Osteoporosis has been described as the most common disease in the old age group. As the bone mineral density decreases, the skeleton becomes more prone to fracture. Hip fractures occur late in life following substantial reduction in skeletal mass. So the incidence of hip fracture is increasing due to prolongation of average life span. The bone density of femoral neck, Ward triangle, and trochanteric region were measured by dual energy x-ray absorptiometry (DEXA) in 15 patients with femoral neck fractures and in 58 patients with intertrochanteric fractures to evaluate the relationship between bone mineral density (BMD) value and fracture type. The results were as follows 1. In femoral neck fracture group, the mean BMD value was 0.59+/-0.02 g/cm2 in femoral neck, 0.38+/-0.08 g/cm2 in Ward triangle and 0.48+/-0.09 g/cm2 in trochanteric region. In intertrochanteric fracture group, the mean BMD value was 0.57+/-0.09 g/cm2 in femoral neck, 0.39+/-0.10 g/cm2 in Ward triangle, and 0.47+/-0.13 g/cm2 in trochanteric region. 2. In femoral neck fracture group, the fracture threshold value was 0.75 g/cm 2 in femoral neck, 0.60 g/cm2 in Ward triangle and 0.67 g/cm2 in trochanteric region. In intertrochanteric fracture group, the fracture threshold value was 0.63 g/cm2 in femoral neck, 0.51 g/cm2 in Ward triangle, and 0.57 g/cm2 in trochanteric region. In conclusion, there was no statistical relationship in BMD value between neck fracture and intertrochanter fracture group, and no statistical relationship between BMD value and each fracture type in femoral neck and intertrochanter fracture. The type of hip fracture may be related to the degree of trauma rather than the value of the BMD.
Absorptiometry, Photon ; Bone Density* ; Femoral Neck Fractures ; Femur ; Femur Neck ; Hip Fractures ; Hip* ; Humans ; Incidence ; Neck ; Osteoporosis ; Skeleton

The complications of Salter's innominate osteotomy in the treatment of congenital dislocation of the hip were avascular necrosis of the femoral head, hematoma, rotation of distal pelvic fragment, infection, fracture of femoral shaft and redislocation. Among them the causes of redislocation were technical failure, immobilization failure and absorption the bone graft, etc. We experienced a case of redislocation after open reduction and Salter s innominate osteotomy in congenital dislocation of the hip which was induced by a foreign body reaction to the suture material.
Absorption ; Dislocations* ; Foreign-Body Reaction ; Head ; Hematoma ; Hip* ; Immobilization ; Necrosis ; Osteotomy* ; Sutures ; Transplants

Compression ulnar neuropathy was predicted by Guyon in 1961,following his anatomical studies of the ulnar tunnel. Nearly a half century later Ramsey Hunt first reported isolated ulnar motor paralysis in the hand, due to chronic occupational trauma. Many authors has tried to describe the etiology of the ulnar nerve compression syndrome at or around the wrist. That is most frequently caused by ganglion, occupational neuritis, thrombosis of the ulnar artery, thickening of volar ligament or different kinds of trauma (e.g. fractures of the carpal bones). Now we experienced a case of the ulnar nerve compression syndrome at distal forearm by an anomalous branch of the ulnar nerve by piercing the distal tendon of the flexor carpi ulnaris.
Forearm ; Ganglion Cysts ; Hand ; Ligaments ; Neuritis ; Paralysis ; Tendons ; Thrombosis ; Ulnar Artery ; Ulnar Nerve Compression Syndromes ; Ulnar Nerve ; Ulnar Neuropathies ; Wrist

