Traumatic Lumbar Plexopathy by Seat Belt Injury

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss an extremely uncommon cause of lumbar plexopathy seat belt injury. SUMMARY OF LITERATURE REVIEW: For patients who undergo traffic accidents, most cases of seat belt injury cause trauma to the lower torso. Seat belt injury is associated with variable clinical problems such as vascular injury, intestinal injury (perforation), vertebral injury (flexion-distraction injury), chest wall injury, diaphragmatic rupture/hernia, bladder rupture, lumbosacral plexopathy, and other related conditions. MATERIALS AND METHODS: A 38-year-old male truck driver (traffic accident victim) who suffered monoplegia of his right leg due to lumbar plexus injury without spinal column involvement. Injury to a lumbar plexus and the internal vasculatures originated from direct compression to internal abdominal organs (the iliopsoas muscle and internal vasculatures anterior to the lumbar vertebrae) caused by the seat belt. We have illustrated an extremely uncommon cause of a neurologic deficit from a traffic accident through this case. RESULTS: Under the impression of traumatic lumbar plexopathy, we managed it conservatively, and the patient showed signs of recovery from neurologic deficit. CONCLUSIONS: We need to review the lumbar plexus pathway, in patients with atypical motor weakness and sensory loss of the lower extremities which are not unaccompanied by demonstrable spinal lesions. Therefore, close history taking, physical examination and comprehension of injury mechanism are important in the diagnosis.

Congenital Anomaly of the Atlas Misdiagnosed as Posterior Arch Fracture of the Atlas and Atlantoaxial Subluxation

Partial or complete absence of the posterior arch of the atlas is a well-documented anomaly but a relatively rare condition. This condition is usually asymptomatic so most are diagnosed incidentally. There have been a few documented cases of congenital defects of the posterior arch of the atlas combined with atlantoaxial subluxation. We report a very rare case of congenital anomaly of the atlas combined with atlantoaxial subluxation, that can be misdiagnosed as posterior arch fracture.

The Inferior Accessory Ossicle of the Anterior Arch of the Atlas Misdiagnosed as Anterior Arch Fracture: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a very rare case of the inferior accessory ossicle of the anterior arch of the atlas misdiagnosed as anterior arch fracture. SUMMARY OF LITERATURE REVIEW: It is necessary to know the existence of inferior accessory ossicle of the anterior arch of the atlas, even though it is extremely rare. MATERIALS AND METHODS: A 29-year-old woman was referred to our emergency service unit with symptoms of neck pain and scalp laceration, after being involved in a car accident. She was diagnosed as the inferior accessory ossicle of the anterior arch of the atlas, by multiple diagnostic mordalities. RESULTS: The symptom of neck pain was relieved spontaneously, and her symptom has been relieved at her latest visit, as a follow up within 3 months. CONCLUSIONS: It is important to be aware of cervical anatomical variants because we commonly confuse it with other pathologic conditions, such as a fracture and thus, misdiagnose the condition.

Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Spondylolisthesis and Degenerative Segmental Instability

STUDY DESIGN: This is a retrospective case study. PURPOSE: This study was designed to analyze the surgical outcomes of patients who underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) for the treatment of spondylolisthesis and degenerative segmental instability. OVERVIEW OF LITERATURE: If the surgical outcomes of a procedure are evaluated together with multiple indications, it is not clear how the procedure helped each subgroup of patients. For the reason that some indications achieve better outcomes than the others, we performed a subgroup analysis using validated outcome measures to demonstrate the optimal indications and the treatment results of TLIF. METHODS: We conducted subgroup analyses by comparing the prospectively collecting data from the consecutive patients who underwent single-level minimally invasive TLIF for the treatment of the following 3 subgroups of indications: 23 cases of low-grade spondylolytic spondylolisthesis, 24 cases of degenerative spondylolisthesis, and 19 cases of degenerative segmental instability. RESULTS: The average duration of follow up was 36.1 +/- 9.9 months (range, 24 to 63 months). The preoperative pain and disability scores were significantly improved at final postoperative follow-up in all the subgroups (all measurements: p < 0.0001). The 3 subgroups exhibited an equivalent improvement of the pain and disability scores at the final follow-up. The rates of radiographic solid fusion and complications were also similar among the 3 groups. CONCLUSIONS: Our data suggests that minimally invasive TLIF optimally and equivalently alleviates all of the associated symptoms and disabilities from low-grade spondylolisthesis and degenerative segmental instability. Furthermore, these patients seem to have optimal surgical indications for minimally invasive TLIF, while maintaining favorable surgical outcomes.

Cementless Total Hip Arthroplasty Using VerSys Fiber Metal Midcoat Stem: a Minimum 3-Years Follow-up

PURPOSE: The purpose of this study was to retrospectively evaluate the results of cementless total hip arthroplasties that used a Versys fiber metal midcoat femoral stem. MATERIALS AND METHODS: From March 2000 to June 2005, 28 cases in 23 patients were followed up for a minimum of three years. The average follow up period was 5.1 years. Clinical results were evaluated by Harris hip scores. Radiographic analysis was done by evaluating fixation stability, osteolysis, stress shielding, and cortical hypertrophy. RESULTS: The mean Harris hip score improved from 43.1 to 93.8 at the last follow up. In radiographic analyses of the stem, there was no evidence of positional changes or vertical subsidence. There was heterotopic ossification in four, distal cortical hypertrophy in two, proximal stress shielding in twenty, and femoral osteolysis in five cases. The femoral stem revealed a stable bony ingrowth in all. The acetabular cup revealed a stable bony ingrowth in all. There was no evidence of horizontal or vertical migration or of a change of inclination angle of the acetabular cup. CONCLUSION: Cementless total hip arthroplasty using a Versys fiber metal midcoat femoral stem showed good clinical and radiologic results, but long term follow up is needed.

