Spontaneous Healing of Ruptured Anterior Cruciate Ligament / 대한정형외과학회잡지

The primary healing potential of anterior cruciate ligament (ACL) has been reported to be extremely poor in clinical and experimental studies. Most authors believe that the ACL does not heal spontaneously after rupture. In 1998, Kurosaka et al. reported two cases of a spontaneously healed torn ACL after non-surgical treatment; only a few cases have been reported. There are some reports of the spontaneously healed ACL or good clinical results after an ACL rupture in a conservative treatment group, but most studies were done by follow-up MRI or the clinical scores. This study experienced a case of spontaneous healing of a ruptured ACL confirmed by magnetic resonance imaging and arthroscopy. This paper reports a case with a review of the literature.

Symptomatic Calcific Deposition in Posterior Cruciate Ligament of the Knee / 대한정형외과학회잡지

Calcium deposition disease, including calcific tendinitis, rarely affects the knee joint. Only a few cases can be found in the literatures and there is no case report of symptomatic calcific deposition arising from the posterior cruciate ligament in Korea. The authors encountered a case of symptomatic calcific deposition arising from the posterior cruciate ligament, which was excised arthroscopically and confirmed pathologically. This paper reports this case with a review of the relevant literature.

Comparison of Histological and Biochemical Findings with Magnetic Resonance Imaging on the Degeneration Severity of Meniscus / 대한정형외과학회잡지

PURPOSE: The aim of this study is to determine whether degeneration severities of meniscus assessed using magnetic resonance imaging (MRI) would well estimate those assessed using histological and biochemical examinations. MATERIALS AND METHODS: Seven lateral menisci from knees with osteoarthritis undergoing total knee arthroplasty (study group) and five from normal controls (control group) were examined for this study. Degeneration severities of the menisci were graded using MRI, histologic and biochemical examinations of the menisci were then performed. Comparative analyses of MRI grading and results of histological/biochemical examinations of the menisci were performed in each group. In addition, comparative analyses of histological/biochemical conditions were performed between specimens of the study group and the control group showing grade 0 on MRI. RESULTS: All specimens from the control group showed grade 0 on MRI and their histology was also grade 0. In addition, no significant differences in biochemical results were observed among the specimens of the control group. In the lateral meniscus from the study group showing degeneration on MRI it was found that the water and proteoglycan contents increased with increasing grade of degeneration whereas the collagen content decreased. The meniscus specimens of the control group and the study group showing grade 0 on MRI had similar histologic findings but had different biochemical properties. The grade I, II degenerations on MRI were not well matched with the histologic findings in the study group. CONCLUSION: Severities of meniscus degeneration on MRI did not well reflect the histologic findings of the meniscus. This finding may be due to the water content of the meniscus. The factors of the high signal intensity of the degenerated lateral meniscus on MRI may be due to the decreased component of collagen and increased proteoglycan. Our findings suggested that caution should be taken when the severities of meniscus degeneration on MRI are attributed to histologic severities of degenerated meniscus.

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.

A Case of Arthroscopic Excision of Synovial Hemangioma with Dual Coagulation Shaver

A 17-year-old male patient visited our hospital with a palpable mass on the lateral aspect of the knee joint of five years duration without any related trauma history. The patient felt tenderness around the mass and had limitations in doing flexion exercises. Magnetic resonance imaging of the knee suggested the possibility of synovial hemangioma, and thus surgical treatment was planned. A tumor within the knee joint was found by arthroscopy, and a resection was carried out by dual coagulation shaver. The biopsy confirmed the diagnosis of a synovial hemangiomas. The patient presented months later at the out-patient clinic with no evidence of recurrence.

Treatment of Nonunion of Tibia with Extracorporeal Shock Wave Therapy: A Case Report

Almost tibia fractures can be surgically treated, but nonunion may occur in 10~30%, and they may accompany various complications by operation. This research was designed to review literatures and report a case of patient with nonunion of the tibia that showed good result when performing the extracorporeal shock wave therapy as a conservative treatment.

