Periprosthetic fractures after total hip arthroplasty or hemiarthroplasty are an uncommon complication. These fractures have problems of fixation of fracture and stability of the femoral component. Ipsilateral femoral fractures after hip arthroplasty occurred in 14 cases (11 patients) out of 510 hip arthroplasties performed between January 1985 and May 1996. These fractures occurred at an average of 3 years and 6 months after primary hip arthroplasty. These fractures were classified by Johansson classification. Nine fractures were treated with plate and cerclage wires. Four fractures were treated with skeletal traction. Bone graft was applied to the fracture site in 9 fractures which were treated by open reduction and internal fixation with plate and cerclage wires. Average follow up period was 21 months. The results were as follows. 1. All but three of the fractures had been developed by low energy trauma. Seven patients had osteolytic lesion around femoral component. Of the seven patients who had osteolytic lesions, six patients had periprosthetic fractures which connected with osteolytic lesions. We think that osteolysis is one of the important factors of the periprosthetic fractures after hip arthroplasty. 2. Four cases were treated by skeletal traction. One case had malunion. Progressive subsidence of femoral component was noted after union of fracture in 3 cases. Therefore these periprosthetic fractures which had an osteolysis and subsidence preoperatively should be managed with operative methods. 3. Nine fractures which had treated with plates and autogenous bone graft showed good hip joint function with stable femoral component. We think that stabilization of periprosthetic fractures with plates and cerclage seemed to be a good method for femoral fractures after hip arthroplasty.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Classification ; Femoral Fractures* ; Follow-Up Studies ; Hemiarthroplasty ; Hip Joint ; Hip* ; Humans ; Osteolysis ; Periprosthetic Fractures ; Traction ; Transplants

Purpose: The purpose of our study is to examine early radiographic findings and clinical signs of failure of the microstructure surface HA-coated acetabular cup. Material and methods: This study included 41 revisions of 204 THA with hydroxyapatite-coated acetabular cup from April 1992 to November 1996. Radiolucent line around cups, change in the cup angle and osteolysis were evaluated in serial radiographs. Acetabular cup was defined as loosening if any movement occurred at the bone and socket interface by manual rotation and extension force intraoperatively or migration of more than 2 mm and change of the cup angle by more than 5 degrees in radiographs. Results: The radiolucent line was observed in 12 of the 41 hips at an average of 55.4 months postoperatively and was most commonly located in zone III. All of the 12 hips showing radiolucent lines were classified as loosening by radiographically in 8 cases and intraoperatively in 4 cases. Radiographic loosening occurred at an average of 28.8 months after the appearance of a radiolucent line. Inguinal pain was noted in 18 of the 19 cases revised for acetabular cup loosening. Conclusion: The most important radiographic finding for the early diagnosis of loosening was progressive radiolucent lines, which occurred most frequently in zone 3.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Early Diagnosis ; Hip ; Osteolysis

Vibrio vulnificus is a fatal marine Gram-negative bacillus that might cause septicemia, necrotizing cellulites in patients with underlying liver disease or an immunocompromised health status, and is associated with high mortality. It is usually attributed to the ingestion of raw shellfish or traumatic exposure to the marine environment. The clinical manifestation includes fever, chill, hypotension, and skin lesions such as erythematous patch, vesicle, bullae that develop into necrosis and wound infections. We report a case of Vibrio vulnificus septicemia and necrotizing fascitis in a patient who presented with septic arthritis of the knee as the first clinical manifestation.
Mortality

PURPOSE: The purpose of this study is to evaluate the pronator quadrates muscle in patients who underwent internal fixation with a volar locking plate for unstable distal radius fractures. MATERIALS AND METHODS: Forty patients who underwent internal fixation with a volar locking plate for unstable distal radius fracture were enrolled. We evaluated the clinical results according to the Mayo wrist score, the wrist range of motion, and the grip strength at the last follow-up. Using ultrasonography, muscle thickness of the pronator quadrates was compared between injured and uninjured arm. RESULTS: Bone union was achieved in all cases. The mean Mayo wrist score was 82.79 points. The grip strength of the injured arm was decreased to 89.1% of the uninjured side. The decrease of pronation range of the injured wrist motions was significant (82.3degrees, p=0.004). There was significant atrophy of the pronator quadrates muscle on the injured side (injured side: 3.19 mm, uninjured side: 4.72 mm, p=0.001); and the decrement of muscle thickness in pronator quadrates showed an association with the Mayo wrist score (r=-0.35, p=0.042). CONCLUSION: These results suggest that continuity of the muscle is maintained after use of the volar locking plating for unstable distal radius fractures with repair of pronator quadrates; however, there is atrophy of pronator quadrates muscle and limitation of pronation in the injured wrist.
Arm ; Atrophy ; Follow-Up Studies ; Hand Strength ; Humans ; Pronation ; Radius Fractures* ; Range of Motion, Articular ; Ultrasonography ; Wrist

