The purpose of this study was to assess the effect of basic-fibroblast growth factor (bFGF) on the xenograft for radial bone defect in adult rats. Twenty adult Wistar rats weighing between 200 and 250g were divided into two groups; bFGF group (10 rats, 20 radiuses) and non-bFGF group (10 rats, 20 radiuses). A segmental bone defect measuring 5mm in length was made at both radiuses 10mm proximal to the wrist joint. The defect was filled with xenograft (Lubboc) measuring 3x3x5 mm in size. The xenograft was treated with 400 ng/ml bFGF (recombinant human basic-fibroblast growth factor ) mixed with liquid collagen (Vitrogen 100) in the bFGF group, but with collagen alone in the non- bFGF group. At 6 and 12 weeks after the treatment, the radiuses were harvested and examined histologically and the area of the remained xenograft not replaced by host bone was measured by image analysis system (VIDAS) on mid-sagittal section. The new bone formation and maturation from the differentiation of osteoblast was more remarkable in the bFGF group than in the non-bFGF group. At the time of 6 and 12 weeks after the treatment, the mean of the remained xenograft area was significantly smaller in the bFGF (9.16+/-0.49mm2, 6.20+/-0.30mm2) than in the non-bFGF group (12.16+/-0.59mm2, 10.07+/-0.48mm2) (P<0.001). In comparison with the areas of new bone replacemet area between 6 week and 12 week groups, sigificant and remarkable new bone replacement area could be achieved in the bFGF group than in the non-bFGF group (P<0.05). From these results, it is suggested that bFGF might increase the replacement of xenograft by new host bone and accelerate the healing process for the segmental bone defect of the radius in adult rats.
Adult ; Animals ; Collagen ; Fibroblast Growth Factor 2 ; Heterografts ; Humans ; Osteoblasts ; Osteogenesis ; Radius ; Rats* ; Rats, Wistar ; Wrist Joint

Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.
Biomarkers* ; Diving ; Epidemiologic Studies* ; Epidemiology ; Hyperlipidemias ; Osteonecrosis* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Protein S ; Risk Factors ; Thrombophilia

No abstract available.
Femur* ; Hip Fractures* ; Hip*

STUDY DESIGN: The authors reviewed the dural tears in the thoracolumbar fractures treated surgically. OBJECTIVES: To evaluate the incidence and the predictive values for the presence of dural tears in the thoracolumbar fractures. SUMMARY OF LITERATURE REVIEW: Many authors reported that the dural tear was usually related to the thoracolumbar fractures especially with laminar fracture and neurologic deficit. The dural tears may lead complications such as the entrapment of spinal nerve root, delayed wound healing, cerebrospinal fluid fistula, and myelomeningocele. Previous reports emphasized posterior approach to confirm and treat the dural tears using laminectomy. So it is very important that surgeons should identify the presence of dural tear preoperatiyely to determine the surgical approach and treatment options. MATERIALS AND METHODS: The authors reviewed 22 patients of thoracolumbar fractures treated with posterior laminectomy, posterior decompression, posterolateral fusion, and instntmentation from August 1993 to August 1996. The follow-up period was minimally 12 months. We checked the canal compromise, the injury of the posterior column including laminar fracture and ligamental injury, and neurologic deficits as the predictive values. The statistical analysis was done to evaluate the relationship between the dural tear and the predictive values. RESULTS: The incidence of dural tear was 54.4% of the thoracolumbar fractures. The canal encroachment, the injury of the posterior column, and the neurologic deficits were not significantly related with the dural tears in statistical analysis. But we could find the tendency that is related to the dural tear and posterior column injury. CONCLUSION: The authors concluded that we could find the possible presence of dural tears in the severe thoracoiumbar which were needed the surgical treatment and we could suggest the injury of posterior column was a possible value that could predict the presence of dural tear.
Cerebrospinal Fluid ; Decompression ; Fistula ; Follow-Up Studies ; Humans ; Incidence ; Laminectomy ; Ligaments ; Meningomyelocele ; Neurologic Manifestations ; Spinal Nerve Roots ; Tears* ; Wound Healing

