Diagnosis of Bone and Joint Infection in Neonates / 대한정형외과학회잡지

PURPOSE: The purpose of our study is to evaluate the diagnostic significance of clinical findings, WBC count, ESR, CRP, simple X-ray, ultrasonography and bone sanning in neonates. MATERIALS AND METHODS: From January 1995 to May 1998, we have experienced 14 cases of pyogenic osteomyelitis and pyogenic arthritis in neonates. The mean age of patients was 16.7 days and the involved sites were 6 cases of pyogenic arhtritis of hip, 5 cases of pyogenic arthritis of hip with proximal femur osteomyelitis, 2 cases of pyogenic arthritis of shoulder with proximal humerus osteomyelitis and 1 case of proximal tibia osteomyelitis. RESULTS: The most frequent clinical signs were local swelling and pseudoparalysis of involved extremity. Laboratory findings showed that elevated ESR was in 11/14 (79%), positive CRP in 6/8 (75%), leukocytosis in 6/14 cases (43%). Abnomal findings in simple X-ray was in 7/13 (54%), positive bone scanning findings in 3/8 (37.5%), positive ultrasonographic findings in 11/11 cases (100%). CONCLUSIONS: ITherefore we concluded that careful physical examination and ultrasonography were important for early diagnosis of bone or joint infection in neonates

Primary Repair of Posterolateral Rotary Instability of the Knee / 대한정형외과학회잡지

PURPOSE: The purpose of our study was to determine the effectiveness of primary repair of arcuate ligament complex in posterolateral rotary instability of knee. MATERIALS AND METHODS: We reviewed the clinical records and operative notes of 9 patients who were treated by primary repair for the acute posterolateral rotary instability and followed more than 1 year. All the 9 knees had a positive external rotation recurvatum test and a positive posterolateral drawer test, One or more components of the arcuate ligament complex were injured in all cases and associated injuries were posterior cruciate ligament rupture in 6, lateral collateral ligament in 5, anterior cruciate ligament partial rupture in 2, biceps femoris rupture in 2, meniscus tear in 3, iliotibial band rupture in 1, ipsilateral femur fracture in 1 and peroneal nerve palsy in 1. RESULTS: By objective rating index, the results were classified as good (4 patients), fair (4 patients) and poor (1 patient). By functionally, the results were classified as good (6 patients), fair (3 patients). CONCLUSIONS: Consequently, we believe that primary repair of arcuate ligament complex in acute stage can result in objectively and functionally acceptable knee function.

Diagnostic and Operative Arthroscopy of the Knee Under Local Anesthesia

Local anesthesia for arthroscopic procedure of the knee is an increasinglv popular technique that avoids the use of general anesthesia and the associated risks of respiratory depression, aspiration, and postoperative sedation. Many authors, for example McGinty etc., Martin, Yoshiya etc., advocated local anesthesia as safe and efficient method for arthroscopic procedures of the knee. We performed arthoroscopy of the knee under local anesthesia on 150 patients for diagnostic and operative purposes between January l993 and December l996. The technique of local anesthesia that we used was that 20cc of 0.5%; bupivacaine with I:200,000 epinephrine was injected into superolateral portal of the knee joint and additional 10-20cc ot 1% lidocaine into the arthroscopic portals. Pnevmatic tourniquet wa, not applied in all cases. We analysed the 150 cases and the results were as follows; The diagnostic arthroscopy was performed in 50 cases and the operative arthroscopy was in 100 cases. The duration ot local anethesia was from 4 hours to 12 hours, with an average of 6 hours. In 35 cases arthroscopy was performed as outpatient procedure and average hospital stay excluding other problem was 5 days. No complication related to systemic toxicity by local anesthetics was observed. Conclusively arthroscopy of the knee under local anesthesia is safe and effective procedure to avoid the risks of general anesthesia but patients selection is very important.