PURPOSE: To evaluate the results of internal fixation and autogenous bone graft for the phalangeal nonunion in the hand. MATERIALS AND METHODS: From Feb. 2000 until May 2006, thirteen cases that had been treated for non-union of phalanges in the hand were investigated retrospectively. Seven cases were treated with mini-plate fixation and autogenous cancellous graft and six cases with Kirschner wire fixation and autogenous cancellous graft. We analyzed bony union period radiographically and clinical results according to Belsky's score. RESULTS: Thirteen cases obtained bony union. Seven cases of mini-plate fixation and bone graft, and six cases of K-wire fixation and bone graft achieved the bony union postoperatively on average 7.9 weeks and 6.3 weeks, respectively. Clinical results were "good" in four cases and "poor" in nine cases according to the Belsky's score. Only one of ten cases with associated injuries, such as tendon, nerve, arterial injuries and other finger fractures in the injured hand, had the good clinical result, but all three cases without associated injuries had the good one. CONCLUSION: Internal fixation and autogenous bone graft can be a successful treatment of phalangeal nonunion. However, more careful choice of surgical treatment methods and preoperative explanation of poor post-operative results or complications should be made for phalangeal nonunion with associated injuries in the finger because of poor outcome in those cases.
Fingers ; Hand ; Retrospective Studies ; Tendons ; Transplants

PURPOSE: To compare and analyse radiologic reduction loss between fixation with K-wire only group and fixation with K-wire and external fixator group for surgical treatment of distal radial fracture. MATERIALS AND METHOD: We analysed 60 patients who received the operative treatment with K-wire fixation only or K-wire and external fixator and also were in regular follow up at least one year. We compared radiologic reduction loss of radial length, radial inclination and volar tilt between immediate post-operative radiograph and latest follow up radiograph according to operative methods, fracture patterns and age groups. RESULTS: Reduction loss of volar tilt was greater in fixation with K-wire only group than fixation with K-wire and external fixator group (p<0.05). Reduction losses of radial length and radial inclination were more in intra-articular subgroup than extra-articular subgroup in fixation with K-wire only group (p<0.05). No significant difference of reduction loss was noted between intra-articular and extra-articular subgroups in fixation with K-wire and external fixator group. CONCLUSION: More radiologic reduction loss can be expected in fixation with K-wire only group for intra-articular distal radius fracture compared with extra-articular distal radius fracture. Additional external fixation should be added in intra-articular distal radius fracture to reduce radiologic reduction loss.
External Fixators ; Follow-Up Studies ; Humans ; Radius Fractures* ; Radius*

STUDY DESIGN: A prospective sonographic study. PURPOSE: To verify the effectiveness of simultaneous application of two landmarks, Doppler image of the vertebral artery and shape of the transverse tubercle of the seventh cervical (C7) vertebra. OVERVIEW OF LITERATURE: Counting upwards from the C7 vertebra which only has a posterior tubercle of the transverse process is a commonly used method for ultrasound-guided cervical nerve root block. However, each transverse process has a different shape. METHODS: Sonograms of 20 volunteers were examined. At first, we identified the C7 transverse process based on the presence of the vertebral artery without the anterior tubercle. The C5 and C6 transverse processes were identified based on the presence of anterior tubercle without the vertebral artery. Subsequently, we placed needles on the C5, C6, and C7 transverse processes and the location and direction of needles were confirmed by fluoroscopy. RESULTS: In the 120 segments, 93.3% of needles were placed correctly as desired; 97.5% of needles were placed on the 5C transverse process; 97.5% of needles were placed on the C6 transverse process; and 85.0% of needles were placed on the C7 transverse process, respectively. Both sides showed the same accuracy of 93.3%. CONCLUSIONS: Simultaneous application of Doppler image of the vertebral artery and shape of the C7 transverse tubercle showed 93.3% accuracy in identifying the target cervical level. Therefore, Doppler image of the vertebral artery can be considered to be a useful landmark for ultrasound-guided cervical nerve root block.
Fluoroscopy ; Needles ; Nerve Block ; Prospective Studies ; Spine* ; Ultrasonography ; Vertebral Artery* ; Volunteers