Thirteen Polio patients with leg length inequality were undergone Ilizarov lengthening procedures and have been followed along for an average two years(range, 1-3.8 years) after removal of the fixator. The age of patients(M:F=7:6) ranged from 18.0 to 32.2 years(average 26.4 years). The difference of true leg length averaged 2.1cm with the tibia being 3.3cm the femur, 1.2cm. The corticotomy was done at the proximal tibia and distal fibula in all case. The fixation period of the Ilizarov apparatus averaged 9.3 months. The length gain averaged 3.0cm for an average 3.8cm inequality. The healing index averaged 3.1mon/cm. Two out of thirteen patients complained of pain in the operated leg. The limping gait was improved in all patients except one. According to Paley's classification, there were ten cases of problems, one obstacle and four true complications. The problems were pin site infection controled with local antibiotics injection. There was one case of obstacle; tibial valgus deformity developed during lengthening. True complications included peroneal nerve injury, aggravation of preexsiting equinovalgus and claw toe deformities, aggravation of preexsiting valgus deformity of ankle and tibial valgus deformity. The complications execpt in one case of peroneal nerve palsy were solved out by the secondary procedures. In summery, the bone healing by distraction osteogenesis with the Ilizarov technique was relatively delayed in polio patients and it seems necessary to modify the technique to shorten the prolonged external fixation period.
Ankle ; Anti-Bacterial Agents ; Classification ; Congenital Abnormalities ; Femur ; Fibula ; Gait ; Hammer Toe Syndrome ; Humans ; Ilizarov Technique ; Infection Control ; Leg Length Inequality ; Leg ; Osteogenesis, Distraction ; Paralysis ; Peroneal Nerve ; Poliomyelitis ; Socioeconomic Factors ; Tibia

We report our series of the Ilizarov surgery for lengthening and deformity correction in upper extremity at the Severance Hospital and the Yong-Dong Severance Hospital between February 1992 and October 1994. We performed the Ilizarov surgery in 12 limb segments, there were 3 humerus, 5 radius, 3 ulna and 1 metacarpal bone. The etiologies of the limb length discrepancies were 7 posttraumatic physeal injuires, 2 congenital deformities, 1 posttraumatic bone loss, 1 posttraumatic amputation and 1 postinfectious physeal injury. The goals of treatment were bone lengthening alone in 8 cases, bone lengthening and deformity correction including angular correction in 4 cases. The bone was lengthened between 1.0 cm and 9.2 cm (mean 3.7 cm) representing a 8.1% to 63.0% (mean 24.5%) increase in length. The healing index varies from 1.0 mos/cm to 10.5 mos/cm (mean 3.4 mos/cm) except three cases which need additional fixation with plate and screws add to wedge osteotomy. By radiologic appearance of the distraction callus, the straight type were 6 cases, the attenuated type were 4 cases and the pillar type were 2 cases. The healing indices of each type were 1/5 mos/cm, 7.7 mos/cm and 12.4 mos/cm, respectively. In conclusion, lengthening and deformity correction of the upper extremity can be successfully achieved by gradual mechanical distraction using the Ilizarov method. In case of pillar type, healing index was high and therefore control of the rate and the rhythm should be tried. If this control is of no use, early interventional procedure would be beneficial. The healing index of the straight type was much lower than that of the attenuated or the pillar type.
Amputation ; Bone Lengthening ; Bony Callus ; Congenital Abnormalities ; Extremities ; Humerus ; Ilizarov Technique ; Osteotomy ; Radius ; Ulna ; Upper Extremity

PURPOSE: To evaluate the early clinical results of lumbar microdiscectomy using minimally invasive tubular retractor (METRx-MD system, Medtronic Sofamor Danek, Memphis, TN), and to validate the merits of minimally invasive spinal surgery. MATERIALS AND METHODS: From April, 2003 to April 2004 we retrospectively studied a consecutive series of 45 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. In all cases, minimally invasive approach using the tubular retractor were performed with a 2 cm sized paramedian incision. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, need for blood replacement, time needed before ambulation, length of hospital stay, and complications. The clinical outcomes were assessed by the modified MacNab criteria. RESULTS: Minimally invasive tubular microdiscectomy was performed in 45 patients over a 12-month period with an average follow-up of approximately 8 months. The clinical outcomes assessed by MacNab criteria were excellent in 33 patients (73%), good in 10 patients (22%). The average operative time was 63 minutes (range, 35 to 95 minutes). The average blood loss was 62 mL (range, 50 to 110 mL). None of the patients needed blood replacement. With the exception of 2 patients, all patients could walk at the day of surgery. The average hospital stay was 2.3 days. None of the patients had dural tear, wound problem, or other complications. CONCLUSION: Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further long-term, randomized, prospective investigations are needed to fully evaluate the impact of this technique.
Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Length of Stay ; Operative Time ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Incidences of postoperative mucoceles of the frontal, ethmoid, or sphenoid sinuses are currently on the rise. The clinical rogression of the postoperative mucoceles in the frontal, ethmoid, or sphenoid sinuses are different from that of the maxillary mucoceles. In this study, we investigated the clinical patterns and treatments of postoperative mucoceles, which have developed in the frontal, ethmoid, or sphenoid sinuses. MATERIALS AND METHODS: Between June,1994 and August, 2005, twenty-six patients with thirty postoperative mucoceles were treated surgically. They had a previous history of operation and incidences of maxillary mucoceles were excluded from the study. A review of the clinical subjects were performed using their clinical records and radiological findings. RESULTS: The locations of the postoperative mucoceles were, in the order of frequency, the ethmoid, frontal, fronto-ethmoid, spheno- ethmoid, sphenoid, and fronto-ethmoidsphenoid sinus. Postoperative mucoceles occurs mostly in the form of ophthalmic symptoms and headache. The ophthalmic manifestations were different between the anterior, posterior and the antero-posterior mucocele group. The mean duration until diagnosed as postoperative mucocele since the previous sinus surgery was 9.9 years, and endoscopic sinus surgeries and intranasal ethmoidectomies with Caldwell-Luc operations were the majority among previous surgeries. Most postoperative mucoceles could be successfully treated with an endoscopic marsupialization. CONCLUSION: Frontal, ethmoid, or sphenoid postoperative mucoceles developed mostly on the ethmoid sinus and occurs mainly in the form of ophthalmic symptoms. Most postoperative mucoceles were successfully treated with an endoscopic marsupialization.
Ethmoid Sinus ; Headache ; Humans ; Incidence ; Mucocele* ; Paranasal Sinuses ; Sphenoid Sinus*

