Post-traumatic kyphosis is generally recognized as the result of failure of initial treatment in injured spine. The purposes of this study are to find out the surgical indications in residual post-traumatic kyphosis and to analysis the result of operative correction in post-traumatic kyphosis. The authors analyzed 14 cases of post-traumatic kyphosis, operated from Jan. 1992 to Mar. 1996. Their injuries were estimated initially compression fracture in 12 cases, hurst fracture in 2 cases. Their initial treatments were conservative method in 12 cases, anterior fusion in 1case & laminectomy in 1 case. The results of this study are as follows: 1) By standard Cobb lateral measurement, the mean preoperative kyphosis of 32.9degrees was reduced to 14.2 degrees(56.8% correction ratio). 2) Symptomatic improvement was definite, stooping with fatigue pain, mid back pain and accompanied claudication were improved in all cases. And low hack pain due to compensatory lordosis was improved in 5 of 6 cases. 3) We acquired bone union in all cases. We concluded that some thoraco-lumhar fractures could be underestimated in supine X-ray and needed more meticulous evaluation and follow-up. In addition, preexisting symptomatic lumhar degeneration below fracture should be considered in initial surgical decision making of post-traumatic kyphosis.
Animals ; Back Pain ; Decision Making ; Fatigue ; Follow-Up Studies ; Fractures, Compression ; Kyphosis* ; Laminectomy ; Lordosis ; Spine

Open tibial pilon fractures present extensive soft tissue disruption and common complications such as sepsis or skin slough, and deserve special cosideration in addition to the challenging reconstructive problems. The purpose of this study is to assess the effectiveness of limited internal fixation and external fixation for the treatment of the open tibial pilon fractures, and to introduce some idea in Ilizarov device use. We reviewed 27 open tibial pilon fractures treated with limited internal fixation and external fixation from Feb. 1992 to Mar. 1996(follow-up range, 1 to 5 years). Fracture classification(Ruedi and Allgower) was type I in 5, type II in 10 and type III in 12, open wound type(Gustilo-Anderson) was II in 8, IIIA in 17 and IIIB in two. Secondary procedures were 16 soft tissue procedures, 13 bone graftings and 2 limb lengthening. Mean time for removal of the external fixators was 3.5 months(range, 6 to 21 weeks), and clinical union averaged 4.3 months(range, 12 to 25 weeks). At the time of last follow-up, radiologic grading(Burwell and Charnley) showed 13 good(48%), 10 fair(37%) and 4 poor results(15%). Objective functional grading(Ovadia and Beals) showed 5 excellent(19%), 15 good(56%), 6 fair(22%) and 1 poor(4%), and subjective grading 2 excellent(7%), 16 good(59%), 7 fair(26%) and 2 poor(7%). Common complications included 10 wound sepsis(37%), 6 posttraumatic arthritis(22%) and 5 malunions(19%). In conclusion, we cosider limited internal fixation and external fixation is an effective treatment modality till bone union for open tibial pilon fractures, and Ilizarov method using tension wires crossed only through the fracture fragments can provide a sufficient early and late stability.
External Fixators ; Extremities ; Follow-Up Studies ; Ilizarov Technique ; Sepsis ; Skin ; Tibia ; Transplants ; Wounds and Injuries

Spinal epidural abscess is an uncommon, but a significant disease due to its high morbidity and mortality rate if not diagnosed in time. Although early diagnosis and prompt surgical intervention is needed for better prognosis of this disease, the diagnosis of spinal epidural abscess is often elusive despite modern medical advances, and depends on a high index of suspicion. we report a case of lumbar spinal epidural abscess of unknown origin complicated by cauda equina syndrome.
Cauda Equina* ; Diagnosis ; Early Diagnosis ; Epidural Abscess* ; Mortality ; Polyradiculopathy* ; Prognosis

Spinal epidural hematoma is a rare complication of epidural anesthesia and most commonly associated with intraoperative or postoperative anticoagulant administration. We describe the case of an acute thoracolumbar epidural hematoma at the T12-L4 level complicated by cauda equina syndrome, which occurred after placement of spinal epidural catheter for anesthesia and anticoagulant therapy for acute myocardial infarction developed postoperatively. In our experience, the spinal epidural catheterization and anticoagulant therapy may potentially increase the risk of epidural hematoma formation.
Anesthesia ; Anesthesia, Epidural* ; Catheterization ; Catheters ; Cauda Equina* ; Hematoma* ; Hematoma, Epidural, Spinal ; Heparin* ; Myocardial Infarction ; Polyradiculopathy*