STUDY DESIGN: Retrospective study. PURPOSE: This study was designed to determine the effectiveness of bone mineral density measurement as a supplementary tool for evaluation of osteogenic potential in patients with spinal fusion. To this end, we correlated bone mineral density (BMD) with osteogenic potential from cultured mesenchymal stem cells (MSCs). OVERVIEW OF LITERATURE: Many studies have correlated osteogenic potential of in vitro cultured MSCs with aging or osteoporosis. METHODS: We studied twenty-five individuals with harvested bone marrow from the ilium during lumbar spinal surgery. The BMD of the femoral neck was measured using dual energy X-ray absorptiometry prior to bone marrow aspiration, and the osteoporotic group was classified as those with T-scores below-2.5. After MSCs were isolated from bone marrow, in vitro induction of osteogenesis was performed. We analyzed the patient's osteogenic potential from cultured MSCs such as mineral deposition stain, bone alkaline phosphatase (ALP) activity and osteoblast-specific gene expression in RT-PCR. RESULTS: On mineral staining, the osteoporotic group had a scanty matrix mineral deposition in contrast to the non-osteoporotic group. The expression of osteocalcin in the osteoporotic group was 1.5 to 3 times less than in the non-osteoporotic group. At the 3rd week after the induction of osteogenesis, the activity of ALP of cultured MSCs in the osteoporotic group was lower than in the control group (mean, 45+/-19 u/L, in osteoporotic group vs 136+/-7 u/L in non-osteoporotic), and there was a statistically significant and positive correlation between BMD & ALP (r=0.487, p=0.013). CONCLUSIONS: There is a positive correlation between BMD and osteogenic potential derived from MSCs. The measurement of BMD can provide supplementary data for evaluating osteogenic potential clinically.
Absorptiometry, Photon ; Aging ; Alkaline Phosphatase ; Bone Density ; Bone Marrow ; Durapatite ; Femur Neck ; Gene Expression ; Humans ; Ilium ; Mesenchymal Stromal Cells ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Retrospective Studies ; Spinal Fusion

PURPOSE: To evaluate of efficacy of the treatment options for a femoral shaft nonunion occurring after intramedullary nailing. MATERIAL AND METHODS: Thirty-one patients with nonunion of a femoral shaft fracture, who had been treated with interlocking intramedullary nailing from January 1996 to December 2000, were examined. Twenty-six had oligotrophic nonunion and five were hypervascular. Forty-five procedures were performed for 31 nonunions; bone grafting for 14, exchange nailing for 13, plate augmentation and bone grafting for 14 and dynamization for 4 cases. RESULTS: The success rate after a single procedure was only 58%. The four dynamization cases failed to unite. Seven of the 13 (54%) nonunion cases treated with nail exchange healed satisfactorily. All cases treated with plate augmentation and bone grafting achieved successful union. The mean period from fracture to union was 20 months. CONCLUSION: Exchange nailing is not always a reliable procedure for treating nonunion of a femoral shaft fracture. Plate augmentation and bone grafting were found to be a successful mode of therapy for the femoral shaft nonunion without complications.
Bone Transplantation ; Femur ; Fracture Fixation, Intramedullary* ; Humans

Fractures of the pelvic ring after long fusions to the lumbosacral spine is a heretofore rarely reported complication. Stress fractures of the pelvic ring are a potential source of late pain after fusions of the lumbosacral spine. We report two cases of stress fracture of the pelvic bone after lumbar spinal fusion.
Fractures, Stress* ; Pelvic Bones* ; Pelvis ; Spinal Fusion* ; Spine