High Prevalence of Sarcopenia in Korean Patients after Hip Fracture: a Case-Control Study

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height2) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.

Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results

PURPOSE: To evaluate the radiologic and functional outcomes of medial open wedge high tibial osteotomy (HTO) combined with arthroscopic procedure in patients with medial osteoarthritis. MATERIALS AND METHODS: From June 1996 to March 2010, 26 patients (32 knees) who underwent medial open wedge osteotomy and arthroscopic operation for medial osteoarthritis were retrospectively reviewed. Measurements included hip-knee-ankle (HKA) angle, femorotibial angle, medial proximal tibial angle, posterior tibial slope angle, and Kellgren-Lawrence grade. Clinical evaluation was performed using Lysholm knee scoring scale and knee and function score of the American Knee Society. RESULTS: Differences between the mean preoperative and postoperative measurements were significant in all angles including the HKA angle (−5.7° and +5.5°), femorotibial angle (−1.9° and +9.8°), and medial proximal tibial angle (82.9° and 90.5°) (p<0.05). Mean Lysholm knee scoring scale was 63.6 preoperatively and 88.7 at the last follow-up, mean Knee Society knee score was 61.2 and 86.6, and mean function score was 59.3 and 87.2, respectively. All differences were significant (p<0.05). CONCLUSIONS: Medial open wedge HTO in combination with arthroscopic procedure is an effective treatment method for medial osteoarthritis to treat varus deformity and an intra-articular lesion.

The Efficacy and Safety of Autologous Transfusion in Unilateral Total Knee Arthroplasty

PURPOSE: Although allogeneic blood transfusion is the most common method of transfusion in total knee arthroplasty (TKA), there are reports showing significant decrease in the amount of allogeneic transfusion and incidence of side effects after combined use of autologous transfusion. The purpose of this study is to investigate the efficacy of using an autologous transfusion device in TKA. MATERIALS AND METHODS: Patients who underwent TKA at our institution from January 2003 to January 2014 were divided into two groups: group A (n=127) who received allogeneic transfusion only in TKA and group B (n=118) who received autologous transfusion via an autologous transfusion device and allogeneic transfusion. In both groups, the patients were transfused when the hemoglobin level was below 9 g/dL. In group B, blood collected by the autologous transfusion device was transfused only once after surgery. The total blood loss volume, total transfusion volume, and the presence of side effects were assessed based on medical records. RESULTS: Group A received 294.6 mL more allogeneic transfusion than group B (p<0.001). There were no significant differences with regard to the development of side effects between groups. CONCLUSIONS: Application of an autologous transfusion device during TKA can be effective in reducing the allogeneic transfusion volume. Moreover, allogeneic transfusion was not necessary after autologous transfusion in some patients.

Baker's Cyst Filled with Hematoma at the Lower Calf

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.

Deformity Correction by Femoral Supracondylar Dome Osteotomy with Retrograde Intramedullary Nailing in Varus Deformity of the Distal Femur after Pathologic Fracture of Giant Cell Tumor

Angular deformities of the distal femur occur in congenital diseases or due to acquired causes, such as malunion after a fracture of the distal femur. Angular deformities of the lower extremities affect the mechanical axis, causing changes in the weight pressure on the articular surface. As a result, angular deformities quicken the progression of osteoarthritis. Therefore, correction of deformities should be performed to prevent the progression of osteoarthritis. Distal femoral osteotomy is one of the methods to correct angular deformities in unicompartmental osteoarthritis. However, femoral supracondylar dome osteotomy with retrograde intramedullary nailing in the distal femur with a varus deformity has been rarely reported. Herein, we describe a technique for femoral supracondylar dome osteotomy with retrograde intramedullary nailing in a varus deformity after a pathologic fracture of giant cell tumor in the distal femur with a review of the relevant literature.

Reliability of Singh Index in Female Patients Older than 65 Years with Proximal Femoral Fracture / 대한골다공증학회지

OBJECTIVES: To evaluate osteoporosis in acute trauma situations, we compared reliability of Singh index values with bone mineral density in female patients older than 65 years with proximal femur fractures. MATERIALS AND METHODS: We enrolled 145 patients who treated between June 2006 and May 2011. The radiograph was done and assessed by 3 observers to determine Singh index values. The reliability of Singh index was expressed in terms of intraobserver and interobserver agreements using Fleiss's overall Kappa values, Pearson correlation coefficients, Kendall's Tau-b values. Correlation of bone mineral density and Singh index was measured using linear by linear association. RESULTS: Kappa values for intraobserver agreement ranged from 0.361 to 0.454. Kappa values for interobserver agreement ranged from 0.325 to 0.423 neither did not reach good reliability overall. There was no statistically significant correlation between Singh index and bone mineral density. CONCLUSIONS: Singh index is inappropriate method for clinic and research work due to poor interobserver agreement, though it is a simple and inexpensive method of assessing the osteoporosis in acute trauma patients.

