PURPOSE: Using magnetic resonance imaging (MRI) as the standard of reference, the purpose of this study was to evaluate the accuracy of sonoelastography (SE) for assessment of fatty degeneration of suprasupinatus (SSP). MATERIALS AND METHODS: A retrospective analysis was conducted in 131 shoulders of 126 consecutive patients who underwent shoulder MRI, and SE. Oblique sagittal images of SSP were obtained using SE; the SE images were evaluated by two orthopedic surgeons using a 256 degree color map image. RESULTS: When the supraspinatus fatty degenerations were based on MRI findings, the sensitivity of SE was 89.47%, specificity 92.85%, and accuracy 91.60%. The interobserver reliability of the SE findings was 'almost perfect agreement' with a weighted kappa coefficient of 0.81. By comparison of MRI with the SE findings, the grades of MRI and SE showed positive correlation (r=0.85, p< or =0.001). In addition, the occupation ratio and blue region area ratio also showed positive correlation (r=0.69, p< or =0.001). CONCLUSION: SE is valuable in quantitative assessment of the severity of fatty atrophy of the supraspinatus and has excellent accuracy, excellent correlation with MRI and conventional ultrasonography, and excellent interobserver reliability.
Atrophy ; Elasticity Imaging Techniques* ; Humans ; Magnetic Resonance Imaging ; Occupations ; Orthopedics ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder ; Ultrasonography

PURPOSE: Awareness on continuing medical education (CME) of the Korean Orthopaedic Association (KOA) was investigated in order to augment the weak educational points of the conventional academic CME. MATERIALS AND METHODS: The web-survey was conducted in the KOA on the awareness of conventional academic or web-based CME. The questionnaire included working conditions, intimacy of informational technology, and strengths and weaknesses of academic and web-based CME. RESULTS: Among 3,427 emails sent, 168 (4.9% of effective response rate) responses were received. Of the responders, 74.4% of the responders could not attend CME frequently because of working time (35.7%) and a distance far from the working place (13.2%). The merits of academic CME included as the opportunity for considerations of other members' thoughts on some clinical matters (64.3%); however, the weak points were holding several similar conferences (60.1%) and too short time for adequate study (53.0%). They wanted that surgical procedures and tips (49.0%) to be provided in the form of lecture slides (44.6%) or movie clips (37.6%) in web-based CME. 95.5% of the responders showed positive response regarding the need for web-based CME. CONCLUSION: Results of the survey showed high needs and interests in web-based CME, which could support the weaknesses of the academic CME with less time for education and limited accessibility to CME due to time or space barriers due to their working conditions.
Congresses as Topic ; Education ; Education, Medical, Continuing* ; Electronic Mail ; Surveys and Questionnaires

PURPOSE: Coccygodynia is a painful condition localized in the region of the coccyx. Most cases of coccygodynia are treated conservatively. However, we conducted an analysis of patients who underwent coccygectomy, with chronic intractable coccygodynia and assessed the results of their treatment. MATERIALS AND METHODS: From March 2003 to August 2013, this study was conducted in order to investigate the benefit of coccygectomy in cases where conservative treatment has failed. We compared preoperative and postoperative visual analog scales (VAS) scores and confirmed duration of symptom free, complications. RESULTS: The average duration of symptom free was 3.4 months, and VAS score improved from 7.3 to 1.6. There was one wound infection. CONCLUSION: We can obtain satisfactory results through coccygectomy for chronic intractable coccygodynia.
Coccyx ; Humans ; Visual Analog Scale ; Wound Infection

High tibial osteotomy is an established method in treatment of medial knee osteoarthritis with varus deformity in younger patients. The popliteal artery is vulnerable to injury during surgeries performed around the knee joint. Pseudoaneurysm of the popliteal artery following medial opening wedge high tibial osteotomy is rare. A femoral angiogram revealed a pseudoaneurysm arising from the popliteal artery near the osteotomy site. Careful placement of retractors around the osteotomy site during sawing and flexing the knee to displace the popliteal artery away are recommended to prevent this complication. We report on the case of a pseudoaneurysm of the popliteal artery complicating medial opening wedge high tibial osteotomy that was treated clinically and radio-graphically with literature reviews.
Aneurysm, False* ; Angiography ; Congenital Abnormalities ; Genu Varum ; Humans ; Knee ; Knee Joint ; Osteoarthritis, Knee ; Osteotomy* ; Popliteal Artery*