Bdhcet's disease is a systemic vasculitis with a variety of clinical manifestations and occasionally involves arterial and venous system. The vascular involvement occurs in approximately 7~35% of patients with Bdhcet's disease and classified into venous thrombosis, arterial thrombosis and arterial aneurysm. The aneurysmal formation is more common than occlusion, though the two may coexist. Arterial aneurysm has been reported in both small and large vessels including the thoracic and abdominal aorta, carotid, common iliac, pulmonary, coronary, subclavian, peripheral arteries and occasionally involves multiple vessels. We experienced a 40-year-old male patient with Bdhcet's disease presented with recurrent, multiple aneurysms of right subclavian artery, innominate artery and left radial artery. We present here an unusual case with a brief review of the literatures and the other case reports of Bdhcet's disease with multiple aneurysms in Korea.
Adult ; Aneurysm* ; Aorta, Abdominal ; Arteries ; Brachiocephalic Trunk ; Humans ; Korea ; Male ; Radial Artery ; Subclavian Artery ; Systemic Vasculitis ; Thrombosis ; Venous Thrombosis

Modular designs of hip prostheses have become popular recently. Along with complications inherent in all hip arthroplasty systems, modular systems have the additional potential for dissociation of components. Five male patients underwent total hip arthroplasties, in which all of the acetabular components were Harris-Galante II porous acetabular cups. Many years after the operation, the polyethylene liners were dissociated without any previous trauma or dislocation of the femoral heads, these dissociations and dislodgements were managed with open reduction. This complication can be predicted from clinical symptoms and signs. Roentgenograms must be taken and carefully compared to previous roentgenograms. We postulated two causes for the dissociation. First, the polyethylene liner was not fixed securely within the acetabular metal shell at the time of operation. Second, the locking mechanism of the acetabular metal shell was not strong enough to firmly hold the polyethylene liner within the acetabular metal shell. It does warrant that certain precautions must be taken when implanting modular components. The locking mechanism of the harris-Galante II porous acetabular component is mechanically weak and fails easily, therefore its design must be improved in an attempt to prevent postoperative dissociation of the polyethylene liner.
Acetabulum* ; Adult ; Case Report ; Hip Prosthesis/adverse effects* ; Human ; Male ; Metals* ; Middle Age ; Polyethylenes* ; Prosthesis Design ; Prosthesis Failure*

A 25-year-old 7 month pregnant woman with mitral stenosis was hospitalized because of life threatening hemoptysis dispite intensive medical treatment. Emergency mitral commissurotomy resulted in prompt cessation of hemorrhage and at nine months follows-up, the hemoptysis has not recurred. Mitral valve surgery appears to be consitently associated with rapid and sustained cessation of hemoptysis. Therefore, surgery should be considered in hemoptysis due to mitral stenosis, particulary when the danger of asphyxiation exists.
Adult ; Emergencies* ; Female ; Hemoptysis* ; Hemorrhage ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Pregnant Women