Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

Isolated fracture of the distal humeral trochlea occurs while the axial load delivered to the elbow passes through the trochlear of the distal humerus. It has been rarely reported, because of those reasons. The trochlea is located deep inside of the elbow joint space and since it does not have the direct attachment with muscles or ligaments, a force is hardly transmitted directly. Also ulno-humeral joint is less influenced by compressive or shear force than radio-humeral joint. We report a case of isolated trochlear fracture with review of the literature.
Elbow ; Elbow Joint ; Humerus ; Joints ; Ligaments ; Muscles

High-velocity gunshot injury (muzzle velocity greater than 609.6 m/s) is uncommon and primarily a military injury. Humerus shaft fracture, caused by a high-velocity gunshot, should be considered as a severe open fracture. The principles of treatment are immediate and aggressive irrigation, wide debridement, primary delayed wound closure, and broad-spectrum intravenous antibiotics. External fixation has been widely used for fracture fixation. We report a case of humerus shaft fracture secondary to high-velocity gunshot (machine gun) injury, with a literature review.
Anti-Bacterial Agents ; Debridement ; Fracture Fixation ; Fractures, Open ; Humans ; Humerus ; Military Personnel ; Wounds and Injuries ; Wounds, Gunshot

PURPOSE: We wanted to assess the clinical results and the complications of treating femoral head fractures. MATERIALS AND METHODS: Twenty patients with femoral head fractures and who had a minimum 1 year follow up were enrolled in this study from April 2004 to June 2008. The clinical outcomes were evaluated according to the mechanism of injury, the reduction time, the Pipkin classification, the treatment methods, the surgical approach and the complications. RESULTS: There were 5 cases of Pipkin type I and 2 cases of Pipkin type II, 1 case of Pipkin type III and 12 cases of Pipkin type IV. All the patients underwent operation except 1 patient; there were 5 excisions, 7 internal fixations, 1 prosthesis, and 6 internal fixations of combined acetabular fixation without surgery for the femoral head fractures. The average Harris hip score at 1 year after operation was 80.0 (range: 57~99): there were 4 excellent, 7 good, 5 fair and 4 poor results. The complications of the femoral head fractures were 2 cases of avascular necrosis and 2 cases of posttraumatic osteoarthritis. CONCLUSION: Internal fixation of the femoral head with using Herbert screws showed a favorable outcome, while excision of the femoral head fragments did not. Internal fixation of Pipkin type 1 or 2 fractures could be performed by the anterior approach. The posterior approach combined with surgical dislocation is especially useful in internal fixation of concurrent posterior acetabular fractures, and it has the advantage of preserving the blood supply to the femoral head.
Dislocations ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Dislocation ; Humans ; Imidazoles ; Necrosis ; Nitro Compounds ; Prostheses and Implants

PURPOSE: This study examined the clinical course of subtrochanteric fractures of the femur as well as the risk factors of complications. MATERIALS AND METHODS: A retrospective study was performed on 56 patients with femoral subtrochanteric fractures who were treated at our hospital from 2004 to 2008. Risk factors, such as the type of fracture, type of implant, soft tissue dissection at the fracture site, communition of the medial cortex and degree of fracture displacement after the reduction, were compared to determine their effect on the rate of complications, such as nonunion and implant failure. Open reduction with a soft tissue dissection at the fracture site was performed in 34 cases, and a closed reduction was performed in 22 cases. Thirty five cases had medial cortex communition and 21 cases did not. RESULTS: There were 8 cases of nonunion(14.3%). There was a positive correlation between the degree of fracture displacement after the reduction and the union time (P=0.017). The union time was longer when there was communition of the medial cortex. A subtrochanteric fracture using an open reduction tended to have a long union time but this was not statistically significant. There was no correlation between the type of implant and union time. CONCLUSION: The union time is longer in subtrochanteric fractures with communition of the medial cortex. Therefore, it is important to preserve the blood supply at the fracture site using a closed reduction and restore the fracture reduction accurately.
Displacement (Psychology) ; Femur ; Hip Fractures ; Humans ; Retrospective Studies ; Risk Factors

