Characteristics of Blood Mixed Cement in Percutaneous Vertebroplasty / 대한정형외과학회잡지

PURPOSE: This study evaluated the efficacy of blood mixed cement for osteoporotic vertebral compression fractures in reducing the complications of percutaneous vertebroplasty using conventional cement. MATERIALS AND METHODS: This study was performed retrospectively in 80 patients, from January 2016 to January 2017. Porous cement was formed by mixing 2, 4, and 6 ml of blood with 20 g of cement used previously. A tube with a diameter and length of 2.8 mm and 215 mm, respectively, was used and the polymerization temperature, setting time, and optimal passing-time were measured and compared with those using only conventional cement. Radiologically, the results were evaluated and compared. RESULTS: The polymerization temperature was 70.3℃, 55.3℃, 52.7℃, and 45.5℃ in the conventional cement (R), 2 ml (B2), 4 ml (B4), and 6 ml (B6), respectively, and the corresponding setting time decreased from 960 seconds (R) to 558 seconds (B2), 533 seconds (B4), and 500 seconds (B6). The optimal passing-time was 45 seconds (B2), 60 seconds (B4), and 78 seconds (B6) at 73 seconds (R), respectively and as the amount of blood increased, it was similar to the cement passing-time. The radiological results showed that the height restoration rates and the vertebral subsidence rates similar among the groups. Two cases of adjacent vertebral compression fractures in the R group and one in the B2 and B4 groups were encountered, and the leakage rate of the cement was approximately two times higher than that in the conventional cement group. CONCLUSION: In conventional percutaneous vertebroplasty, the procedure of using autologous blood with cement decreased the polymerization temperature, reduced the setting time, and the incidence of cement leakage was low. These properties may contribute to more favorable mechanical properties that can reduce the complications compared to conventional cements alone.

Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess

OBJECTIVES@#We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images.SUMMARY OF LITERATURE REVIEW: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare.@*MATERIALS AND METHODS@#A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4-5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection.@*RESULTS@#The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout.@*CONCLUSIONS@#This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.

Tophaceous Gout of the Lumbar Spine Mimicking Infectious Spondylodiscitis and Epidural Abscess

STUDY DESIGN: Case report OBJECTIVES: We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images. SUMMARY OF LITERATURE REVIEW: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare. MATERIALS AND METHODS: A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4-5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection. RESULTS: The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout. CONCLUSIONS: This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain.

Efficacy of Taurolidine Irrigation in Primary Total Knee Arthroplasty

PURPOSE: Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis. The aim of this study was to evaluate the efficacy of taurolidine irrigation in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: All patients who underwent TKA at our institute from January 2015 to March 2017 were eligible. There were 300 patients in the taurolidine irrigation group and 300 patients in the control group. The patients in the taurolidine irrigation group were irrigated after implantation with a mix of 250 mL of taurolidine and 750 mL of normal saline. The patients in the control group were not irrigated after implantation. We compared postoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and infection rate between groups. RESULTS: The taurolidine irrigation group had a significantly lower CRP (5.39 mg/dL vs. 7.55 mg/dL; p<0.001) and ESR (53.21 mm/hr vs. 58.74 mm/hr; p=0.003) on postoperative day 3 after TKA, as compared with the control group. However, there was no difference between the two groups on postoperative days 6, 13, and 20. Periprosthetic joint infection occurred in one patient in the taurolidine irrigation group. CONCLUSIONS: We believe that it is not necessary to use taurolidine for patients who undergo primary TKA.

Arthroscopic Bridging Repair Using Human Dermis Allografts for Irreparable Rotator Cuff Tears

BACKGROUND: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. METHODS: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. RESULTS: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. CONCLUSIONS: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.

Arthroscopic Bridging Repair Using Human Dermis Allografts for Irreparable Rotator Cuff Tears

BACKGROUND: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. METHODS: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. RESULTS: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. CONCLUSIONS: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.

Interference of Union after the Use of Beta-Tricalcium Phosphate Block in High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy (HTO) is a commonly used treatment for genu varum and medial compartment osteoarthritis. Recently open wedge HTO has been the preferred method due to its facilitated technique, fewer neurovascular and joint injuries, etc. In open wedge HTO materials such as autogenous, allogenous bone graft and tricalcium phosphate (TCP) are used to help with bone union and have a role in filling in the empty space. However the authors of this study report on two cases of nonunion 1 year after HTO using TCP block.

Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles

PURPOSE: To evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy. MATERIALS AND METHODS: Ten patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed. RESULTS: The average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5+/-4.2 mm) was significantly greater than that of the contralateral knees (7.7+/-3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides. CONCLUSIONS: During the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle.

Curvilinear Incision in Total Ankle Arthroplasty: A Case Report / 대한정형외과연구학회지

The most common complication of total ankle arthroplasty is skin problem including delayed wound healing, skin necrosis, and superficial wound infection. In the present study, we aimed to reduce the wound complications associated with total ankle arthroplasty using a curvilinear incision. We examined 5 patients with ankle osteoarthritis who underwent total ankle arthroplasty using a curvilinear incision from September 2012 to January 2013. Wound dehiscence was noted in 1 case, which was treated with a re-repair procedure at 13 days after the initial surgery. The use of a curvilinear incision in total ankle arthroplasty may reduce the associated wound complications.

Orthopedic disease and sports medicine related to lower limbs

In this study, the cause, diagnosis, and treatment of common lower limb injuries during the sports activities were presented. Sports injuries of the lower limbs are the most common injuries in the sports medicine field due to the high level of use of the lower limbs during sports activities. The common causes of leg injuries in athletes are traumatic force over the critical limit of normal tissue, repetitive microtrauma, and overuse. Common hip and pelvis problems encountered by the authors include trochanteric bursitis, snapping hip syndrome, and labral tears. The anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, and meniscus have been most frequently involved in sports injuries affecting the knees. Lateral ankle sprain represents one of common injuries in the athletic population. Common overuse injuries are tendinopathies, stress fractures, chronic exertional compartment syndrome, and shin splints. Athletic activity provides a variety of positive benefits to participants' health. To safely continue those activities, an injury prevention program focusing on injuries that may occur in specific sports activities is recommended for participants. Early diagnosis and proper treatment are also important in promoting prompt recovery and preventing secondary injuries.

The Validity and Reliability of the EMC Device; For the Checking ofthe Mobility of the First Ray of the Foot / 대한정형외과학회잡지

PURPOSE: To evaluate the validity and intra-rater, inter-rater reliability of the EMC device used to check the mobility of the first ray of the foot. MATERIALS AND METHODS: Sixty-nine cases (43 patients) of mild to severe hallux valgus feet were enrolled in this study. For an analysis of the validity of the EMC device, the dorsal mobility of the first ray of the foot was measured using the modified Coleman block test and EMC device. The intra- and inter-rater reliability of EMC device was evaluated by measuring the dorsal mobility of the first ray of the foot twice with three independent raters blinded to other's results. The results were analyzed for the intra-rater reliability and for inter-rater reliability. RESULTS: The mean value of the dorsal mobility of the first ray of the foot by the EMC device and modified Coleman block test was 8.3 mm (range; 4.3-12.3 mm) and 7.4 mm (range; 3.4-10.3 mm), respectively. There was a significant difference between the EMC device and modified Coleman block test (p<0.05). However, both the measured data, showed a good correlation (Pearson correlation coefficient=0.84). The paired t-test for intra-rater reliability and ANOVA testing for inter-rater reliability showed no statistically significant difference. CONCLUSION: The EMC device is reliable and valid for measuring the mobility of the first ray of the foot.

Treatment of Postoperative Tarsal Tunnel Syndrome with Autogeneous Vein Wrapping Graft / 대한족부족관절학회지

Management of postoperative tarsal tunnel syndrome is a perplexing problem to the surgeons. Autogenous vein wrapping graft is a effective method to decompress the tarsal tunnel. We treated 2 cases of postoperative tarsal tunnel syndrome with autogenous saphenous vein wrapping graft technique, and could get good results. Autogenous vein wrapping graft seems to be a good technique for tarsal tunnel syndrome with severe adhesion, particularly after surgery, and postoperative nerve adhesion can be prevented.

Treatment of Large Heel Defect in Diabetic Patients; Use of Artificial Bypass Graft and Antero-lateral Thigh Perforator Flap: A Case Report / 대한족부족관절학회지

In diabetic foot with arterial occlusive disease, skin defect on heel was tried to treat with free flap or local flap, but couldn't be treated well. Therefore below knee amputation was perfomed mostly. But we treated a patient of large heel defect with using of artificial bypass graft and antero-lateral thigh perforator flap.