Comparision of Anterior Segment Parameters in Angle-Closure Glaucoma Using Scheimpflug Camera

PURPOSE: To compare anterior segment parameters in angle-closure glaucoma (ACG), primary open angle glaucoma (POAG), and normal subjects (N) using a Schiempflug camera. METHODS: Central corneal thickness (CCT), lens thickness (LT), axial length (AL), anterior chamber angle (ACA), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured in ACG (93 eyes of 92 patients), POAG (90 eyes of 87 patients), and normal (91 eyes of 88 subjects) with Pentacam(R) and A-scan. All of the results and measurements were then compared. RESULTS: Compared to normal and POAG patients, ACG patients presented with significantly different measurements of CCT, LT, AL, and ACA, ACD, and ACV (p<0.05). Further, correlations were high between three measurements (ACA, ACD, ACV) in ACG, and the best correlations were found in acute angle-closure glaucoma (P<0.05). CONCLUSIONS: By using a Schiempflug camera it was possible to assess the correlation between anterior segment parameters (ACA, ACD, ACV) in glaucoma patients. The best correlations were found in acute angle-closure glaucoma, and thus anterior segment parameters can offer reciprocally complementary information.

Three Cases of Corneal Tattooing for the Treatment of Traumatic Iris Defect

PURPOSE: To investigate the effects of corneal tattooing on patients with a traumatic iris defect. CASE SUMMARY: Corneal tattooing operation was performed on three patients (3 cases) with a traumatic iris defect. In case 1, the cornea was dyed with Davidson(R) marking dyes (Bradley Products Inc., MN, US) and the amniotic membrane with the central incision was permanently transplanted. In case 2, both corneal dyeing and permanent amniotic membrane transplantation were performed on the area of partial iris loss. In case 3, corneal dyeing was performed after the intrastromal cornea was dissected. Corneal reepithelization was found in the first 2 cases 12 and 9 days after amniotic membrane transplantation, respectively. Three months after the transplantation, all three cases showed an improvement in best corrected visual acuity (BCVA), with an increase of one or more lines on the Snellen Chart. Simultaneously, preoperative monocular contrast and glare were also found to beimproved in all three cases. In both cases 1 and 2, 60% of the initially used dyes still remained in the cornea 6 months after the surgery, and in case 3, 90% of the initial dye remained. Except for the moderate astigmatism found earlier after the surgery in case 3, no serious complications developed. CONCLUSIONS: Corneal tattooing can improve the visual acuity and reduce glare in eyes with a traumatic iris defect and is cosmetically pleasing. Furthermore, corneal tattooing can be performed more easily and repeatedly than black diaphragm intraocular lens implantation.

Treatment of Recurrent Spontaneous Acute Hemarthrosis after Total Knee Arthroplasty: A Case Report

A 67-year-old woman presented with six acute recurrent hemorrhagic episodes sixteen months after primary total knee arthroplasty. Femoral angiography demonstrated a prominent vascular blush on the superolateral side of the knee joint. The patient underwent therapeutic embolization of the superior lateral geniculate artery and a muscular branch from the popliteal artery. However, neglected embolization to the lateral inferior artery induced another episode of acute hemarthrosis. Finally, open arthrotomy allowed for identification and coagulation of the focus of acute bleeding in the lateral inferior geniculate artery.

The effect of location and angle of drilling on the changes of the distance between two block specimens during screwing on miniplate fixation

Treatment of Brachymetatarsia by Distraction Osteogenesis / 대한족부족관절학회지

PURPOSE: To evaluate the efficacy of distraction osteogenesis for fourth brachymetatarsia. MATERIALS AND METHODS: Seven patients (10 cases) who were treated by distraction osteogenesis for fourth brachymetatarsia from March 2000 to December 2003 were reviewed retrospectively. RESULTS: The average length gain of fourth metatarsus was 16.6 mm (37%) and the average healing index was 50 days/cm. The final results according to AOFAS functional scale were excellent in 8 cases and good in 2 cases. CONCLUSION: Distraction osteogenesis is an effective treatment for fourth brachymetatarsia in spite of some minor complications.

Treatment of Brachymetatarsia by Distraction Osteogenesis / 대한족부족관절학회지

PURPOSE: To evaluate the efficacy of distraction osteogenesis for fourth brachymetatarsia. MATERIALS AND METHODS: Seven patients (10 cases) who were treated by distraction osteogenesis for fourth brachymetatarsia from March 2000 to December 2003 were reviewed retrospectively. RESULTS: The average length gain of fourth metatarsus was 16.6 mm (37%) and the average healing index was 50 days/cm. The final results according to AOFAS functional scale were excellent in 8 cases and good in 2 cases. CONCLUSION: Distraction osteogenesis is an effective treatment for fourth brachymetatarsia in spite of some minor complications.