Extracorporeal Shockwave Therapy for Calcifying Tendinitis of Hands: Two Cases Report

Calcifying tendinitis of the hand is rare, and known to be self-limited or to show improvement with conservative therapy. However, poor response to treatment has been observed in cases of chronic conditions. The authors have performed extracorporeal shock wave therapy on a 19-year-old woman with chronic calcifying tendinitis of the extensor carpi ulnaris tendon, and a 45-year-old female with the condition involving the 4th finger flexor tendon, who showed no response to conservative treatment. Pain relief and radiological improvements were observed in the both patients.

Intraoperative Balloon Angioplasty in Diabetic Foot with Peripheral Artery Occlusive Disease During Amputation: Two Case Reports / 대한정형외과학회잡지

Amputation should be considered for the patients with limb necrosis or infection due to major vessel obstruction combined with diabetes. Patients with peripheral artery occlusive disease combined with diabetes have a higher risk of amputation and a higher possibility of reoperation than those patients without diabetes because of complications that include hematoma, infection and necrosis of the stump. We report here on 2 cases for which balloon angioplasty was used to promote wound healing on the stump site during amputation, and the patients had peripheral artery occlusive disease with a diabetic foot. The wounds healed early without complication in both cases.

Short Term Result of Minimally Invasive Total Knee Arthroplasty with Mini-Midvastus Approach / 대한정형외과학회잡지

PURPOSE: To investigate the effectiveness of minimally invasive total knee arthroplasty using the mini-midvastus approach through analyzing the short-term clinical outcomes. MATERIALS AND METHODS: Seventy-seven consecutive total knee arthroplasties were performed with the mini-midvastus surgical technique from August 2005 to February 2006 and were followed for more than 1 year after the procedure. All operations were performed with the Nexgen LPS-flex total knee system using a MIS quad-sparing instrument. The evaluation included preoperative and postoperative clinical data, surgical and radiological outcomes. RESULTS: The length of skin incision was average 8.4+/-0.6 cm and the operation time was average 95.5+/-15.7 minutes. The blood loss was average 727.5+/-315.5 cc. The tibial component alignment angles averaged 0.2+/-1.3degrees varus and the tibiofemoral angles averaged 5.8+/-1.8degrees. The mean ROM and the mean HSS score was 117+/-10degrees and 120+/-11degrees, 88.9+/-7.1 and 96.2+/-4.5 at eight weeks and one year after surgery respectively. CONCLUSION: If proper surgical procedures are performed using the appropriate surgical instruments, minimally invasive total knee arthroplasty with the assistance of the mini-midvastus approach, can result in good clinical outcomes and alignment of the implants.

US Features of Angioleiomyoma Arising from Superficial Soft Tissue

PURPOSE: To describe the sonographic features of angioleiomyoma arising from superficial soft tissue. MATERIALS AND METHODS: A retrospective study of the sonographic findings of 11 pathologically proven angioleiomyomas was performed. We evaluated the location, layer, size, shape, margin, echotexture, echogenicity, internal content, presence of calcification, and relationship to adjacent structures on gray scale sonography. We evaluated the presence, degree, and distribution pattern of vascularity within the mass on color Doppler sonography. RESULTS: All tumors were located in the subcutaneous layers of the extremities (5 in hand, 2 in elbow, 2 in knee, 1 in foot, 1 in calf). The sizes ranged from 8 to 30 mm, with an average size of 15.5 mm. All lesions were relatively homogeneous and hypoechoic, with well-defined margins and oval to round shape. There were no intratumoral calcifications or cystic portions in any of the masses. Vascularity was not detected in any patient (type 1), but was easily detected in 10 other patients. The degree of vascularity was mild (type 2) in 1 patient, moderate (type 3) in 4, and abundant (type 4) in 5. CONCLUSION: Although angioleiomyoma is an uncommon entity, our study suggests that it must be included in the differential diagnosis of well-defined, hypoechoic, vascular subcutaneous tumors in the extremities.