Comparison of Bone Mineral Density in Elderly Patients over 65 Years according to Presence and Types of Hip Fracture

PURPOSE: We measured the BMD of elderly patients with osteoporotic hip fracture in order to understand the relationship between BMD of each sites and hip fracture occurrence or the types, and also to suggest a reference point for starting an osteoporosis treatment program. MATERIALS AND METHODS: From July 2007 to February 2010, we investigated total 147 elderly osteoporotic hip fracture patients over 65 years. For control group, 80 patients who were over 65-year-old and did not have any fracture were selected. BMD was compared at each site between each groups statistically. RESULTS: In the comparison of femur intertrochanter and neck fracture groups, BMD of femur neck and trochanter areas and L2, L3 areas were significantly less in intertrochanteric fracture group. In the analysis according to the classification of intertrochanteric fracture, BMD of intertrochanter and Ward's triangle area were significantly less in unstable fracture group than stable one. Each of the fracture threshold of intertrochanteric and neck fracture group was -1.10 and -1.36 of the T-score in proximal femur, and -1.40 and -1.40 of the T-score in lumbar vertebrae. CONCLUSION: To examine the BMD of both proximal femur and lumbar vertebrae areas is helpful to predict the hip fracture occurrence and the type of hip fracture. And for the prevention of hip fracture in elderly patients over 65 years, we propose that the aggressive treatment of osteoporosis should be started to prevent fracture for patients with a T-score less than -1.40.

Percutaneous A1 Pulley Release of Locked Trigger Thumb in Children

PURPOSE: To report the clinical outcomes of percutaneous A1 pulley release for the surgical treatment of locked trigger thumb in children. MATERIALS AND METHODS: Twenty-six trigger thumbs in 24 patients with a average of 14.2 months follow-up after percutaneous release were enrolled. There were 15 females and 9 males with an average age of 39 months. The mean time from first presentation to surgery was 16 months. Procedures were performed under local anesthesia. Postoperative examinations at immediate, 3 months and 1-year recorded pain, triggering and range of motion and presence of complications. RESULTS: All thumbs had a satisfactory result without digital nerve injury. Eleven patients(46%) had a mean 14.3degrees extension loss of the interphalangeal joint and 12.0degrees hyperextension of the metacarpophalangeal joint of the thumb, compared to the contralateral thumb. At final follow-up, all but 1 patient were completely resolved. The duration of symptoms and age were higher in the group with thumb deformity (p<0.05). CONCLUSION: Temporary thumb deformity is possible after surgical treatment of trigger thumb in children with a long duration of symptoms. Percutaneous release can be a safe and satisfactory treatment option in pediatric trigger thumb.

Comparison of the Outcomes on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction Using a Hamstring Autograft or a Tibialis Anterior Allograft

PURPOSE: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. MATERIALS AND METHODS: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. RESULTS: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. CONCLUSION: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

Surgical Treatment of Thoracic Outlet Syndrome Secondary to Clavicular Malunion

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.

Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail

PURPOSE: Retrograde intrameullary nail is one of the treatment of periprosthetic supracondylar femoral fracture after total knee replacement (TKR), but all TKRs will not permit to insert a supracondylar nail. Therefore, we have investigated the compatibility of the TKRs with supracondylar nail. MATERIALS AND METHODS: Using trial femoral component of the 5 used TKRs in Korea and saw bone model, we checked their compatibility and measured the dimensions of the intercondylar notches in both cruciate retaining (CR) and posterior stabilized (PS) type. RESULTS: Although most CR prostheses had an intercondylar notch large enough to accept a supracondylar nail, in some case, this was not possible due to the notch being situated too far posteriorly. The position of the intercondylar notch is also important factor in the PS prostheses. CONCLUSION: The notch position, rather than the notch size, was the most important factor in determining nail compatibility with femoral stem.

