Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

PURPOSE: A prospective randomized study was performed to compare the clinical results of standard vs. minimally invasive TKA (MIS TKA), and to identify the preoperative factors that help to figure out the indications of MIS TKA. MATERIALS AND METHODS: Eighty patients with osteoarthritic knees were randomized to standard TKA and MIS TKA groups. The operations were performed by one senior author with the same TKA system. Preoperative evaluation included body mass index (BMI), range of motion (ROM), deformity, and WOMAC and Knee Society scores. Operative factors were evaluated, including length of skin incision, operation time, and operative complications. Postoperative evaluation was performed daily until discharge from hospital, at 1 month, 3 months, 6 months, and 1 year postoperatively, including blood loss, amount of epidural anesthesia, visual analog scale (VAS), ROM, possible day of active straight leg raising (SLR), possible day of discharge, complications, WOMAC and Knee Society scores, patient's satisfaction with the operative scar, and radiological evaluation. RESULTS: There were statistically significant differences in daily VAS, operation time, length of skin incision, and possible day of SLR (p<0.05). There were no significant differences in other clinical aspects that were compared in this study. Complications occurred only in MIS group; 1 partial tear of MCL and 1 fracture of lateral femoral condyle. Preoperative ROM or BMI was not correlated with longer operation time. Significantly longer operation time was observed when both the preoperative fixed flexion contracture and varus deformity were greater than 10 degrees, or one or both of them was greater than 15 degrees (p<0.05). CONCLUSION: MIS TKA has the advantage of less pain, shorter skin incision, and earlier possible SLR in the early postoperative period, but it requires a longer operation time and careful surgical technique. The surgeon should select the MIS procedure by carefully considering its advantages and disadvantages. Both the preoperative flexion contracture and varus deformity greater than 10 degrees, or one of them greater than 15 degrees seems to be the relative contraindication of MIS TKA from the result of this study.
Anesthesia, Epidural ; Arthroplasty* ; Body Mass Index ; Cicatrix ; Congenital Abnormalities ; Contracture ; Humans ; Knee* ; Leg ; Postoperative Period ; Prospective Studies* ; Range of Motion, Articular ; Skin ; Visual Analog Scale

OBJECTIVES: To estimate the prevalence of hypertension, rates of awareness, treatment modalities, and control of hypertension, and also to identify factors in rural Korea that are related to these aspects of hypertension. METHODS: A cross-sectional survey, including blood pressure(BP) measurements and interviews, investigating the variables in the health belief model was performed from August to November, 1999 on 1,426 (79.4%) study subjects out of 1,797 registered residents over 30 years old in Ibansong-Myun, Chinju City. A second survey was performed from January to March, 2000 on 376 (80.0%) subjects out of 470 hypertensive (or suspected hypertensive) subjects found in the first survey. Two BP readings were taken in each survey using a standard mercury sphygmomanometer. Hypertension was defined as either a BP reading < 140/90 mmHg in both surveys, or as subjects on oral hypertensive medication. RESULTS: Estimated hypertension prevalence was 24.9% for men, and 30.4% for women. Rates of hypertension awareness, treatment (the regular use of oral hypertensives), and control (reduction of BP to <140/90 mmHg) were 52.5%, 34.4%, and 12.9%, respectively. The factors related to lower hypertension awareness in the logistic regression analysis were male gender, farming occupation, and higher perceived barrier to medical treatment (those for whom visiting health professionals is a burden). CONCLUSIONS: To improve the low awareness, treatment, and control of hypertension, a more active and out-reaching hypertension control program, including routine BP measurements for every visitor to primary care facilities, is needed in rural Korea.
Adult ; Cross-Sectional Studies ; Female ; Gyeongsangnam-do ; Health Occupations ; Humans ; Hypertension* ; Korea* ; Logistic Models ; Male ; Occupations ; Prevalence* ; Primary Health Care ; Reading ; Sphygmomanometers

STUDY DESIGN: This case report presents a 50-year-old patient with tabetic Charcoal spinal arthropathy combined with spinal stenosis, and its management. OBJECTIVES: To present the case report and follow-up results of Charcoal arthropathy with spinal stenosis of the lumbosacral spine, which was treated by circumferential fusion with instrumentation and decompressive laminectomy. LITERATURE REVIEW: Most reports of Charcot spine mention the etiology, clinical characteristics, pathology, and management of the condition. Surgical management of Chariot spines with spinal stenosis are rare. There is no report of the two-stage procedure of circumferential fusion and decom-pression for Charcot spine with spinal stenosis. MATERIALS AND METHODS: The patient complained of back pain, radiating pain to both lower legs, and 100m neurologic claudication. Serologic testing was positive in VDRL and FTA-ABS tests. Surgical treat-nent consisted of anterior resection of the L5 body with an autogenous iliad bone graft. It was followed by a posterior wide laminectomy of L5 for spinal stenosis, and CD instrumentation with transpedicular screws was applied to L3-S1 with lateral bone graft. RESULTS: At 27 months follow-up, clinical symptoms of back pain and radiating pain were disappeared. The patient walked without claudication, and satisfied with her condition. Firm bony fusions from L3 to S1 were obtained. There was no evidence of further destruction or neural compromise in the 27 months following surgery. CONCLUSION: A case of Charcoal arthropathy of the lumbosacral spine with spinal stenosis of L3-5 and L5-S1 has been reported, and the pathology, clinical features, and management of this condition were discussed. Circumferential fusion for Charcot spine and wide decompressive laminectomy for spinal stenosis are advisable.
Back Pain ; Charcoal ; Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Middle Aged ; Pathology ; Pathology, Clinical ; Serologic Tests ; Spinal Stenosis* ; Spine* ; Transplants