Displacement of Polished Femoral Stem during Reduction of a Dislocated Cemented Total Hip Arthroplasty: A Case Report

Displacement of a polished femoral stem from its cement mantle occurred during an attempted reduction of a dislocated total hip arthroplasty. This might be related to the geometry and surface finish of the stem, as well as the wedge-shaped and highly polished design. The stem became displaced when the femoral head impinged the acetabular margin during the reduction of the dislocated prosthesis. Surgeons need to be aware of this complication associated with using a polished femoral stem. This can be avoided by cementing over the shoulder of the stem as well as careful reduction under fluoroscopic control.

Minimally Invasive Posterior Lumbar Interbody Fusion: Comparison with Traditional Open Surgery / 대한정형외과학회잡지

PURPOSE: To compare the the clinical and radiographic results of the two approaches for posterior lumbar fusion, one-level posterior lumbar interbody fusion (PLIF) performed with a minimally invasive approach or the traditional open approach. MATERIALS AND METHODS: This study examined a consecutive series of 46 patients who underwent one-level PLIF procedure (27 cases performed with minimally invasive approach and 19 cases with traditional open approach) by one surgeon at one hospital. The following data were compared with a minimum 1-year follow-up: the clinical and radiographic results, surgical time, estimated blood loss, transfusion requirements, postoperative back pain, time needed before ambulation, length of hospital stay, and complications. RESULTS: There was no statistical difference between the two groups in terms of the clinical and radiographic results at the last follow-up. The minimally invasive group was found to have a less blood loss, fewer transfusion requirements, less postoperative back pain, a shorter recovery time, and a shorter hospital stay. However, minimally invasive group required a longer surgical time and there were 2 cases with technical complications. CONCLUSION: This study confirmed the favorable results reported by previous uncontrolled cohort studies. It also showed that the minimally invasive approach had a similar surgical efficacy to that of traditional open approach. However, minimally invasive technique requires a steep learning curve and attention in order to lower the risk of complications.

Operative Treatment for Proximal Phalangeal Neck Fractures of the Finger in Children

Displacement and inappropriate treatment of a proximal phalangeal neck fracture may result in malunion of the fracture with consequent loss of motion and gross deformity, especially in children. We performed a retrospective study of twenty-four patients who had undergone operative treatment for a proximal phalangeal neck fracture, with a mean follow-up evaluation of 14 months (range: 12-30 months). We analyzed the types of fractures, their causes, operative treatments, complications, and functional outcomes. The age of the patients ranged from 2 to 14 years (average: 4.8 years). Twenty of the 24 patients had open reduction and internal fixation, and fourteen of these 20 patients had criss-cross pin fixation. Four of the 24 patients had closed reduction and percutaneous pinning. The average length of immobilization was 3.5 weeks. Excellent or good results were seen in 18 patients (75%). Two patients had complications, which included volar angular deformity and mild button-hole deformity. We recommend that careful initial radiography, particularly, true lateral view radiographs, be required for proper diagnosis. The best results can only be obtained with accurate anatomical reduction of the fracture and early active motion exercise.

Comparison between Operative and Conservative Treatment of the 5th Metacarpal Neck Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results between conservative and operative treatments and to give guidelines in the treatment of angulated fifth metacarpal neck fracture. MATERIALS AND METHODS: The 43 cases of fifth metacarpal neck fracture (25 operative cases, 18 conservative case) were reviewed. The functional and radiologic results between two groups were evaluated. RESULTS: Both the operative group (preop.: 41.9 degree) and the conservative group (preop.: 39.7degree)showed satisfactory results (operative group: 15.3 degree, conservative group: 24.1degree) immediately after the correction. The maintenance of angulation correction was superior in operative group (15.7degree) than in conservative group (34.2degree), and patients' subjective satisfactions were superior in operative group too. Depressed knuckle on dorsum of hand was more frequently observed in conservative group (38.9%) than operative group (4%). Functional result in both groups was good. CONCLUSION: Because the correction of angulation was not maintained well in conservative group and a large portion of complications often occurred in cases of angulation more than 40 degree, operative treatment is needed in cases of angulation of fractured site more than 40 degree in the fifth metacarpal neck fracture.