Tibio-talo-calcaneal Arthrodesis with Multiple Cannulated Screw Fixation / 대한족부족관절학회지

PURPOSE: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. MATERIALS AND METHODS: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. RESULTS: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. CONCLUSION: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

Solitary Synovial Chondromatosis as a Cause of Trigger Finger at the A3 Pulley: A Case Report / 대한정형외과학회잡지

A trigger finger is commonly secondary to stenosing tenosynovitis at the A1 pulley. However, there have been occasional reports of triggering at other sites as well as from other etiologies. We describe a patient who suffered a triggering of the left middle finger at the A3 pulley due to the solitary synovial chondromatosis obstructing the flexor tendon from gliding.

The Effect of Different Wavelength of Low Power Laser on Fracture Healing / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to evaluate the effect of different wave length of low power laser on early fracture healing. METHODS AND MATERIALS: Nine week old female English Hartley guinea pigs were used for this experiment. Sixty guinea pigs were divided into three groups, and then right femur was fractured and fixed with an intramedullary nail. The frequency of 632 nm and 830 nm semi-conductor laser machines were used. Finally, 46 guinea pigs were survived (including 14 cases in control group, 16 cases in 632 nm group and 16 cases in 830 nm group). Guinea pigs were sacrificed at 3 and 6 weeks separately. The gross, radiologic and histologic findings were assessed by the Modified Zorlu Scoring System. The statistical evaluation was done by repetitive measured ANOVA test. RESULTS: In the gross findings and radiologic findings, both of 632 nm and 830 nm radiation groups showed a greater amount of callus formation at postoperative 3 weeks with statistical significance (P0.05). The result of histological findings showed that an increase of osteoblastic proliferation in two radiation groups was greater than that in the control group at 3 and 6 weeks (P<0.01). Enhancement of osteoblastic proliferation was greater in 830 nm group compared to in 632 nm group at 3 weeks (P<0.05). The comparison between the experimental groups for wave length of 632 nm and 830 nm at 6 weeks showed significant difference (P<0.05). CONCLUSION: In this study, it became known that applying 632 nm and 830 nm wavelength laser to the fracture site accelerate bony union, and 830 nm wavelength laser showed earlier bony union than 630 nm wavelength laser.

Ankle Morphometry in Adults using MRI / 대한족부족관절학회지

PURPOSE: To provide basic data on anatomy of the ankle joint in adults using magnetic resonance imaging as well as to compare measurements with available data of corresponding dimension in the different sizes of the total ankle replacements design (HINTEGRA(R)). MATERIALS AND METHODS: Magnetic resonance (MR) sagittal and coronal images from one hundred-forty nine were studied. Post traumatic, arthritic, or grossly deformed ankles at any reason were excluded. Lengths, widths of the main parts of this articulation and also the radius of curvature of talar dome were measured in the MR images. Statistical analysis was performed on these measurements. RESULTS: On MR coronal image data, average tibial width was 30.0+/-4.1 mm and talar width was 27.0+/-3.4 mm. On sagittal image date, average anteroposterior length of the distal tibia was 39.0+/-4.2 mm, average anteroposterior length of the talus was 31.3+/-2.8 mm, and average sagittal radius of curvature of talar dome was 20.1+/-2.9 mm. All measurements in male were significantly larger than in female (p<0.01), but a significant difference according to age was not found. CONCLUSION: Ankle morphometric data define a basis of size, particularly useful in the design of ankle prostheses.

Bouquet Pin Intramedullary Nail Technique of the 5th Metacarpal Neck Fractures

PURPOSE: To evaluate radiologic and clinical results of bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture. MATERIALS AND METHODS: Between April, 2005 and February, 2006, 17 patients treated by bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture were evaluated. All patients were reviewed clinically and radiologically after operation. RESULTS: All of 17 cases of fractures were completely united. In the anteroposterior radiographs, the average of preoperative angulation was corrected from 34.4° to 5.2°. Also, in the oblique radiographs, radiographic results of angulation correction were satisfactory which was corrected from 44.2° to 11.7°. Although, the averages of difference between postoperative and final follow-up angulations were 1.5° in the anteroposterior radiographs and 0.9° in the oblique radiographs, they were not statistically different. All patients were excellent clinically except 1 patient who has moderate joint stiffness after operation. CONCLUSION: Selecting of appropriate patients who is indicated, bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture could be a good treatment method without complications.

