Associations of COL2A1 Gene Polymorphisms and Ankylosing Spondylitis in the Korean Population

Objectives@#The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) of COL2A1 affect the development of ankylosing spondylitis (AS).Summary of Literature Review: Many factors have been reported to be involved in the etiology of AS. Human leukocyte antigen (HLA)-B27 has been established as a genetic factor involved in the development of AS; however, it has been reported in recent studies that various genetic polymorphisms may be related to the development of AS. The collagen, type II, alpha 1 gene (COL2A1 ) plays a role in cartilage formation and maintaining the vitreous humor in the eye. Several previous studies have investigated the associations of COL2A1 with spinal degenerative diseases, but no case-control comparative study has yet investigated the effect of COL2A1 variants on the development of AS. @*Materials and Methods@#The study was planned with 96 AS patients in the study group and 330 healthy individuals in the control group. We searched the gene region of the COL2A1 gene in the NCBI SNP database (http://www.ncbi.nlm.nih.gov/snp), and 3 SNPs (rs3803183, rs2070739 and rs1793949) were found using sequencing to be significantly different between the AS and control groups. Multiple logistic regression models for genetic analysis were applied @*Results@#Three SNPs (rs3803183, rs2070739 and rs1793949) of COL2A1 showed significant associations with AS patients compared to control subjects (p<0.05). @*Conclusions@#SNPs of COL2A1 may be associated with the development of AS in the Korean population.

Incidence and Associated Factors of Delirium after Orthopedic Surgery / 대한정형외과학회잡지

PURPOSE: To investigate the incidence and associated factors of delirium after orthopedic surgery. MATERIALS AND METHODS: A total of 2,122 cases, who were older than 20 years and underwent orthopedic surgery at a single medical center during a one year period were included. Among them, 132 patients who were diagnosed with delirium after surgery under the Diagnostic and Statistical Manual of Mental Disorders-V criteria and medicated under the consultation of a psychiatrist were included in the study The differences in the incidence of delirium and several affecting factors were analyzed. RESULTS: The overall incidence of delirium after surgery was 6.2% (132 in 2,122 cases). The mean age of the delirium group was 77.4 years (range, 54–92 years), which was higher than that of the non-delirium group (58.1 years). The percentage of women in the delirium group was 63.6% (84 in 132 cases), which was higher than that of the women in the non-delirium group (49.0%). The incidence of delirium after surgery was 9.3% (85 in 916 cases) due to trauma and 3.9% (47 in 1206 cases) due to disease. The incidence of postoperative delirium according to the surgical region was 29.2% (7 in 24 cases) in two or more regions, 13.7% (72 in 526 cases) in the hip, and 9.6% (14 in 146 cases) in the spine, 3.5% (20 in 577 cases) in the knee-lower leg, 2.5% (5 in 199 cases) in the foot-ankle, 2.4% (11 in 457 cases) in the shoulder-elbow, and 1.6% (3 in 189 cases) in the forearm-wrist-hand. Delirium occurred more rapidly in women and surgery due to disease, and the duration of delirium was longer in patients with dementia and major depressive disorders. CONCLUSION: The incidence of postoperative delirium was high in cases of surgery due to trauma and in cases of surgery in two or more sites. The incidence of postoperative delirium according to a single surgical region was higher in the order of the hip, spine, and knee. Active intervention is needed regarding the correctable risk factor.

Osteochondroma of the Distal Clavicle: A Rare Cause of Impingement and Biceps Tear of the Shoulder

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.

Radiological Stability after Revision of Infected Total Knee Arthroplasty Using Modular Metal Augments

PURPOSE: To evaluate the radiological stability according to the number of modular augments after revision of infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Between February 2006 and September 2013, 37 patients (39 knees) followed > or =2 years after revision of infected TKA using modular metal augments for bone defects were reviewed retrospectively. We divided the patients into 3 groups according to the number of augments into group A ( or = augments, 7 knees) and evaluated the width of radiolucent zones around the implant at the last follow-up. RESULTS: There were 3 Anderson Orthopedic Research Institute type I, 33 type II, and 3 type III bone defects. The mean number of radiolucent zones of group A was 3 and the sum of width averaged 4.4 mm. In group B, the values were 4.8 and 6.2 mm, respectively. In group C, the values were 8.1 and 12.9 mm, respectively. The differences between the three groups were statistically significant. CONCLUSIONS: In revision TKA with modular metal augmentation caused by infected TKA, increased modularity can result in radiological instability.

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.

