Acute Compartment Syndrome after Anticoagulant Therapy to Misdiagnosed Deep Vein Thrombosis / 대한정형외과학회잡지

Acute compartment syndrome, which is an orthopedic emergency, induces irreversible tissue necrosis by increasing the compartment pressure. In serious cases, this event may result in functional impairment, loss of the lower limb, and death by renal failure. When the patient initially presents with pain and swelling that are similar to deep vein thrombosis, a differential diagnosis between the two diseases is very critical. The authors encountered a case of acute compartment syndrome after anticoagulant therapy in a patient presenting with painful swelling of the left leg following a massage that was initially misdiagnosed as deep vein thrombosis. A fasciotomy was performed on this case with satisfactory results. This paper reports this case with a review of the relevant literature.

The Influence of Initial Magnetic Resonance Imaging Findings on the Compression Rate of Thoracolumbar Osteoporotic Vertebral Compression Fracture / 대한정형외과학회잡지

PURPOSE: To investigate the influence of the size of low intensity zone (LIZ) (T1 image) on the vertebral body and the increase in the compression rate in patients with osteoporotic vertebral compression fracture. MATERIALS AND METHODS: In a retrospective study, 187 patients (198 segments) who were followed-up for at least 3 months and diagnosed with thoracolumbar vertebral compression fracture between October 2011 and October 2016, and treated with conservative therapies, such as bed rest and thoraco-lumbar-sacral orthosis. We measured the size of the vertebral LIZ, and fractures on the upper and lower endplates were observed on the initial magnetic resonance imaging. We analyzed the correlation with the increase in compression rate at the last follow-up. Comparisons of the increase in the compression rate were analyzed through a correlation analysis. RESULTS: The larger the size of the LIZ the greater the difference in the increase of the compression rate. The group with the initially LIZ (80%–100%) was significantly increased to 23.87%±17.90% (p=0.007). In case of fracture of upper and lower endplates, an increase in the compression rate was 19.39%±12.59% in the upper endplate fracture, which was significantly higher than that in the absence of endplate fracture (p=0.002). CONCLUSION: The larger the size of the LIZ (T1 image) and superior endplate fracture observed on the initial magnetic resonance imaging after fracture, the greater the increase in the compression rate. In particular, when the size of the LIZ is greater than 80%, the compression rate was significantly increased.

Septic Arthritis after Arthroscopic Meniscal Repair / 대한정형외과학회잡지

The incidence of septic arthritis after knee arthroscopy surgery has rarely been reported in approximately 0.04% to 3.4%. Moreover, septic arthritis after arthroscopic meniscal repair is more rare. There have been some reported cases, but in Korea, it has not been reported thus far. Herein, we report two cases of septic arthritis after arthroscopic meniscal repair with review of literature.

Femoral Shaft Fracture of a Middle-aged Male Adult during Playing Baseball / 대한스포츠의학회지

In general, femur fractures in the younger patient population are the result of high energy trauma, such as motorcycle accidents or traffic accidents. A 43-year-old healthy man presented with painful swelling of his right thigh. Plane radiographs showed short oblique fracture of the femur shaft with comminution. He had no medical history such as osteoporosis or any metabolic bone disorder. He was a healthy man with no smoking and no alcohol drinking, enjoying sports activity such as baseball and football. He was injured during defense time of a baseball game by rapid turning motion to catch a ball. We performed intramedullary interlocking nailing for the femur shaft fracture and the fracture was uneventually healed with no complication. To our knowledge, femur shaft fracture which occurred during playing baseball in a healthy middle-aged man has not been reported in our country. So we report this case with a review of the literature.

Muscular Injury of Iliacus and Gluteus Maximus after Mountain Climbing / 대한스포츠의학회지

Iliacus muscle is the strongest hip flexor of gluteal region that acts with psoas muscle, whereas gluteus maximus muscle is the largest muscle engaged in extension and external rotation of the hip. Mountaineering requires strong contractile force of both flexor and extensor around the hip. A 57-year-old man presented to our hospital with severe pain in left groin after mountaineering for 5 hours without a break. Magnetic resonance imaging revealed incomplete rupture of iliacus muscle and strain of gluteus maximus muscle. Conservative treatment was done. At 3 months of follow-up, he returned to normal life. If we are going to climb mountain, it is important to start warming up with some stretches, take a break while climbing, and use climbing sticks. There have been no report about athletic injury of both iliacus and gluteus maximus after mountaineering. So we report this case with a review of the literature.