OBJECTIVES: The purpose of this study was to investigate the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the relationship between AUDIT score and liver function test. METHODS: AUDIT questionnaires were distributed to 440 blue-collar workers. We compared liver function test with firstly, normal and hazardous drinking as defined by WHO, and secondly, with normal, hazardous and harmful drinking as measured by Kim et al.(1999). We also compared influencing factors on abnormal liver function. RESULTS: By simple analysis in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 2.81) based on the guideline of WHO. By chi-square test for linear trend in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 1.23) and harmful drinking (odds ratio 2.14) based on the guideline of Kim et al.By multiple logistic regression analysis, abnormal liver function was significantly affected by AUDIT questionnaires No. 1-3 (odds ratio- high risk 2.39), age (odds ratio- thirties 1.95, forties 2.40, fifties 3.85), BMI (odds ratio- overweight 1.66, obesity 4.53), guideline by WHO (odds ratio- hazardous drinking 2.10), and guideline by Kim et al (odds ratio- harmful drinking 2.20) CONCLUSIONS: We found that the problem of alcohol drinking as measured by AUDIT was significantly associated with abnormal liver function. Therefore we suggest that AUDIT will be useful for the predictive test of abnormal liver function and screening test of hazardous and harmful drinking.
Alcohol Drinking ; Drinking ; Liver Function Tests* ; Liver* ; Logistic Models ; Mass Screening ; Obesity ; Overweight ; Questionnaires

Periarticular cysts in the shoulder joint are relatively rare. The most common are paralabral cysts, which can cause suprascapular nerve entrapment syndrome. Acromioclavicular juxtaarticular cysts have been described in association with full-thickness rotator cuff tears and a degenerated acromioclavicular joint. Intramuscular cysts of the rotator cuff are a relatively rare and unknown type of periarticular cyst. We report a case of an intramuscular cyst of the rotator cuff that was associated with a tear of the rotator cuff.
Acromioclavicular Joint ; Nerve Compression Syndromes ; Rotator Cuff ; Shoulder Joint

Spindle cell lipoma (SCL) is a rare lipoma variant that account for approximately 1.5% of all adipocyte-origin tumors; SCL usually occurs on the posterior neck or shoulder. The histological characteristics of SCL include mature, univacuolar fat cells and fibroblast-like spindle cells in a matrix of collagen and mucoid material. It is important to note that spindle cell lipoma can be mistaken both clinically and histologically for liposarcoma. We report here on a rare case of SCL in a 48-year-old male, and the patient presented with a large right neck mass that involved the lateral neck space and larynx.
Adipocytes ; Antigens, CD34 ; Collagen ; Humans ; Immunohistochemistry ; Larynx ; Lipoma ; Liposarcoma ; Male ; Middle Aged ; Neck ; Shoulder

Many patients, physicians and even orthopedic surgeons commonly have misconceptions about several shoulder disorders, so they misdiagnose these diseases and treat patients inappropriately. In this article, we describe some common misconceptions and misdiagnosis in shoulder disorders; such as rotator cuff disease, SLAP lesion, clavicle fracture et al. It will be helpful to understand how these disorders can be approached and managed.
Clavicle ; Diagnostic Errors* ; Humans ; Orthopedics ; Rotator Cuff ; Shoulder*

Purpose of the study. The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision. Material. Out of twenty eight total knee arthroplasty revisions, 13 revisions were performed for infected total knee arthroplasties between 1985 and l.996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Seven infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average (range, 18-105 months). They were one male and six female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Five cases revealed positive growth of causative bacteria, while two were not identified. METHOD: The protocol for two-stage revision began with tbe removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and tibia was filled with antibiotics-impregnated cement spacer and beads. Wound was closed and the leg was placed in soft knee brace. Patients received intravenous antibiotic therapy based on culture results for 4-6 weeks. Reimplantation was followed using total condylar prosthesis of posterior stabilizing type in five and semiconstrained type in two cases. RESULT: Two-stage revision was successful in six cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.l points, the average Knee Society knee score was 78.6 points and the average functional score was 76.7 points. Patients could regain average 100 degrees of knee flexion. CONCLUSION: The result of two-stage revision for infected total knee arthroplasty was satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.
Anti-Bacterial Agents* ; Arthrodesis ; Arthroplasty* ; Bacteria ; Braces ; Female ; Femur ; Follow-Up Studies ; Humans ; Knee* ; Leg ; Male ; Osteoarthritis ; Prostheses and Implants ; Recurrence ; Replantation ; Suppuration ; Tibia ; Wounds and Injuries

We reviewed twenty-six tibial bone defects which had been treated by internal bone transport to evaluate the results and complications and of the Ilizarov method. The causes of defects were open fracture(13 cases) and infected non-union(13 cases) The mean bone defect was 8.2 cm, ranging from 2 cm to 20 cm, in open fracture and 6.5 cm, ranging from 2 cm to 17 cm, in infected nonunion. All cases attained bone union. The mean radiologic consolidation index was 1.3 month/cm. The mean external fixation time was 18.5 months, ranging from 4 months to 33 months. Complications were pin-tract infection(20 cases), equines contracture of ankle(4 cases), knee flexion contracture(1 case), axial deviation(5 cases), valgus deformity of ankle(1 case), leg length discrepancy(7 cases), stress fracture at corticotomy site(2 cases), delayed union(1 case), infection recurrence(1 case), soft tissue invagination(3 cases) and refracture(2 case). The Ilizarov method is a useful treatment for tibial bone defects. Bone grafting at the docking site is recommended in order to shorten the treatment time and to avoid refracture and nonunion.
Bone Transplantation ; Congenital Abnormalities ; Contracture ; Fractures, Open ; Fractures, Stress ; Ilizarov Technique ; Knee ; Leg