PURPOSE: We performed clinical and radiological evaluation of surgical outcomes of congenital vertical talus. MATERIALS AND METHODS: Fifteen surgically treated feet in 9 patients (6 bilateral and 3 unilateral) which were followed-up for at least 2 years were included. Mean patient age at the time of surgery was 10.9 months. The surgical technique was a one-stage correction using the Kumar technique with a Cincinnati skin incision. In 7 feet we also transferred half of the tibialis anterior to the talar neck (the Grice technique). Radiologic parameters (talo-calcaneal angle, talo-first metatarsal angle, tibio-talar angle, tibio-calcaneal angle) were analyzed pre- and postoperatively and at the last follow-up, and clinical outcomes by the Laaveg-Ponseti score. RESULTS: Talus orientation was improved in all patients. All radiologic parameters showed statistically significant improvement by the last follow-up. The mean Laaveg-Ponseti score at the last follow-up was 16 for patient satisfaction, 16 for function, and 24 for pain. There was no recurrence, however one case of talar neck fracture occurred during the tibialis anterior transfer. CONCLUSION: One-stage surgical correction for congenital vertical talus at an early age provides satisfactory functional and cosmetic results.
Follow-Up Studies ; Foot ; Humans ; Metatarsal Bones ; Neck ; Patient Satisfaction ; Recurrence ; Skin ; Talus*

PURPOSE: Spinal fusion surgery can be associated with significant blood loss, often requiring blood transfusion. The objective of this retrospective study was to evaluate the efficacy of tranexamic acid in reducing blood loss and transfusion after lumbar spinal fusion. MATERIALS AND METHODS: A total of 75 consecutive patients undergoing spinal fusion surgery for spinal stenosis were included in this study. Thirty-five patients who were administered tranexamic acid were compared with 40 patients who did not receive the drug. Blood loss through drain, amount of blood transfusion, and hematological laboratory findings were evaluated. RESULTS: Blood loss through drain for the first 24 hours after surgery was 548.6+/-192.1 ml in the tranexamic acid group and 1,089.8+/-368.3 ml in the control group with a significant difference (p=0.001). Total blood loss through drain was 1,010.5+/-452.5 ml in the tranexamic acid group and 1,512.7+/-427.8 ml in the control group with a significant difference (p=0.005). Time to removal of drains after surgery was not different, 2.6+/-0.8 days in the tranexamic acid group and 2.5+/-1.1 days in the control group (p=0.885). Packed red blood cell (RBC) transfusion for the postoperative period and the number of patients requiring transfusion was significantly lower in the tranexamic acid group than in the control group. A prolongation of protrombin time was observed in the control group on first postoperative day. There were no complications related to the use of tranexamic acid. CONCLUSION: Tranexamic acid had an effect on reducing blood loss through drain for the first 24 hours and total blood loss after spinal fusion surgery. As a result, there was less of a requirement for RBC transfusion after surgery.
Blood Transfusion ; Drainage ; Erythrocytes ; Hemorrhage ; Humans ; Postoperative Period ; Retrospective Studies ; Spinal Fusion* ; Spinal Stenosis ; Tranexamic Acid*

