No abstract available.

Purpose: To report the surgical skills needed, and the clinical results of, minimally invasive hip surgery with dynamic hip screws and the comparison with the classical technique in stable pertrochanteric fractures of the femur. Materials and Methods: Thirty-two patients with pertrochanteric fractures of the femur who were treated with dynamic compression hip screws between April 1999 and March 2004, and were evaluated retrospectively, and were followed up for more than 12 months. 16 cases were treated with a classical dynamic hip screw technique and 16 cases with a minimally invasive technique in random order. The mean age was 73.2 years, and there were 11 males and 21 females. The operative times, total hemovac bleeding loss, functional scores, and average hemoglobin decrease ratios were evaluated. The clinical assessments were performed with the Harris Hip Score (HSS) and bony union was evaluated with serial follow-up plain radiographs. Results: The average operative time was 63.9 minutes with the classical technique and 42.5 minutes with the minimally invasive technique. The total average hemovac blood loss was 640 cc with the classical technique and 143 cc with the minimally invasive technique. Clinically, the HHS was an average of 85.9 and 89.2 in groups 1 and 2, respectively, by the last follow-up and there were no statistically significant differences between the two groups (P <0.05) The hemoglobin decrease ratio was the same in both groups and there was no nonunion. Conclusion: Minimally invasive dynamic hip screw insertion was useful in stable pertrochanteric fractures, because it decreased blood loss and operative times; and there were no changes in fracture healing and functional outcomes.
Female ; Femur ; Follow-Up Studies ; Fracture Healing ; Hemorrhage ; Hip* ; Humans ; Male ; Operative Time ; Retrospective Studies ; Surgical Procedures, Minimally Invasive

No abstract available.
Erythema* ; Hydroxychloroquine* ; Sjogren's Syndrome*

Arthroscopic repair of an isolated teres minor tendon tear without associated shoulder joint pathology has not been reported in the literature. We report on a case of isolated teres minor tendon tear after trauma. The patient complained of severe shoulder pain and progressive limited range of motion 4 months after the injury. Magnetic resonance imaging showed a full-thickness tear of the teres minor tendon at its musculotendinous junction and arthroscopic repair was performed. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. Here, the authors report this case and provide a review of literature.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pathology ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Tears* ; Tendons*

BACKGROUND: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. METHODS: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat's modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. RESULTS: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor's syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. CONCLUSIONS: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery.
Anesthesia, General ; Brachial Plexus* ; Catheters ; Dyspnea ; Follow-Up Studies ; Humans ; Hypesthesia ; Nausea ; Nerve Block ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Recovery Room ; Shoulder* ; Taste Disorders ; Vomiting

PURPOSE: To investigate the in vitro effects of Dehydroepiandrosterone (DHEA)-pyruvate on human osteoarthritic chondrocytes. METHODS: Chondrocytes isolated from human osteoarthritic knee cartilage were three-dimensionally cultured in Alginate beads. Cells were treated with dehydroepiandrosterone in the presence or absence of IL-1. The effects on chondrocytes were analyzed by MTS assay (for chondrocytes proliferation), DMB assay (for glycosaminoglycan synthesis), and indole assay (for DNA amount). Gene expressions of MMP-1,3, TIMP-1 as well as IL-1 induced gene expression of MMP-1, 3 were analyzed using RT-PCR. The protein synthesis of MMP-1,3 and TIMP-1 was determined by ELISA. RESULTS: Treatment of chondrocytes with DHEA-pyruvate did not affect chondrocytes proliferation regardless of concentrations when compared with control. GAG synthesis was not changed significantly during culture period regardless of concentrations. DHEA-pyruvate suppressed the expression of MMP-1 significantly at a concentration of 50 micrometer and above. The gene expression of MMP-3 was also suppressed. The expression of TIMP-1 was significantly increased by DHEA-pyruvate at concentration of 50 micrometer. The effects of DHEA-pyruvate were also prominent in the presence of IL-1, in which IL-1induced gene expressions of not only MMP-1, but also MMP-3 were suppressed at a lower concentration of 10 micrometer and 50 micrometer, respectively. In enzyme activity measurement, the results came in line with the results obtained by RT-PCR, which means DHEA-pyruvate influences on the gene transcription level. CONCLUSION: Our study clearly demonstrated that DHEA-pyruvate has the ability to modulate the imbalance between MMPs and TIMP-1 during osteoarthritis at the transcription level, suggesting its protective role against loss of articular cartilage.
Cartilage ; Cartilage, Articular ; Chondrocytes* ; Dehydroepiandrosterone ; DNA ; Enzyme-Linked Immunosorbent Assay ; Gene Expression ; Humans* ; Interleukin-1 ; Knee ; Matrix Metalloproteinases ; Osteoarthritis ; Tissue Inhibitor of Metalloproteinase-1

PURPOSE: To assess union and complication rates associated with the use of 2 small diameter headless compression screws and volar wedge bone grafting for the treatment of scaphoid fracture waist nonunions with collapse. METHODS: A total of 12 patients (11 male and 1 female) at an average age of 32.5 years were treated with open reduction and internal fixation with 2 small diameter headless compression screws for scaphoid nonunions with a mean follow-up of 11 months. Tricortical wedge shaped autograft were harvested from the iliac crest and placed into the nonunion site to restore length and alignment in all patients. Union was determined by radiographs and computed tomography, and scapholunate and radiolunate angles, and height-to-length ratio were calculated on final radiographs and follow-up computed tomography. RESULTS: All 12 scaphoids united with a mean time for 2.8 months. The mean postoperative scapholunate angle was significantly reduced from 73° preoperatively to 56° postoperatively. The mean radiolunate angle was significantly improved from 21° from neutral preoperatively to 12° postoperatively. The height-to-length ratio was also demonstrated significant improvement from 0.73 preoperatively to 0.60 postoperatively. No hardware problems were identified and no revision procedures have been necessary. CONCLUSION: Our results indicate that the use of 2 small diameter headless compression screws with volar structural bone graft stabilizes the fracture for predictable union, while reducing the deformity reliably from a collapsed scaphoid nonunion. The presented technique is safe and effective, and may provide superior biomechanical stability, especially against the torsional force.
Autografts ; Bone Transplantation ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Male ; Torsion, Mechanical ; Transplants

No abstract available.

Purpose: To retrospectively compare the fixation methods for reattaching a trochanteric fragment in a pertrochanteric fracture treated with bipolar hemiarthroplasty. Materials and methods: Forty cases of an unstable femur pertrochanteric fracture were analyzed and followed up for average of 19(6~40) months. There were 18 cases fixed with tension band wiring (group 1), 7 cases treated using modified tension band wiring with K-wires (group 2) and 15 cases treated with the GTRD (Greater Trochanteric Reattachment Device) (group 3). Result: Group 1 was treated with simple a surgical procedure and the results were good. The second group had firm fixation postoperatively but required additional surgery in two cases to remove the K-wires because of wire migration after ambulation. Group 3 had relatively good results but required more dissection and a longer operating time. Conclusion: Tension band wiring or GTRD are good fixation methods for reattaching trochanteric fragments in pertrochanteric fractures. Moreover, tension band wiring is recommended for old osteoporotic patients due to a simple procedure and firm fixation. The use of modified tension band wiring using K-wire or a Steinmann-pin should not be used due to the possibility of distant migration.
Femur* ; Hemiarthroplasty* ; Humans ; Retrospective Studies ; Walking