Result of Internal Fixation for Stable Femoral Neck Fractures in Elderly Patients / 대한고관절학회지

PURPOSE: This study was conducted to evaluate the results of internal fixation for stable femoral neck fractures occurring in patients over 65 years old. MATERIALS AND METHODS: Between 2008 and 2014, we evaluated 25 patients over 65 years old with Garden type 1 and 2 femoral neck fractures that were treated with internal fixation after a minimum follow up of 1 year. There were 5 males and 20 females and the average age was 72.3 years (range, 65-84 years) at the time of surgery. Fracture site union, horizontal shortening and complications were evaluated as radiographic parameters and change of walking ability (as measured using Koval walking ability score) was investigated as a clinical parameter. RESULTS: Union of fracture site was achieved in 24 out of the 25 cases (96.0%). The average length of horizontal shortening was 6.5 mm (range, 0.2-19.7 mm). At final follow up, 3 cases experienced complications: nonunion (n=1), avascular necrosis (n=1), and subtrochanteric fracture after minor trauma (n=1). Walking ability decreased an average of 1 step at the final follow up. CONCLUSION: Internal fixation for stable femoral neck fractures occurring in patients over 65 years showed satisfactory union rates. However, care should be taken with this technique given the possibility of decreased walking ability resulting from horizontal shortening.

Revision Total Hip Arthroplasty with Constrained Liner in Patients with Abductor Insufficiency / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate clinical and radiographic results of revision total hip arthroplasty with constrained liner in patients with abductor insufficiency. MATERIALS AND METHODS: In this study, 30 patients treated with constrained liner during revision total hip arthroplasty due to abductor insufficiency were evaluated after minimum 2-year follow-up. There were 14 men and 16 women and the mean follow-up period was 4.6 years. Re-dislocation and aseptic loosening of the implant were defined as a failure of the constrained liner. Harris hip score and ambulatory function were evaluated as a clinical parameter and osteolysis, aseptic loosening of the implant and other complications were evaluated as a radiologic parameter. RESULTS: During the follow-up period, there were 4 cases (13.3%) of constrained liner failure including two cases of re-dislocation and two cases of acetabular cup aseptic loosening. The average Harris hip score was improved from 38.3 points preoperatively to 73.4 points at last follow up. At the final follow-up, there were 20 cases (66.7%) of improvement in ambulatory function. There was 1 case of infection and 1 case of periprosthetic fracture. CONCLUSION: Use of a constrained liner during revision total hip arthroplasty showed satisfactory results for prevention of re-dislocation in patients with abductor insufficiency. However longer term studies on loosening of implants are needed.

Thoracic Spine Tumor Mimicking Cauda Equina Syndrome / 계명의대학술지

Cauda equina syndrome (CES) is one of the typical symptoms condition requires emergency operation. This syndrome is always accompanied by sciatica. Because schwannomas rarely cause sciatica, it is seldom considered as a pain source in the patient with radiculopathy. A 74-year-old male patient presented with lumbar radiculopathy symptoms with, mild stenosis on lumbar MRI scan. All conservative treatment including medication failed to subside the symptoms. Thoracic spine MRI revealed a large tumor in the thoracic region. The symptoms disappeared after excision of the tumor. The tumor was diagnosed as a schwannoma.

Surgical Treatment in Cervical Myelopathy Combined with Flail Arm Syndrome / 계명의대학술지

Flail arm syndrome (FAS) is a variant of the amyotrophic lateral sclerosis also known as Lou Gehrig's disease. FAS is a kind of motor neuron disease that represents a bilateral proximal muscle wasting of upper extremities. Degenerative cervical spondylosis is a common cause of cervical myelopathy and radiculopathy. The coexistence of cervical spondylosis and motor neuron disease can cause difficulties in diagnosis and treatment. This case is a cervical spondylotic myelopathy associated with FAS who had undergone surgical treatment. After the operation, subjective symptoms of the patient was more aggravated and it may be owing to natural history of FAS. The surgical treatment must be made very carefully in cervical spondylotic myelopathy patient combined with motor neuron disease.

