No abstract available.
Slipped Capital Femoral Epiphyses*

The back pain is increasingly becoming a major problem in the elderly people. The cause of back pain in the elderly patient is quite different from in the young subject. And relationship of the occurrence of osteoporosis with the incidence of fractures in general is currently regarded as a major factor. The authors performed clinical observation on 194 elderly patients who were treated for back pain during 5 years period from April, 1983 to April, 1988 at the Department of Orthopaedic Surgery, Severance Hospital and relationship between osteoporosis and compression fracture of spine was reviewed. The results were as follows : l. Among the 194 cases of back pain(28.3% of total admission cases), whose age were over 50: 142 cases were female and 52 cases were male, being more common in female. 2. Most common cause of back pain was the compression fracture of spine : 86 cases(44.3 %). Osteoporosis was associated with 66 cases(76.7%) out of 86 cases. 3. The number of compression fracture in same patient was more frequent in osteoporotic patient and thoracolumber junction (T12, Ll) was the major site of fracture (45.6%). Compression fracture of spine caused by osteoporosis occured at multiple level in 60.6%. 4. Twenty three cases(34.8%) of compression fracture of spine with osteoporosis were found to have previous history of fractures of spine and/or extremities by radiological examination. Regarding this results, compression fractures of spine was not infrequent cause of back pain in the elderly. It was thought that re-fracture of spine should be prevented by vigorous approach against osteoporosis along with the treatment of presenting fracture in these patients.
Aged ; Back Pain ; Clinical Study ; Extremities ; Female ; Fractures, Compression ; Humans ; Incidence ; Male ; Osteoporosis ; Spine

Since 1952, Ilizarov external fixator has been developed and used for more than 30 years in Russia and world-wide interest on it has been prevalent during last 2-3 years. The fixation of the tension applied thin wires to the metal frame resist flexional and translational deformity just like other extenal fixators. But, it allows cyclic axial micro-motion at the fracture site without loss of reduction so that it can provide good environment for the fracture healing biologically and biomechanically. Another advantage of Ilizarov external fixator is that it permits mobilization of the adjacent joints and weight bearing of the fractured limb during the application of it and shortens the duration of administration. Since 1988, We applied the Ilizarov external fixator for the treatment of diffcult tibial fractures (open comminuted, segmented and comminuted fractures, nonunion, maunion) and obtained good results in 7 cases. So we report our results even if we had limited cases and experiences.
Congenital Abnormalities ; External Fixators ; Extremities ; Fracture Healing ; Fractures, Comminuted ; Joints ; Russia ; Tibia ; Tibial Fractures ; Weight-Bearing

PURPOSE: While sleeping problems increase with advancing age, there are inherent differences in sleep between males and females. Previous studies have shown inconsistent results of the relationship between sleep duration and risk of injury from falling. While controlling various sociodemographic and health-related factors, national representative data were used in order to analyze the association between sleep duration and injury from falling among older adults. MATERIALS AND METHODS: The data were obtained from the Korean Community Health Survey of 2011. A total of 55654 individuals aged 65 years and older participated in the study. Multivariable logistic regression analysis was conducted to identify the factors associated with injury from falling. RESULTS: After adjusting for covariates, such as age, sex, marital status, whether or not an individual is a recipient of benefits from the National Basic Livelihood Act, hypertension, diabetes mellitus, dyslipidemia, stress level, and self-rated health status, those who slept five hours or less per day [odds ratio (OR)=1.26; 95% confidence interval (CI)=1.18–1.34; p<0.001] or eight hours or more per day (OR=1.11; 95% CI=1.04–1.17; p=0.001) presented significantly higher ORs for injury from falling. A similar result was found when we conducted stratification by sex. CONCLUSION: The current study supports that there is a relationship between short sleep duration and injury from falling and also identified a marginal risk of long sleep in older adults. Therefore, sleep management in older adults with inadequate sleep duration may be necessary.
Accidental Falls* ; Adult* ; Cross-Sectional Studies* ; Diabetes Mellitus ; Dyslipidemias ; Female ; Health Surveys* ; Humans ; Hypertension ; Korea ; Logistic Models ; Male ; Marital Status