PURPOSE: Fat embolism syndrome is caused by traumatic and nontraumatic conditions, and most commonly associated with fractures of long bones of the lower extremity. Clinical manifestation of the fat embolism syndrome occurs in a minority of patients with fat emboli. The incidence of fat emboilsm has been reported 5-10%. The pulmonary symptoms of fat embolism are clinically important but hard to diagnose, so treatment was often delayed. The purpose of this study is to search for the development of fat embolism after long bone fracture of rabbit, and to demonstrate pulmonary fat embolism by high resolution computerized tomograhy (HRCT) and pathologic findings. MATERIALS AND METHODS: Twelve rabbits (Newzealand, 2.5-3 Kg) were divided into 2, 24, 72 hours and control groups after closed tibiofibular fracture. The presence of involvement was classified by high resolution computerized tomography with ground glass opacity, consolidation and focal hyperlucency. The extent was measured by 10% grading scale. Gross inspection, histologic examination and histochemistry (Oil red 0) were performed in removed lungs. RESULTS: Ground glass opacity was found in 100% of test subjects, consolidation was found in 89%, bronchovascular bundle thickening was found in 78% and focal hyperlucency was found in 33%. Fat embolism was developed in all groups with the 24-hour group showing maximal changes. Microscopically the vessel was occluded with fat globule which was stained with Oil red 0 stain. CONCLUSIONS: The abnormal density lesion on HRCT was correlated with pathologic finding and was induced by fat emboli after long bone fracture of the rabbit
Embolism, Fat* ; Fractures, Bone* ; Glass ; Humans ; Incidence ; Lower Extremity ; Lung ; Pathology ; Rabbits

Atlas fracture accounts for 1% to 3% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. Only a few cases involving complications after surgical treatment have been reported. We present a case of anterior atlas arch stress fracture accompanied by worsening neurologic symptoms following atlas posterior arch resection for cervical myelopathy with retro-odontoid pseudotumor.
Cervical Atlas ; Fractures, Stress* ; Motor Vehicles ; Neurologic Manifestations ; Spinal Cord Diseases* ; Spine

PURPOSE: The objective of this study is to analyze the radiologic fusion rate in posterior lumbar interbody fusion (PLIF) using silicon-containing porous hydroxyapatite (Si-HA) chips packed within a cage. MATERIALS AND METHODS: Twelve patients who underwent PLIF using Si-HA (BoneMedik-S(TM); Meta-Biomed, Cheongju, Korea) blocks packed within a cage were enrolled. PLIF was performed in the same manner in all patients. A cage filled with Si-HA was inserted into disc space. Serial X-rays and 3-dimensional computed tomography (3D-CT) were performed for evaluation of the fusion status. RESULTS: At postoperative 12 months, 11 cases showed grade IV and one case showed grade III on X-rays. At postoperative 24 months, all cases showed grade IV (complete fusion). Assessment of fusion by 3D-CT also showed grade I in all cases at postoperative 12 months. CONCLUSION: Considering the above results, Si-HA packed in a cage appears to be an effective bone graft material for use in PLIF.
Chungcheongbuk-do ; Durapatite* ; Humans ; Lumbar Vertebrae ; Spine* ; Transplants

PURPOSE: To compare the functional and radiographic results of the treatment in unstable intra-articular fractures of distal radius by closed reduction and external fixation versus open reduction and internal fixation. MATERIALS AND METHODS: Forty cases of unstable intra-articular fractures of distal radius were treated either by application of closed reduction and external fixation (CREF) or by open reduction and internal fixation (ORIF) between March 1989 and June 1997. They were followed up for more than one year. To assess the functional results, we used Green and O' Brien' s score system and for the radiographic results, measured volar tilt, radial inclination and radial length. RESULT: In functional results, excellent to good results were obtained in 19 cases (76%) in the CREF group and 10 cases (80%) in the ORIF group, and the average score was 81.4 and 82.8 by the Green and O' Brien' s score system. In radiographic results, mean loss of volar tilt, radial inclination and radial length were 1.4 degree (13.4%), 2.0 degree (9.0%), 1.3 mm (10.3%) in the CREF group and 1.2 degree (10.8%), 1.6 degree (6.1%) and 1.2 mm (11.5%) in the ORIF group on last follow-up radiographs. There was no evidence of statistical difference between two groups in functional and radiographic results (P>0.05). CONCLUSIONS: If an appropriate operative method is selected according to the presence of several properties, including the pattern of fracture, the general condition and activity of patient and the degree of soft tissue injury, the two operative managements are considered useful to restoring articular congruity and alignment and to allow early postoperative range of motion exercise
Follow-Up Studies ; Humans ; Intra-Articular Fractures* ; Radius* ; Range of Motion, Articular ; Soft Tissue Injuries