: 87% Acute, other fixation devices 67% Old, Compression-plate flxation: 67% Old, Other fixation devices 23% 6. Achieved bony union in all cases in compression-plate fixation group and experienced 3 cases of non-union in the group treated with other fixation devices. Among 3, two cases of non-union were due to post-operative infection and technical failure and the other one was a solitary ulnar fracture which was treated with rush pin.