Analysis of Treatment Results of Unstable Distal Clavicle Fractures Using Hook Plate / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the treatment results and complications in unstable distal clavicle fractures which were treated with a Hook plate, and, in particular, to compare the functional results before and after removal of the Hook plate. MATERIALS AND METHODS: We examined 20 cases in 20 patients who underwent removal of Hook plates after bony union was obtained in an unstable fracture of the distal clavicle (Neer type II) from March 2009 to December 2012. The average follow-up period after initial surgery was 12 months (8-20 months). Plates were removed at 18 weeks (ranged from 10-36 weeks) after initial fixation. University of California at Los Angeles (UCLA) and Korean Shoulder Scoring System (KSS) scores were used for clinical functional evaluation, and plain radiographs were used for radiological evaluation. RESULTS: In radiological evaluation, bony union was obtained at an average of 11.4 weeks (ranged from 8-14 weeks) in all of the 20 patients. All of the 20 patients showed limited range of motion, mild pain, and discomfort of the shoulder before removal of the Hook plate, and all of the 20 patients showed better results in UCLA and KSS score after removal of the plate, when compared to before removal. Stress fracture as a major complication, was united completely with a 'figure of 8' bandage and deep wound infection was resolved after repeated debridement and antibiotic treatment with satisfactory functional results. CONCLUSION: Hook plate in treatment of unstable fracture of the distal clavicle is considered to be a useful method because rigid fixation can be obtained. However, there are some complications, such as limited range of motion, pain, and discomfort of the shoulder joint, before removal of the Hook plate. Therefore, we think that removal of the Hook plate as soon as possible if bony union is obtained would be desirable.

Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid / 대한정형외과학회잡지

An 82-year-old woman underwent surgery for the left intertrochanteric fracture. However, during hospitalization, she complained of pain on the right knee. Radiographs showed moderately degenerative arthritis and intrameniscal calcification. Hyaluronic acid was administered by intraarticular injection. After injection, arthritic symptoms improved. Five days after injection, she complained of severe pain, swelling, and heating sensation in the right knee with chills and fever. Blood test showed elevated white blood cell (WBC) count and C-reactive protein. WBC in synovial fluid increased to 47,250/mm3. Antimicrobial therapy was administered under the impression of acute pyogenic arthritis by adverse reaction of hyaluronic acid injection. Polarization microscope showed calcium pyrophosphate dihydrate crystals. Synovial fluid culture was negative. Finally, she was diagnosed as pseudogout. The symptoms improved within one week. To our knowledge, there has been no report of pseudogout following intraarticular injection of hyaluronic acid in Korea. Therefore, we report this case with a review of the literature.

Perspectives of Stem Cell Therapy in Orthopaedics / 대한고관절학회지

No abstract available.

The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

PURPOSE: We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture. MATERIALS AND METHODS: From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes. RESULTS: The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death. CONCLUSION: In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.

Deep Infection Caused by Gas-Forming Bacteria after Total Hip Arthroplasty

A deep infection after total hip arthroplasty is a very severe complication that occurs in about 1~2% of the patients. The major cause of this infection is Staphylococcus aureus in the early stage and Staphylococcus epidermidis in the late stage A nontraumatic gas-forming infection is rare and difficult to diagnose because of its slower clinical course than that of gas gangrene. Therefore, it has a high mortality rate due to delayed treatment. There have been no reports on gas-forming infection by Escherichia coli after total hip arthroplasty. We report here on a patient who was treated by open arthrotomy and the patient expired due to a Escherichia coli, gas-forming infection after undergoing total hip arthroplasty.

Matrix Metalloproteinase-2 Expression of the Injured Anterior Cruciate Ligament in the Knee and Changes in Relation to Signal Transduction Pathways / 대한정형외과연구학회지

PURPOSE: This study was designed to pursue the basic relationship between MMP-2 and ligament injury via ex vivo stretching of the anterior cruciate ligament (ACL) and its changes by signal transduction pathway. MATERIALS AND METHODS: After femur-ACL-tibia complex was harvested from rats, release of MMP-2 in stretch group and non-stretch group was checked using gelatin zymography. Firstly, authors investigated whether MMP-2 was released from the ligament or not and if so, how long it was released. In addition, the complexes were divided into two groups. In group I, 5 and 12N weights were used to stretch the complex for 10, 30, and 60-minute. In group II, after the ligament complexes were stretched by 15N for 30 minutes, various signal pathway inhibitors such as pertusis toxin, SP600125, PD98059, KT5720, curcumin, and Bay11-7082 were added to their supernatants. MMP-2 activity was evaluated. RESULTS: MMP-2 was immediately released after ligament injury and its activity was increased in proportion to stretching duration and magnitude. As for the signal pathways, inhibition of JNK, ERK, AP-1, and NF-k beta pathways caused MMP-2 expression to be decreased. CONCLUSION: It is considered that the release of MMP-2 plays an important role in remodeling process after ACL injury.