STUDY DESIGN: The authors reviewed 14 patients with neurologic deficits caused by ossification of ligamentum flavum(OLF) of thoracic and thoracolumbar spine. OBJECTIVE: To evaluate the clinical and roentgenographic characteristics and suggest the treatment method of the OLF in the thoracic and thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: The reported OLF mainly developed at the thoracolumbar area. It compressed the spinal cord and resulted to the symptoms of thoracic myelopathy. The methods of treatment were posterior decompression including laminectomy or laminoplasty, and sometimes anterior and posterior decompression, with or without fusion. The OLF was not common disease yet and many surgeons have met a problem in making the decision of the extent of posterior decompression multiple or selective. METHODS: The authors reviewed 14 patients with the OLF using clinical reports and roentgenographic studies. We checked the plain roentgenograms, computed tomograms, and magnetic resonance imagings. We performed the posterior decompression using total laminectomy without fusion. We divided three groups according to the operative methods. Group I included the patients with one or two levels of OLF treated with posterior extensive laminectomy. Group II included the patients with OLF in three or more levels, or combined other cord-compressing diseases. They had been treated with multiple posterior or anterior decompression for the entire cord-compressing levels. Group III included the patients with same conditions as group II but they had been treated with selective decompression for the mainly symptomatic levels of OLF. RESULTS: We found the OLF at 54 segments of 14 patients. The involvement of OLF was 29 segments(53.7%) in thoracolumbar and 25 segments(46.3%) in thoracic area. The most commonly involved segment was T10-11(16.7%) and the second was T11-12(14.8%). Clinically the most common neurologic deficit was motor weakness and sensory deficit. The most symptomatic level of OLF was T10-11 and T12-Ll segment(28.6% at each) and the next was T11-12 segment(21.4%). We got the favorable results in group I and group III. But the final results of group II were not good. CONCLUSION: The OLF was most common at the thoracolumbar area and the symptoms and signs were revealed same as those of the thoracic myelopathy. We obtained favorable clinical results after posterior laminectomy without fusion in cases with the OLF in 1-2 segments. In the cases with multiple OLF in three or more segments, or the cases with other cord-compressing diseases, we could get more favorable results in the patients with the selective decompression than the patients with multiple decompression for the entire cord-compressing diseases.
Decompression ; Humans ; Laminectomy ; Ligamentum Flavum* ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Diseases ; Spine*

Henoch-Sch nlein purpura is a small-vessel vasculitis characterized by palpable purpura, abdominal pain, hematuria and arthralgia. Joint involvement occurs in 2/3 of the cases and the joint symptoms are misapprehended as an orthopaedic problem because they are often severe and occurs before characteristic purpura. It has been reported that the joint symptoms can be improved without any sequelae. But, recently some authors suggest that severe joint destruction can occur when combined with rheumatoid arthritis and the patients are FILA-DR4 positive. So, the regular follow-up for joint symptoms and screening test for the risky patients having possibility for progression of arthritis are required. In order to increase the attention of the orthopaedic surgeons on this disease and study the progression of joint symptoms, possibility of development of screening test for the risky patients and the characterisitics of the disease, we analyzed the 58 patients of Henoch-Sch nlein purpura. The following results were obtained. Among 58 patients 34 cases were male and 25 cases were female, 5 to 10-year-old children were affected more frequently and the disease occurs frequently in spring and winter season. Joint symptoms developed in 22/58 patients(37.9%) and occurs before characteristic purpura in 5/22 patients(22.7%) among the joint symptom-developed patients. Knee and ankle were affected in most patients and the inflammatory signs such as high fever, leukocytosis and elevated ESR were accompanied with joint symptom, so it resembled the symptoms and signs of pyogenic arthritis. Most of the patients recovered without remaining sequelae but 9 patients(15.5%) among joint symptom-developed patients complained repeated attacks of arthralgia. The HLA B27 were all positive in those patients. So, it was assumed that the joint symptom in Henoch-Sch nlein purpura has a correlation with genetic environment and through the broad prospective study, the HLA typing can be a screening test for the risky group prone to suffer from repeated attack or aggravation of arthritis.
Abdominal Pain ; Ankle ; Arthralgia ; Arthritis ; Arthritis, Rheumatoid ; Child ; Female ; Fever ; Follow-Up Studies ; Hematuria ; Histocompatibility Testing ; Humans ; Joints* ; Knee ; Leukocytosis ; Male ; Mass Screening ; Purpura* ; Seasons ; Vasculitis