PURPOSE: This goal of this study is to evaluate the clinical and radiological outcomes of proximal tibial comminuted fractures treated with medial minimally invasive percutaneous plate osteosynthesis (MIPPO). MATERIALS AND METHODS: We evaluated 43 patients who underwent medial MIPPO from February 2008 to February 2012 and were followed up for more than one year. According to the AO/OTA classification, there were 30 patients of 41-A3 and 13 patients of 41-C2. Thirty-six patients had closed fractures and seven patients had open fractures. We assessed clinical outcomes, radiologic results and postoperative complications. RESULTS: All fractures were united at an average of 18.3+/-8.1 weeks except three patients with nonunion. According to Schatzker and Lambert assessment, excellent results were achieved for 22 patients and good results were achieved for 21 patients. The average tibial plateau angle was 89.1degrees+/-2.7degrees and the average posterior tibial slope angle was 10.5degrees+/-4.6degrees. In assessment of lower limb alignment, the average femorotibial angle was 175.1degrees+/-2.9degrees and the mean deviation of mechanical axis was 46.5%+/-12.7%. In terms of complications, three patients had nonunion, but complete bony union was achieved by autogenous cancellous bone grafting. Seven patients complained of skin irritation around the plate. However, there was no skin necrosis, infection, or limited range of motion in seven patients with skin irritation. CONCLUSION: Medial MIPPO for proximal tibial comminuted fractures provides favorable clinical outcomes and good radiological alignments.
Axis, Cervical Vertebra ; Bone Transplantation ; Classification ; Fractures, Closed ; Fractures, Comminuted* ; Fractures, Open ; Humans ; Lower Extremity ; Necrosis ; Postoperative Complications ; Range of Motion, Articular ; Skin ; Tibia

Acquired perforating dermatosis (APD) triggers severe itching, and is observed most often in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). Various treatments, such as topical steroids, topical and oral retinoids, allopurinol, and ultraviolet B (UVB) phototherapy, have been used. However, as the precise etiology is unknown, there are a lack of well-established treatment guidelines. We report a peritoneal dialysis patient with a diagnosis of APD who was resistant to topical steroids, phototherapy, allopurinol, and topical retinoids. Severe pruritus persisted, which compromised his ability to lead a normal life. As a final treatment option, we used oral isotretinoin and the patient experienced a dramatic improvement.

Minimally invasive plate osteosynthesis (MIPO) is beneficial for proximal tibial fractures since these injuries are mostly caused by high energy traumas. The advantages of MIPO are minimization of soft tissue dissection and preservation of periosteal vascularization. Lateral plating has mostly developed as MIPO for proximal tibial fractures. We introduce minimal invasive percutaneous plate stabilization using a medial locking plate as alternative treatment for proximal tibial fractures.
Tibial Fractures

PURPOSE: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples. METHODS: We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14). RESULTS: Mean operation time was 265.3 +/- 21.3 minutes (mean +/- standard deviation) in the individual group and 170 +/- 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 +/- 1.6 and 2.6 +/- 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 +/- 1.1 and 9.4 +/- 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups. CONCLUSION: LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.
Drainage ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Retrospective Studies ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Sutures

The antisynthetase syndrome is characterized by anti-Jo-1 antibody production, interstitial lung disease, inflammatory muscle disease, and, in many cases, fever, polyarthritis, Raynaud's phenomenon, and mechanic's hands. Joint signs and symptoms occur in up to 90% of patients with antisynthetase syndrome, occasionally as the initial manifestations. Although visual inspection of the hands shows changes that are highly suggestive of rheumatoid arthritis, notable differences exist. Antisynthetase syndrome is a predominantly nonerosive arthropathy with subluxations of the distal interphalangeal joints. It manifests as overlap syndrome with other connective tissue diseases. However, overlap syndrome of antisynthetase syndrome and rheumatoid arthritis is rare. We treated a 51-year-old male patient with overlap syndrome of antisynthetase syndrome and rheumatoid arthritis, and report the case with a review of the literature.
Antibodies, Antinuclear ; Antibody Formation ; Arthritis ; Arthritis, Rheumatoid ; Connective Tissue Diseases ; Fever ; Hand ; Humans ; Joints ; Lung Diseases, Interstitial ; Male ; Middle Aged ; Myositis ; Polymyositis

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.
Accidents, Traffic ; Adolescent ; Bronchi* ; Bronchial Diseases ; Chest Pain ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Pneumoperitoneum* ; Rupture* ; Subcutaneous Emphysema ; Tomography, X-Ray Computed