Senescence of Nucleus Pulposus Chondrocytes in Human Intervertebral Discs

STUDY DESIGN: Senescence-related markers were assessed in surgically obtained human nucleus pulposus (NP) specimens. PURPOSE: To demonstrate the mechanism and signaling pathway involved in the senescence of NP chondrocytes. OVERVIEW OF LITERATURE: The population of senescent disc cells has been shown to be increased in degenerated or herniated discs. However, the mechanism and signaling pathway involved in the senescence of NP chondrocytes are unknown. METHODS: We examined cell senescence markers [senescence-associated beta-galactosidase (SA-beta-gal), telomere length, telomerase activity, p53, p21, pRB and p16] and the hydrogen peroxide (H2O2) content in human NP specimens. RESULTS: The percentage of SA-beta-gal-positive NP chondrocytes increased with age, while the telomere length and telomerase activity declined. However, there was no significant correlation between age and H2O2 content. The NP specimens with grade III or IV degeneration showed significantly higher percentages of SA-beta-gal-positive NP chondrocytes than those with grade II degeneration. Immunohistochemistry showed that senescent NP chondrocytes in all specimens expressed p53, p21, and pRB, while a few NP chondrocytes in only two specimens expressed p16. CONCLUSIONS: The present study demonstrates that, with increasing age and advancing disc degeneration, senescent NP chondrocytes increase or accumulate in the NP. Furthermore, the telomere-based p53, p21, pRB pathway, rather than the stress-based p16, pRB pathway, plays a more important role in the senescence of NP chondrocytes in in vivo conditions. Our results suggest that prevention or reversal of senescence of NP chondrocytes can be a novel mechanism by which to prevent human disc degeneration.

Total Hip Replacement Arthroplasty in Patient with Idiopathic Thrombocytopenic Purpura: Clinical Experience of Perioperative Management

PURPOSE: Patients with idiopathic thrombocytopenic purpura (ITP) survive longer now than in the past, secondary to the development of more effective treatment modalities. The risk of osteonecrosis of the femoral head was known to be increased in these patients in the past. However, until now, there has been no issuance of definite guidelines concerning the perioperative management of patients with ITP undergoing arthroplasty of the hip. We analyzed the outcomes of hip arthroplasty in patients with ITP who received appropriate perioperative hematologic management. MATERIALS AND METHODS: Five patients (six cases) with the diagnoses of osteonecrosis of the femoral head and ITP underwent total hip arthroplasty between November 2001 and January 2004. Perioperatively, their hematologic profiles were evaluated, and appropriate management was undertaken, including transfusion. RESULTS: Total hip arthroplasty in patients with ITP was successful in spite of the risks of perioperative bleeding and infection. CONCLUSION: We recommend total hip arthroplasty in patients with thrombocytopenic disorders like ITP, as long as they are provided with appropriate perioperative hematologic management.

The Efficacy of Intra-articular Infusion of Ropivacaine after Total Knee Arthroplasty / 대한마취과학회지

BACKGROUND: Intravenous patient controlled analgesia may not provide complete postoperative analgesia following total knee arthroplasty. The present study was to evaluate whether the addition of local, intra-articular ropivacaine improves the quality of the analgesia after total knee arthroplasty. METHODS: In the prospective, double-blind trial, 17 patients undergoing total knee arthroplasty of both knees with a standard general anesthetic technique had a infusion catheter placed at each knee joint at the end of surgery. The first knee joints were randomly assigned to receive a bolus of 20 ml 0.75% ropivacaine or saline followed by continuous infusion at 2 ml/h for 48 hours. The later knee joints received saline or ropivacaine that was not administered in the first knee joints in same manner. All patients received IV PCA. The difference in pain for each knee was assessed before surgery and at 2, 4, 6, 12, 24, 36 and 48 hours postoperatively. The use of a visual analogue scale (VAS) for each knee was also assessed at 2, 4, 6, 12, 24, 36 and 48 hours postoperatively. RESULTS: The difference in pain between each knee significantly increased at 4, 6, 12, 24, 36, 48 hours. However, the VAS in the ropivacaine-infused knee was significantly lower than that in the saline-infused knee at 12 and 24 hours. CONCLUSIONS: These results suggest that an intra-articular infusion of a bolus of 20 ml followed by continuous infusion at 2 ml/h with 0.75% ropivacaine after total knee arthroplasty has only a marginal analgesic effect.