Glomus Tumor in a Extradigital Lesion of Foot: A Case Report / 대한족부족관절학회지

Glomus tumors are uncommon soft tissue tumors which usually found in a subungual lesion of hand, producing pain. This uncommon tumors have been reported in other locations, including nasal cavity, stomach, mediastinum, heart, lung, and vagina etc. Especially, it was a very rare case found in an extradigital lesion of foot. Glomus tumors should not be ruled out for an extradigital mass lesion of foot and also any other locations. Although glomus tumors are generally considered a benign lesion, it should be considered that glomus tumors have also reported as a malignant type tumor, even the diagnosis based on histologic features not clinical one.

Arthroscopic Osteochondroplasty of the Osteochonral Lesion of the Talus / 대한족부족관절학회지

PURPOSE: To evaluate the clinical characteristics and the functional results of the osteochondral lesions of the talus (OLT) treated with arthroscopic osteochondroplasty. MATERIALS AND METHODS: The study was based on 25 cases (25 feet) of osteochondral lesion of talus that were treated with arthroscopic osteochondroplasty from May 1997 to June 2005 with at least 1 year follow-up. Follow-up period was average 21.8 months. The average age was 37.2 years old. Male patients were 22 while female were 3. Postoperative evaluation was performed with American Orthopedic Foot and Ankle Society (AOFAS) Functional score, patient satisfaction and complications. RESULTS: Ninety-two percent of patients had trauma history. Seventy-two percent of the lesions were located at the medial dome. As for the cartilage classification, 56% were fibrillation/fissure lesions while 44% were flap tears. Visual analogue scale (VAS) pain score improved from 6.8 points to 2.2 points, and AOFAS score improved from 71.3 points to 87.3 points. Eighty-eight percent of the patients were satisfied with the surgery and average period of returning to previous job was 6.5 weeks. CONCLUSION: We concluded that the arthroscopic osteochondroplasty is a viable surgical option for the osteochondral lesion of the talus.

Treatment of Diaphyseal Fractures of Forearm Both Bones: Comparison between Plate Fixation and Rush Pin Intramedullary Nailing

PURPOSE: To compare the functional results between the plate fixation and Rush pin insertion for the treatment of diaphyseal fractures of the forearm both bones. MATERIALS AND METHODS: We reviewed 51 patients who were treated for diaphyseal fractures of the both forearm bones from 1995 to 2003, and evaluated them with Anderson's method. Eighteen patients were treated with plate fixation of both bones (group I), 14 patients treated with of the Rush pin insertion of the radius and plate fixation of the ulna (group II), 11 patients treated with plate fixation of the radius and Rush pin insertion of the ulna (group III), and 8 patients treated with Rush pin insertion of forearm both bones (group IV). RESULTS: Seventeen out of eighteen cases obtained favorable result (94.4%) in group I, 12 out of 14 cases (85.7%) in group II, 7 out of 11 cases (63.3%) in group III, and 4 out of 8 cases (50.0%) in group IV with statistically significant differences between the groups (p=0.04). CONCLUSION: Plate fixation of forearm both bones yield the best result. Thus, plate fixation of both forearm bones is recommended in treating the diaphyseal fractures of both forearm bones. At least one bone is recommended to be fixed with a plate if it is not possible to fix both forearm bones with plates.

Long Term Results of LCS Mobile Bearing Knee System in Total Knee Arthroplasty

PURPOSE: To evaluate the long-term (over 10 years) clinical and radiologic results of LCS (low contact stress, Depuy, USA) total knee arthroplasty (TKA) retrospectively. MATERIALS AND METHODS: Out of 57 cases who underwent TKA with LCS knee system between June 1994 and August 1995, 33 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survival rate were evaluated. RESULTS: Average flexion contracture was improved from 10.0degrees preoperatively to 3.7degrees at final followup and average ROM was improved from 104.0degrees preoperatively to 115.3degrees at final follow-up (p<0.05). Average HSS score was improved from 49.5 preoperatively to 80.1 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 3.3degrees varus preoperatively to 3.5degrees valgus at final follow-up. There were 4 complications, including infection in two cases and fracture dislocation of polyethylene implant in two cases respectively. Ten year survival rate was 94.1 percent. CONCLUSION: LCS TKA showed excellent results and good survival rate at more than ten years followup. However, more cases should be necessary for statistic significance.