Induction of Mucosal Tolerance Using House Dust Mite-Cholera Toxin B Conjugate in Mouse Model of Allergic Rhinitis: Prophylactic and Long-Term Therapeutic Effects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholera toxin B (CTB) is an effective immunomodulating agent. Mucosal tolerance is a well recognized method for inducing tolerance, but large amounts of antigen is needed. The dosage required can be dramatically reduced through coupling the antigen to the CTB. This study aimed to examine whether mucosal administration of house dust mite coupled to CTB (HDM-CTB conjugate) would modulate specific type 1 hypersensitivity in the murine model of allergic rhinitis and to evaluate the prophylactic and long-term therapeutic effects. MATERIALS AND METHOD: C57BL/6 mice were sensitized with Dermatophagoides farinae extract. After administration of HDM-CTB conjugate, several parameters of allergic response were evaluated. RESULTS: After mucosal adminstration of HDM-CTB conjugate, allergic symptoms, eosinophilic infiltration into nasal mucosa, specific IgE, and the splenic T cell proliferation after Dermatophagoides farinae allergen challenge were suppressed. CONCLUSION: These findings show that HDM-CTB conjugate has an anti-allergic effect in the murine model of allergic rhinitis and suggest that house dust mite allergy can be modulated with mucosal administration of allergen coupled to CTB.

Intramedullary Nailing for the Fracture of Proximal Humerus

PURPOSE: To evaluate the clinical and radiological result of the treatment for the fracture of proximal humerus using intramedullary nail. MATERIALS AND METHODS: Nine cases with fractures around the shoulder joint treated with Polarus IM nail from February 1999 to June 2002 was selected. There were 1 case with segmental fracture, 2 cases with nonunion after conservative treatment, 3 cases with nonunion after IM nail, 1 case with nonunion after pinning, 1 case with metal failure after plate fixation, and 1 case with fracture combined with shoulder dislocation. Bone union was evaluated with simple radiographic findings, and functional evaluation was done using Kona evaluation method. RESULTS: The average follow up period after the operation was 16 months and the average duration of immobilization was 2 weeks. All cases showed radiographic union and the average duration until union was 3.1 months. On the functional evaluation using Kona evaluation method, 3 cases excellent, 3 cases good, 2 cases fair, and 1 case showed poor result. The cases with poor result had combined elbow, forearm, and hand fractures at the initial injury. The complication of periprosthetic fracture caused by repeated trauma was reported in 1 case. CONCLUSION: Polarus IM nailing can result in good clinical and functional results for the treatment of nonunion, plate failure, segmental fracture and fracture of proximal humerus with shoulder dislocation.

Complication of Lateral Condyle Fracture of Humerus in a Patient with Hereditary Sensory Autonomic Neuropathy Type IV: A Case Report / 대한정형외과학회잡지

Hereditory Sensory Automnomic Neuropathy (HSAN) is a rare disorder. Five types of HSAN have been described by Dyck et al. Congenital insensitivity to pain with anhidrosis is classified HSAN Type IV. The clinical features include inability to sweat, causing defective thermoregulation, and congenital analgesia, which leads to orthopedic complications such as osteomyelitis, fractures, self mutilation and neuropathic arthropathies. Abnormal findings on nerve biopsy, virtual absence of unmyelinated nerve fibers, have been reported. We report a 5-year-old boy who presented with congenital insensitivity to pain, anhidrosis with fracture of lateral condyle of humerus and its complication.

DNA Vaccines

No abstract available.