Notochordal Cells Induce Chemotaxis of Cartilage-Endplate Chondrocytes in In Vitro Motility Assays / 대한척추외과학회지

STUDY DESIGN: In vitro motility assays were carried out using rat intervertebral discs (IVDs). OBJECTIVES: To demonstrate the motile properties of the cartilage endplate (CE) chondrocytes and the effect of notochordal cells on this property. LITERATURE REVIEW: Although previous in vivo studies have provided evidence for the migration of CE chondrocyte from hyaline CEs into the notochordal nucleus pulposus (NP), it is unclear if CE chondrocytes of the IVD actually have motile properties. In addition, the effect of notochordal cells on these properties has not been reported. MATERIALS AND METHODS: Notochordal cells and CE chondrocytes were harvested from three-month-old male Wistar rats and cultured separately. The motility was assayed in quadruplicate using a 48-well microchemotaxis chamber and a gelatin-coated 8-micrometer polycarbonate membrane filter. The control medium (serum-free culture medium), notochordal cells (4x, 2x, 1x and 0.5x10(6)) and concentrated conditioned medium (10-, 50-fold) where notochordal cells were cultured were loaded into the wells of the lower chamber, and CE chondrocytes were added to the wells of the upper chamber. At the end of the assays, the CE chondrocytes that migrated to the bottom side of the membrane filter were stained, counted, and compared. RESULTS: Compared with the control medium, the notochordal cells (N = 4x, 2x, 1x and 0.5x10(6)) and concentrated conditioned medium (10- and 50-fold) significantly increased the chemotactic motility of the CE chondrocytes in a number- and concentration-dependent manner (p<0.05). CONCLUSION: The CE chondrocytes of the intervertebral disc are motile, and soluble factors produced by notochordal cells induce the chemotaxis of CE chondrocytes.

Treatment of Acetabular Avulsion Fracture with Labral Tear Using Suture Anchor: A Case Report

We present here an operative method that uses the suture anchor technique in the case of a tiny avulsion fracture of the acetabulum along with a labral tear. Generally it is very difficult to determine how to treat patient with either the conservative method or the operative method because it is difficult to decide on the proper method to fix tiny avulsion fracture fragments to the acetabulum. Unstable hip dislocation was perceived in our case, so we tried to fix the fracture fragments to the acetabular rim&repair the labral tear that was seen on the operation field by using the sutue anchor technique. This is now a popular method to repair labral tear of the shoulder joint.

Matrix Metalloproteinase(MMP)-2 Expression Related to Stretch Injury of the Anterior Cruciate Ligament in the Knee / 대한정형외과학회잡지

PURPOSE: Tissue remodeling is essential for the natural healing of damaged tissue. The matrix metalloproteinases (MMPs) that degrade the extracellular matrix to play a central role in this process. This study was designed to examine the basic relationship between MMP-2 and anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: After the femur-ACL-tibia complex was harvested from rats, the continuous release of MMP-2 in the stretch group was evaluated. The complexes were divided into three groups. To stretch the complexes, in group I, 5 and 12 N weights were used for 10, 30, and 60 minutes. In group II, 5 and 15 N weights were used for 5, 10, 30, 60, and 120 minutes. And in group III, 5, 8, 10, 12, and 15 N weights were used for 30 and 60 minutes. MMP-2 activity was evaluated using 0.05% gelatin zymography. RESULTS: MMP-2 was expressed and the signal intensity was increased according to the stretch duration and magnitude. In the tissue analysis, active MMP-2 was markedly present and the expression was increased in response to the stretch in the supernatant samples. CONCLUSION: MMP-2 was released immediately after ligament injury and its activity was increased in proportion to the stretch duration and magnitude. It is believed that MMP-2 expression plays an important role in the remodeling process after an ACL injury.