PURPOSE: Bipolar hemiarthroplasty of the hip has been used as a treatment modality for displaced femoral neck and intertrochanteric fractures in elderly patients, inflammatory and degenerative diseases of the hip, osteonecrosis of femoral head and limb salvage procedure after tumor resection. Because of the intrinsic stability of the biarticular structure, it is also used for treatment of recurrent dislocation after total hip replacement arthroplasty. However, despite its intrinsic stability, dislocation does occur even after bipolar hemiarthroplasty, and poor prognosis after the dislocation has been reported. So, we tried to investigate the incidence, risk factors, treatment and preventive methods of dislocation after bipolar hemiarthroplasty. MATERIALS AND METHODS: We reviewed 138 patients and 138 bipolar hemiarthroplasties retrospectively to analyze the incidence, timing, risk factors, treatment and preventive methods of the dislocation. RESULTS: The incidence of dislocation was 5.8% (8/138). Female gender, intertrochanteric fracture, pre-existing neuromuscular disorders including cerebrovascular accident, long period of pre-operative and postoperative immobilization were statistically significant (P<0.05) as a risk factor. Related muscular weakness was the most significant predisposing factor for dislocation. CONCLUSIONS: In order to prevent dislocation after bipolar hemiarthroplasty performed in the patients with above risk factors, we must try and encourage early operation, early ambulation, muscle strengthening exercise and application of abduction hip brace.
Aged ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Braces ; Causality ; Dislocations* ; Early Ambulation ; Female ; Femur Neck ; Head ; Hemiarthroplasty* ; Hip Fractures ; Hip* ; Humans ; Immobilization ; Incidence ; Limb Salvage ; Muscle Weakness ; Osteonecrosis ; Prognosis ; Retrospective Studies ; Risk Factors ; Stroke

Minimally invasive surgeries, such as laparoscopic, endoscopic and,arthroscopic surgery are currently being used throughout the world. The field of total hip arthroplasty has over 40 years of experience, and minimally invasive total hip arthtoplasty was introduced to reduce the perioperative morbidities. The advocates for minimally invasive total hip arthroplasty will point out the advantages of reduced pain and early ambulation after the operation because of the minimal soft tissue injury. However, we have to review the advantages and disadvantages of minimally invasive total hip arthroplasty to prevent anyharmful effects of this procedure for the patients who under go it.
Arthroplasty ; Early Ambulation ; Hip ; Humans ; Soft Tissue Injuries

PURPOSE: To evaluate the clinical result of Proximal Femoral Nail (PFN) fixation for intertrochanteric fracture of the femur in elderly patients. MATERIALS AND METHODS: Between January 2004 and June 2006, 119 patients older than 65 years of age, with intertrochanteric fractures, were treated with PFN fixation. Ten patients who died within 4 weeks after operation were excluded from the analysis. Mean duration of follow-up was 13 months. There were 34 males and 75 females, and the mean age was 77.8 years. Operation time, amount of blood loss, transfusion requirement, time to ambulation, length of hospital stay, pre- and post-operative walking status, and post-operative complications were evaluated. Radiologic parameters such as amount of impaction, time to union, and neck-shaft angle were also evaluated. RESULTS: The mean operation time was 42 minutes, transfusion requirement averaged 340 ml, and amount of blood loss averaged 78 ml. The mean hospital stay was 20 days, and time to ambulation averaged 10.3 days. Eighty-five percent of patients returned to previous walking status. The average amount of fracture impaction was 3.8 mm, and mean time to radiologic bony union was 11.7 weeks. Neck-shaft angle was changed to 2.5 degrees varus displacement. Complications included intraoperative femur shaft fracture in 5 cases, protrusion of lag screw into the hip joint in 3 cases, backing out of lag screw in 2 cases, fixation failure in 2 cases, and proximal femur fracture in 1 case. Among these cases, 5 hips (2 cases of fixation failure and 3 cases of femoral head perforation by lag screw) were converted to total hip replacement. CONCLUSION: Because of reduction in operation time, low complication rate, and favorable outcome, PFN fixation is an acceptable alternative for fixation of intertrochanteric fractures in elderly patients.
Aged ; Displacement (Psychology) ; Female ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Fractures ; Hip Joint ; Humans ; Length of Stay ; Male ; Nails ; Walking

Femoral neck stress fractures are rare and when treating are difficult to achieve favorable outcomes. This study characterizes outcomes associated with the use of cephalomedullary nails for fixation of Pauwels type-3 vertical femoral neck undisplaced-incomplete insufficiency fractures. Four consecutive patients with a Pauwels type-3 vertical femoral neck tensile insufficiency fracture from 2016 to 2018 were reviewed. Magnetic resonance imaging data revealed tensile visible fracture lines and hip-joint effusions with a high shear angle. For all patients, bone mineral density and vitamin D levels were low; vitamin D therapy was initiated immediately. Surgical procedures were conducted with cephalomedullary nails (Gamma 3 locking nail system; Stryker) under general anesthesia. A cephalomedullary nail appears to be a safe and effective alternative to the use of multiple parallel screws or a sliding hip screw for fixation of vertical femoral neck stress fractures (level of evidence: Level V).