OBJECTIVE: To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.METHODS: Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.RESULTS: The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4–5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).CONCLUSION: Patients with high BMI or severe disc degeneration should be informed of HLD revision.
Body Mass Index ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Recurrence ; Reoperation ; Retrospective Studies ; Risk Factors

Purpose: This study compared the clinical and radiological results of the femoral neck system (FNS) and cannulated compression screws (CCS) for the fixation of femoral neck fractures. Materials and Methods: Patients who underwent FNS or CCS internal fixation for femoral neckfractures between January 2016 and January 2022 were analyzed retrospectively. The hip joint function using the Harris hip score (HHS) was evaluated three months and one year after surgery. The operation time, fracture healing time, and associated surgical complications in the two groups were compared and analyzed statistically. Results: Seventy-nine patients were categorized into 38 FNS and 41 CCS groups. The FNS group had a longer operation time and higher postoperative HHS at three months (p<0.01). Femoral neck shortening was lower in the FNS group (p=0.022). There were no significant differences in the fracture healing time and other complications. Conclusion There were no differences in most clinical outcomes and complications between the two groups except for the three-month HHS and femoral neck shortening. This study suggests that FNS could be an alternative to CCS for treating femoral neck fractures.

Purpose: This study is evaluated the clinical and radiological outcomes of Hook plate fixation in acute acromioclavicular (AC) joint injuries and the differences according to the type of plate and whether coracoclavicular (CC) ligament repair had been performed. Materials and Methods: Between February 2008 and November 2022, 112 patients treated with a Hook plate for acute AC joint injuries were analyzed retrospectively. The patients were categorized into DePuy Synthes (n=76) and ARIX Hook plate group (n=36), Hook plate with CC ligament repair group (n=42) and Hook plate fixation only group (n=70). The clinical and radiologic outcomes of Hook plate fixation were evaluated by analyzing the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score, coracoclavicular distance (CCD), subacromial erosion and associated surgical complications depending on the different types of Hook plate (DePuy Synthes vs. ARIX clavicle system) and the application of additional CC ligament repair. Results: The median follow-up period after implant removal for the 112 patients was 7.4 months (range, 6.0–124.8 months). The ASES and UCLA scores at the final follow-up were 77.2±6.2 and 31.8±2.3, respectively, and the CCD was 115.5%±28.9% compared to the unaffected side.There were no significant differences in the final VAS score, ASES score, UCLA score, CCD, subacromial erosion and surgical complications between the DePuy Synthes and ARIX Hook plate groups. In addition, there was no difference depending on whether CC ligament repair had been performed. Conclusion Hook plate fixation in acute AC joint injuries showed good clinical and radiological results. It is considered a good surgical method, and there was no difference in the results depending on plate type and CC ligament repair.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

Purpose: This study is evaluated the clinical and radiological outcomes of Hook plate fixation in acute acromioclavicular (AC) joint injuries and the differences according to the type of plate and whether coracoclavicular (CC) ligament repair had been performed. Materials and Methods: Between February 2008 and November 2022, 112 patients treated with a Hook plate for acute AC joint injuries were analyzed retrospectively. The patients were categorized into DePuy Synthes (n=76) and ARIX Hook plate group (n=36), Hook plate with CC ligament repair group (n=42) and Hook plate fixation only group (n=70). The clinical and radiologic outcomes of Hook plate fixation were evaluated by analyzing the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score, coracoclavicular distance (CCD), subacromial erosion and associated surgical complications depending on the different types of Hook plate (DePuy Synthes vs. ARIX clavicle system) and the application of additional CC ligament repair. Results: The median follow-up period after implant removal for the 112 patients was 7.4 months (range, 6.0–124.8 months). The ASES and UCLA scores at the final follow-up were 77.2±6.2 and 31.8±2.3, respectively, and the CCD was 115.5%±28.9% compared to the unaffected side.There were no significant differences in the final VAS score, ASES score, UCLA score, CCD, subacromial erosion and surgical complications between the DePuy Synthes and ARIX Hook plate groups. In addition, there was no difference depending on whether CC ligament repair had been performed. Conclusion Hook plate fixation in acute AC joint injuries showed good clinical and radiological results. It is considered a good surgical method, and there was no difference in the results depending on plate type and CC ligament repair.