Concomitant Carpal Injuries in Distal Radius Fractures: Retrospective Analysis by Plain Radiographs and Computed Tomography

PURPOSE: The purpose of this study is to evaluate the incidence and characteristics of concomitant carpal bone fractures and ligament injuries and to analyze risk factors for carpal injuries in patients with distal radius fractures. MATERIALS AND METHODS: A total of 362 patients with 379 distal radius fractures were reviewed retrospectively. Associated carpal bone fractures and ligament injuries were evaluated by plain radiographs and computed tomography at the time of initial trauma. Correlation between associated carpal injuries and various parameters was also analyzed. RESULTS: Of 379 distal radius fractures, 39 cases (10.3%) had one or more carpal bone fracture and 40 cases (10.6%) had carpal ligament injuries. Overall, carpal injuries occurred in 59 cases (15.6%) distal radius fractures. Associated carpal ligament injuries showed correlation with young age and associated carpal bone fractures showed correlation with AO type B distal radius fractures. Carpal injuries including fracture and ligament injury showed correlation with male, high energy trauma, or associated injuries beyond wrist. CONCLUSION: The incidence of concomitant carpal injuries in patients with distal radius fractures is relatively high. Concomitant carpal injuries were more common in young age, male, high energy trauma, AO type B distal radius fractures, or associated injuries beyond wrist.

Surgical Correction in Patients with Lumbar Degenerative Kyphosis Who Had Low Bone Mineral Density: An Analysis of 40 Patients with a Minimum Follow-Up of Two Years

STUDY DESIGN: Retrospective study. PURPOSE: To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK). OVERVIEW OF LITERATURE: No studies so far have reported the influence of BMD on the surgical correction of LDK. METHODS: Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented. RESULTS: There were 37 females and 3 males. Average age was 65.1+/-4.5 years and mean follow-up was 34.2+/-16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0+/-96.7 mm preoperatively to 45.3+/-41.8 mm postoperatively (p=0.000). LL improved from 10.5degrees+/-14.7degrees to -40.6degrees+/-10.9degrees postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8+/-72.2 mm and LL to 34.7degrees+/-15.8degrees (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis. CONCLUSIONS: Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis.

Magnetic Resonance Neurography Findings in Idiopathic Neuralgic Amyotrophy / 계명의대학술지

Idiopathic neuralgic amyotrophy (INA) is known as Parsonage-Turner syndrome or idiopathic brachial plexitis and is characterized by sudden onset of severe limb pain, followed by weakness and atrophy of limb. There is no specific tests for the diagnosis of INA. The diagnosis of INA is mainly dependent on the clinical history and electrodiagnostic study. It is often confused with more common disorders such as acute cervical radiculopathy, rotator cuff tear, or acute calcific tendinitis. A few recent reports have revealed that magnetic resonance image (MRI) of brachial plexus and shoulder can be helpful in the diagnosis of INA. We report two cases of classic INA in which MRI enhanced specificity and confidence in the diagnosis. MRI of the brachial plexus and corresponding limb as well as cervical spine should be included in patients clinically suspected of INA.

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.

Three Different Methods in Deformity Correction of Degenerative Flat Back: A Single Surgeon's Experience with 64 Consecutive Cases

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back. OVERVIEW OF LITERATURE: There are no comparative studies about different procedures in the treatment of degenerative flat back. METHODS: Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared. RESULTS: The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P. CONCLUSIONS: Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.

Ultrasound-Guided Percutaneous Removal of Wooden Foreign Bodies in the Extremities with Hydro-Dissection Technique

OBJECTIVE: We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases. MATERIALS AND METHODS: Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed. RESULTS: The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance. CONCLUSION: Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

Acute Longus Colli Tendinitis without Calcification / 대한정형외과학회잡지

Calcific tendinitis of the longus colli is an inflammatory disease caused by calcium hydroxyapatite crystal deposition in the longus colli tendon of the prevertebral space. It is also known as retropharyngeal calcific tendinitis or prevertebral tendinitis. The typical imaging characteristics of this entity are calcifications on the superior insertion of the longus colli tendons at the C1-2 level and fluid collection in the retropharyngeal space. However, we introduce a case of acute longus colli tendinitis without definite calcification deposition on image findings.

Metastatic Calcification of the Finger in a Chronic Renal Failure Patient / 대한정형외과학회잡지

Metastatic calcification is defined as ectopic calcification of soft tissues in patients with a systemic mineral imbalance, and dystrophic calcification or heterotopic ossification is distinct from that disease. The authors encountered a metastatic calcification of the finger in a patient with chronic renal failure, the lesion disappeared spontaneously during the observation period. We report on a case of metastatic calcification of the finger with a review of the literature.

Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty

PURPOSE: To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA). MATERIALS AND METHODS: We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed. RESULTS: Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05). CONCLUSIONS: The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.

Sleep Status and Quality of Life in Patients with Frozen Shoulder / 대한정형외과학회잡지

PURPOSE: The aims of this study were to assess sleep status and quality of life (QOL) in patients with frozen shoulder and to evaluate correlations between pain, disability, sleep disturbance and QOL. MATERIALS AND METHODS: Thirty patients with idiopathic frozen shoulder and 60 healthy controls were enrolled into this study. Participants were evaluated using the following: visual analogue scale (VAS), American Shoulder and Elbow Surgeon's Score (ASES), Korean Shoulder Score (KSS), Pittsburg Sleep Quality Index (PSQI), and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF). RESULTS: The mean VAS, ASES, and KSS scores in patient groups were 6.5, 40.3, and 45.1, respectively. The mean PSQI score was 8.6 in the patient group and 4.1 in the control group. Patient groups had significantly higher scores than the control group for the PSQI score (p0.05). The ASES score had a positive correlation with physical health domain and KSS score had a positive correlation with overall QOL and physical health domain of the WHOQOL-BLEF (p<0.05). CONCLUSION: Patients with frozen shoulder had noticeable pain and functional disability. Furthermore, they had significant incidence of sleep disturbance and had a significantly lower QOL.

Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature

The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.

Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft

PURPOSE: This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures. MATERIALS AND METHODS: Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29~76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12~42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali. RESULTS: This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5~18 months). By clinical evaluation according to Mekhali's estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively. CONCLUSION: Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.

Comparative Study of the Clinical Outcomes of Unilateral Transforaminal Lumbar Interbody Fusion(TLIF) with Bilateral TLIF using Wiltse Approach and Conventional Approach

STUDY DESIGN: Comparative study. OBJECTIVES: To compare the outcomes of unilateral TLIF, bilateral TLIF using Wiltse approach and bilateral TLIF using conventional midline approach. SUMMARY OF LITERATURE REVIEW: There are many studies about outcomes of Unilateral TLIF, but few have compared the 3 different fusion procedures. MATERIALS AND METHODS: 60 patients were divided into 3 groups. Each group has enrolled 20 patients (Study group: unilateral TLIF, Control group 1: bilateral TLIF using Wiltse approach, Control group 2: bilateral TLIF using conventional midline approach). For clinical outcomes, we compared operative time, blood loss, time for ambulation and discharge, VAS for back pain and leg pain and ODI among three groups. For radiologic evaluation, disc height and segmental lordosis were examined. RESULTS: The mean operative time was 147 minutes in study group(SG), 172 minutes in control group 1(CG1), 167 minutes in control group 2(CG2). The mean total blood loss was 466ml in SG, 569ml in CG1, 1140ml in CG2 respectively. VAS for back pain at the third postoperative day significantly decreased in SG and CG1 compared with CG2. There was no significant difference in ODI, disc height and segmental lordosis among the groups. CONCLUSION: Using Wiltse approach, there were several advantages in decreasing blood loss, immediate postoperative back pain, hospital stay and early ambulation. Clinical and radiological results of unilateral TLIF were comparable with bilateral TLIF.

Comparative Results of Acetabular Both Column Fracture According to the Fixation Method

PURPOSE: We wanted to compare the clinical and radiological results of surgical treatment of acetabular both column fracture according to the fixation method. MATERIALS AND METHODS: Between 1986 and 2008, 55 patients who underwent surgical treatment for acetabular both column fracture were clinically and radiologically evaluated after a minimum follow-up of one year. Of 55 patients, 29 cases were operated with a cerclage wire or cable (group I) and 26 cases were operated with a plate and screw (group II). The surgical approach, the intra- and post-operative complications and the reduction quality were compared between the two groups. The clinical and radiological results were analyzed according to the criteria reported by Matta. RESULTS: There were 14 (48.3%)/20 (76.9%) cases of anatomical reduction, 12 (41.4%)/6 (23.1%) cases of imperfect reduction, 1/0 case of poor reduction and 2/0 cases of surgical secondary incongruence, respectively. Thirty three patients of 34 anatomically reduced patients showed excellent clinical results and the anterior and posterior combined approach was frequent in group I. There were no differences between the two groups for the complications, although intraoperative complication was more frequent in group II and postoperative complication was more frequent in group I. CONCLUSION: The clinical and radiological results of surgical treatment in patients with both column fracture were satisfactory in both groups. However, the concerns related to the surgical approach and complications will require a randomized prospective study.