Comparison of Ultrasonography and Magnetic Resonance Imaging in Measurement of Lumbar Spine Anatomic Structures / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the usefulness of ultrasonography for lumbar anatomical structure measurement. MATERIALS AND METHODS: From January 2011 to April 2011, 41 patients (22 males, 19 females) with back pain who visited the outpatient department and underwent lumbar magnetic resonance imaging (MRI) were selected. In each level of L4 and L5, we measured the longest distance and horizontal distance between each inferior articular process based off a spinous process. We also measured the distance between the spinous process tip and the vertebral body posterior surface and the thickness and width of the multifidus muscle. All distances were measured with ultrasonography and MRI and the two measurement results were compared. RESULTS: Using ultrasonography and MRI, we measured the distance between the spinous process tip and the posterior surface of the body. The distances were 39.16+/-8.71 mm/39.53+/-6.01 mm at L4 and 38.32+/-9.66 mm/37.74+/-10.54 mm at L5. The right multifidus muscle thickness measurements were 32.13+/-10.79 mm/33.84+/-9 mm at L4 and 31.32+/-10.04 mm/32.84+/-12.28 mm at L5. The measuring distance between the spinous process center to the posterior vertebral body surface and thickness of multifidus muscles by ultrasonography and MRI had significant correlations (p<0.05). CONCLUSION: Limitations still exist in measuring the structure of lumbar anatomy with ultrasonography. However, measuring the distance between the spinous process center to the vertebral body posterior surface and multifidus muscle thickness was effective.

Corrigendum: Comparison of Ultrasonography and Magnetic Resonance Imaging in Measurement of Lumbar Spine Anatomic Structures / 대한정형외과학회잡지

This erratum is being published to correct of affiliation and add an acknowledgement.

Comparison of Ultrasonography and MRI in Measuring of Cervical Soft Tissue Structure / 대한정형외과학회잡지

PURPOSE: We wanted to determine the usefullness of ultrasonography for exploring cervical anatomical structures and to compare its results with those of magnetic resonance imaging. MATERIALS AND METHODS: Between May, 2008 and January, 2009, 16 patient (8 male patients and 8 female patients, average age: 55.5 years old) with neck pain following in out patient clinic and who had cervical MRI performed were selected. By using ultrasonography, we measured the shortest distance of the internal carotid artery, internal jugular vein, sternocleidomastoid muscle and longus colli muscle based on the vertebral body of cricoid cartilage. We also measured the thickness of the longus colli muscle. We measured the average length of the shortest distance and thickness of C6 on MRI axial view. RESULTS: The length using ultrasonography showed that the average length was 2.12 cm for the internal carotid artery, 3.04 cm for the internal jugular vein, 4.34 cm for the sternocleidomastoid muscle and 0.68 cm for the longus colli muscle. Cervical MRI was used to measure the same structures. Its results were 2.23 cm for the internal carotid artery, 3.14 cm for the internal jugular vein, 4.39 cm for the sternocleidomastoid muscle and 0.70 cm for the longus colli muscle. We also measured the thickness of the longus colli muscle with ultrasonography and cervical MRI, and the results were 0.77 cm and 0.76 cm, respectively. There was no statistically significant difference between ultrasonography and MRI for the measurement of length, but there was a statistically significant difference for the measurement of thickness. CONCLUSION: There was a significant difference for the measurement of cervical anatomical stuctures using ultrasonography, and especially the longus coli thickness, as compared with that of MRI. Therefore, we suggest that ultrasonography can give more useful information for the diagnosis and treatment of problems in the cervical spinal field.

Operative Treatment of the Tuberculous Arthritis on the Sternoclavicular Joint: A Report of Two Cases

Tuberculous arthritis on the sternoclavicular joint is an uncommon disease and a delayed diagnosis can be due to the obscure clinical symptoms. We should suspect tuberculous arthritis in patients with slowly progressive pain, swelling, mild fever and a previous history of tuberculosis. Early diagnosis is important through conducting a thorough physical examination and performing laboratory tests and radiologic study. Tuberculous arthritis on the sternoclavicular joint should be treated with a combination of systemic antituberculous agents and thorough surgical debridement in marked damaged joints. When performing this operation, it is important not only to minimized the injury of the costoclavicular ligament, but also to avoid injury to the surrounding the vital structures such as the mediastinum and pleura after aggressive resection or radical debridement. We describe here 2 cases of the tuberculous arthritis on the sternoclavicular joint: one case had a good result after surgical debridement with using an anti-tuberculous agent, and the other had fatal complications such as mediastinal abscess and pleural effusion after the operation.

Clinical Studies on Mysthenia Gravis Associated with Thymoma

Authors studied 123 patients with myasthia gravis, who were admitted to the Seoul National University Hospital from 1981 to 1986 to get the incidence of thymoma in myasthenia gravis. 1. Among 66 cases, 23 were said to have the thymoma by radiological studies such as chest CT scan. 2. True thymoma were confirmed by histopathologic study in 10 out of 15 cases of CT-made thymoma. 3. The incidence of the associated thymoma in myasthenia gravis was calculated to be 19.2%. 4. Among 10 cases of thymoma, 7 cases were above 40 year of age, 3 cases below 40. 5. When these were classified by modified Osserman's classification, type IIA was numbered in only one, type IIB in 5, type III in 2, and type IV in 2. Therefore it is concluded that the thymoma plays significant role in myasthenia gravis and it is important to manage it in the diagnosis and treatment of myasthenia gravis.