The Usefulness of Arthroscopy in the Operative Treatment of Intra-Articular Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: We tried to evaluate the usefulness of the arthroscopy in the operative treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS:Between March 2005 and May 2008, 9 patients with intra-articular calcaneal fractures (Tongue type or Sanders type IIC) were treated with arthroscopically assisted percutaneous reduction and screw fixation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), preoperative and postoperative Bohler's angle and the rate of complication were evaluated. RESULTS:AOFAS score at postoperative 1 year was 88.2 (range, 71-92), and mean VAS score was 2.8 (range, 1-4). Bohler angle was improved from preoperative mean 16.2 degrees to postoperative mean 29.7 degrees . There were no complications such as wound problem, infection or nerve injury. CONCLUSION: Subtalar arthroscopy provides precise view of posterior facet during the operation. Therefore, it can be a useful tool in treating intra-articular calcaneus fractures, especially tongue type and Sanders type IIC fractures.

Iliopsoas Bursitis following Total Hip Replacement Arthroplasty: A Case Report / 대한정형외과학회잡지

PURPOSE: To report the clinical, radiological and surgical findings of iliopsoas bursitis, and to suggest an indication for diagnosis and treatment. MATERIALS AND METHODS: We report two patients with iliopsoas bursitis who underwent THA in between June 1998 to June 2003. All presented with late onset hip joint discomfort, and their diagnosis were confirmed after interdepartmental consultations and with the help of investigations such as interventional angiography and MRI. Their signs, symptoms, investigations and surgical findings were reviewed retrospectively. RESULTS: Iliopsoas bursitis presented with hip pain, leg edema, palpable inguinal mass and ecchymosis, femoral nerve irritation and flexion contracture of hip. The radiographs provided no diagnostic clues but the MRI revealed a well marginated cystic lesion filled with fluid signals. Ultrasonography revealed the anatomic location that enabled guided aspiration and even ruled out vascular compromise. Two patients were treated with USG guided aspiration. One aspirate was serosanguinous and the other was old blood tinged fluid. One patient underwent surgical debridement of the cyst. Surgery revealed an intrapelvic hemorrhagic bursa with an ill-defined cystic wall and intramuscular extension into the iliacus. CONCLUSION: It is important for surgeons to rule out iliopsoas bursitis when a patient presents with vague hip pain after total hip arthroplasty without any evidence of infection or loosening. A diagnosis of iliopsoas bursitis can be made from the clinical features and ultrasonography.

Morphological Changes of Anterior Horn Cells of Lumbar Spinal Cord after Anterior Root Avulsion in Adult Rat / 대한해부학회지

The morphological changes in the anterior horn of the L4 and L5 spinal segments were observed following anterior root avulsion in the adult male Sprague-Dawley rat (300~350 gm) at 5 days, 1 week, 2 weeks and 3 weeks postlesion. The animals were perfused with 4% paraformaldehyde, 0.15% picric acid in 0.1 M phosphate buffer solution and cryostat sections were prepared. Immunohistochemistry was used to identify changes of the phenotype in the anterior horn cells. Primary antibodies, goat anti-choline acetyltransferase (ChaT, 1 : 500, Chemicon), mouse antirat ED-1 (1 : 200, Serotec), rabbit anti-glial fibrillary acidic protein (GFAP, 1 : 200, DAKO) and rabbit anti-vascular endothelial growth factor (VEGF, 1 : 500, Santa Cruz Biotechnology) were used. Avidin-Biotin complex method was performed for immunohistochemical reaction and color reaction was developed with DAB-H2O2. Following results were observed in the anterior horn of lumbar spinal cord; 1. The number of ChaT-immunoreactive (ir) cells were reduced 20% level of control animals at 3 weeks after avulsion. 2. ED-1-ir microglia were significantly increased at 1 week and processes of ED-1-ir microglia surrounded around the axotomized neuronal cell bodies. 3. Gliosis defined by extensive GFAP immunoreactivity was observed both ipsilateral and contralateral side of lesion but the VEGF-ir cells were significantly increased in the ipsilateral side of lesion. Therefore, this study suggested that the majority of axotomized motor neurons were degenerated and the cellular proliferation and phenotype changes including glial cell activation were observed in the lumbar spinal cord after anterior root avulsion of adult rats.

Assessment of Validity, Reliability and Responsiveness of Korean Knee Injury and Osteoarthritis Outcome Score(KOOS) for the Knee Injury / 대한정형외과학회잡지

PURPOSE: To assess the suitability of the Korean KOOS (Knee injury and osteoarthritis outcome score) as a patient-centered clinical measurement of the validity, reliability and responsiveness to the treatment of knee injuries. MATERIALS AND METHODS: One hundred and eight patients who had experienced an arthroscopic ACL reconstruction or a menisectomy between Jan. 2002 and Jun. 2003 were examined immediately after surgery, and 6 and 12 months after surgery. The SF-36 and Lysholm knee scale were administered simultaneously to each case in order to calculate the inter-item correlation. RESULTS: Measurements of the test-retest reliability showed that all intra-class coefficients (ICC) were measured as r=0.75-0.89 and Cronbach's alpha was 0.73-0.81. Regarding the validity, there was a strong correlation with the SF-36 and the Lysholm, subscales (SF-36 vs KOOS: Physical functioning vs ADL (r=0.67)/Physical functioning vs Sports and recreational activities (r=0.61)/Bodily pain vs Pain (r=0.63)). In terms of the responsiveness, the average score measured preoperatively, and three, six and nine months showed a gradual increase. The effect size of pain, symptoms and ADL at postoperative 6 months was 0.8-1.1. A larger effect size was observed in the QOL (1.5) and sports and recreational function (1.3) at 3 months after surgery (n=25). CONCLUSION: The validity, reliability and responsiveness of the Korean KOOS was confirmed and is considered to be a useful clinical metrology for a knee injury.

Treatment of Osteoporotic Unstable Intertrochanteric Fractures: Comparative Study between using Dynamic Hip Screw and Additional Trochanter Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score 0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.

Modified Galeazzi Procedure for Treatment of Habitual Patella Dislocation in Skeletally Immature Patients

PURPOSE: The purpose of this study is to elucidate the clinical feature of the hasbitual patella dislocation in the skeletally immature patients and evaluate the result of modified Galeazzi procedure. MATERIAL AND METHODS: From Aug, 1997 to Jan, 2002 we operated 9 knees in 7 patients. Mean age at surgery was 13.3 years. There were 3 males with 3 knees and 4 females with 6 knees. The lateral retinaculum was released and the medial retinaculum was reefed. Patella was tenodesed with semitenidinosus tendon. The operated knees were immobilized with plaster of cast for 3 weeks and progressive range of motion exercise with hinged brace was permitted. RESULTS: Based on the clinical and radiological evaluation, there were improved results. Especially congruence angle was decreased from preoperative +72 degrees to postoperative +20 degrees. There was 1 recurrence that had increased femoral anteversion and 1 arthrofibrosis that had past history of ipsilateral thigh infection. CONCLUSION: Satisfactory clinical results were obtained with modified Galeazzi procedure for treatment of habitual patella dislocation in skeletally immature patient.