Effectiveness of Patellar Replacementin Total Knee Arthroplasty : Randomized, Prospective Study using Simultaneous Bilateral Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study evaluated the clinical and radiological results of a randomized clinical trial of patella resurfacing. MATERIALS AND METHODS: A blinded, prospective study was carried out for 20 patients who underwent bilateral TKA with one patellar side being resurfaced from Jan. 2002 to Jun. 2003. The clinical results were assessed using the knee society clinical rating system, patellar score and patient-satisfaction score. Radiologically, patellofemoral congruency was assessed by measuring the patellar displacement in the skyline view. RESULTS: There were no significant differences between the resurfaced and non-resurfaced knees with respect to the overall knee society knee scores or the patellar scores. In the patient-satisfaction scale, 2 out of 4 knees with anterior pain postoperatively were unsatisfactory to the patients. The average patellar congruency in the non-resurfacing/resurfacing group was 98.8%/98%. CONCLUSION: The clinical and radiological results after TKA were not associated with patellar resurfacing. It appears that a variety of factors such as preoperative anterior knee pain, pathological lesion and alignment of patella, and the surgical technique are related to the postoperative results.

Treatment of an Unstable Intertrochanteric Fracture of The Femur Using a PMMA Augmented Compression Hip Screw / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the clinical and radiological results of a PMMA augmented compression hip screw for the management of unstable intertrochanteric fractures of the femur in senile patients. MATERIALS AND METHODS: From May 1996 to May 2002, 30 patients (mean age 74.8 years, ranging from 51 to 89) with an unstable intertrochanteric fracture of the femur, were treated with a PMMA augmented compression hip screw. The average follow-up period was 16.8 months (12 to 36). Radiologically, the degrees of osteoporosis, the neck-shaft angle after the reduction, the position of lag screw in the femoral head, the degrees of sliding of the lag screw and the shortening of the limb when union had been achieved, the extent of the insertion of the PMMA cement, and the timing of bone union were analyzed. In addition, the changes in the ambulatory capacity were evaluated by the functional class of Koval. RESULTS: Radiologically, 5 cases of a varus deformity over 10degrees and 7 cases of lag screw sliding more than 15 mm were found in the 30 cases. However, there was no cutting out of the screw in femoral head nor was there fixation failure of the plate. In addition, union was finally achieved in all cases, although there were two cases of a delayed union. Clinically, satisfactory results were obtained in most of the cases according to the functional class of Koval. CONCLUSION: For senile patients with an unstable intertrochanteric fracture of the femur, PMMA augmented compression hip screw appears to be one of the more useful methods allowing the early ambulation and reducing the number of complications by the long immobilization.

The Effect of the Epidermal Growth Factor(EGF) on the Healing of the Injured Anterior Cruciate Ligament of the Knee in Dog: in Vivo Study / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to find out the possibilities of the new treatment via continuous stimulation by photo-immobilization of growth factor in the anterior cruciate ligament(ACL) injury. MATERIALS AND METHODS: Photo-reactive epidermal growth factor(EGF-Az) synthesized by conjugating EGF with N-(4-azidobenzoyloxy)succinimide was immobilized onto biodegradable tissue-regenerative mesh(Bio-Mesh(R)) using UV irradiation. We sutured the BioMesh containing photo-reactive EGF on the artificial defect area of ACL in the left knee of beagle dogs and sutured the BioMesh that was not treated with EGF-Az on the defect area of ACL in the right knee. Four weeks later, we obtained the tissues from the defect area of both ACLs and compared the results of HE stain, immunohistochemistry and RT-PCR in both tissues. RESULTS: In results of HE stain and immunohistochemistry, we observed better cellular proliferation and more definite spindle shape of cells in EGF-immobilized area than in non-EGF defect area. Also cellular density was higher in EGF-immobilized area. On the other hand, cells had shaped more round and cellular density was lower in non-EGF defect area. In results of RT-PCR of GAPDH(Glyceraldehyde-3-phosphate dehydrogenase), COL I(Collagen type I), COL III and EGF, except for TGF-beta1(Transforming growth factor-beta 1), we also observed more definite expressions in EGF-immobilized area than in non-EGF defect area. CONCLUSION: We were able to confirm rapid cellular proliferation via artificial stimulation effect induced by photo-immobilized EGF. If EGF is immobilized onto biodegradable materials for clinical application, it will contribute to the treatment of ACL injury.