Seidel nail provides more advantages for treatment of humeral shaft fracture than other treatment modalities. It enables patients to get high bone union rate, makes surgical technigne less invasive, and allows early mobilization mobilization so that the patients is subjected to more comfortable treatment. But, Seidel nail is apt to injure the rotator cuff and has relatively weak holding power of distal fragment of fracture so that it may result in distraction and rotatory instability, and make nonunion and impaired shoulder function. Thus, in order to the functional and radiological results, complications and technical problems, we evaluated the efficacy of Seidel nail in treatment of 20 cases of hurneral shaft fractures from March l994 to March 1996, retrospectively. The results were as follows. 1. 18 cases(90%) achieved radiological union. 2. The time of union was 12.5 weeks in average. 3. 17 cases achieved satisfactory results according to Neers functional score. 4. The complications included proximal protrusion of nail from the entry site(10%), fracture of greater tuberosity of proximal humerus(5%), loosening of distal spreading screw(10%), and nonunion( l 0%). In conclusion, Seidel nailing is one of good treatment modalities for humeral shaft fracture, but skillful operative technique is needed to obtain the satisfactory functional result. And also, it is necessory to modify the distal locking system of Seidel nail to reinforce the rotational stahility of the fracture site.
Early Ambulation ; Humans ; Humerus ; Retrospective Studies ; Rotator Cuff ; Shoulder

Injuries of the cervical spine from C3 down to C7 are complex and potentially devastating injuries. The treatment of this condition is complicated and controversial. However, there is an increasing tendency to stabilize unstsble cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and rehabilotation. We analysed clinically the 26 patients with unstable lower cervical spine injuries st the department of orthopaedics, National Medical Center from Jan. 1979 to Dec. 1988. The results obtained were as follows:1. The prevalent age distribution was between 20 and 50 years of age(71%), and the ratio between male and female was 6: l. 2. The most common cause of the injury was traffic accident(42%), and the most frequent mechanism of injury was distractive-flexion type(42%). 3. In the overall clinical evaluation, 73% of the patients were judged to have had excellent and good results, and the range of the motion was more limited in the patient who underwent posterior fusion due to wide level of fusion. 4. The patients with distractive-flexion injuries with minimal neurologic deficit were at risk of late instability following conservative treatment, and therefore open reduction and posterior fusion may be advisable. 5. The patients who were given posterior fusion were noted to have a few significant late changes, but the patient with anterior fusion carried a high incidence of progressive kyphotic deformity and persisting, pain. 6. When anterior fusion is used in the patient with posterior instability for the purpose of cord decompression, anterior cervical plate is valuable than the fusion with graft only in view of preventing progressive kyphotic deformity.
Age Distribution ; Congenital Abnormalities ; Decompression ; Early Ambulation ; Female ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Nursing Care ; Spine ; Transplants

PURPOSE: To report a case of focal choroidal excavation associated with central serous chorioretinopathy. CASE SUMMARY: A 48-year-old female presented with a 20-year history of visual disturbance. Focal choroidal excavation with neurosensory retinal detachment was detected in the right eye on optical coherence tomography. Fluorescein angiography showed hyperfluorescene in the area of excavation and multiple focal hyperfluorescences in the perimacular area. Vertically linear hyperfluorescene line was detected in the excavated area caused by retinal pigment epithelial atrophy. Based on the 2 diagnostic findings, we diagnosed a focal choroidal excavation with central serous chorioretinopathy. No progression was detected for 2 months.
Atrophy ; Central Serous Chorioretinopathy* ; Choroid* ; Female ; Fluorescein Angiography ; Humans ; Middle Aged ; Retinal Detachment ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: To evaluate the efficacy and safety of the combination of cataract surgery and intravitreal bevacizumab injection in patients with cataract and diabetic macular edema. METHODS: Patients received an intravitreal injection of bevacizumab(1.25 mg) combined with phacoemulsification and implantation of a posterior chamber intraocular lens. Best corrected visual acuity (BCVA, LogMAR) and, central macular thickness (CMT) were measured using OCT at baseline and at one week, one, three, and six months after surgery, and adverse events were recorded. RESULTS: The mean baseline LogMAR BCVA was 0.84+/-0.50 and mean CMT was 337.1+/-57.50 micrometer. At one week, one, three, and six months after surgery, the mean BCVAs were 0.52+/-0.40, 0.51+/-0.42, 0.52+/-0.34, and 0.46+/-0.37, and the mean CMTs were 356.4+/-86.44 micrometer, 338.8+/-138.4 micrometer, 349.0+/-122.9 micrometer, and 334.2+/-100.4 micrometer, respectively. No adverse events associated with cataract surgery or intravitreal bevacizumab injection were observed. CONCLUSIONS: The short-term results from the present study suggest the combination of cataract surgery and intravitreal bevacizumab injection are safe and effective for the prevention of macular edema aggravation for one month, but has little effect on prevention of macular edema aggravation three months after surgery for diabetic macular edema patients.
Antibodies, Monoclonal, Humanized ; Cataract ; Humans ; Intravitreal Injections ; Lenses, Intraocular ; Macular Edema ; Phacoemulsification ; Visual Acuity ; Bevacizumab

PURPOSE: To evaluate the short-term effect and safety of intravitreally injected bevacizumab in patients with macular edema (ME) caused by retinal vein occlusion (RVO) and diabetic macular edema (DME). METHODS: We retrospectively evaluated 59 eyes of 51 patients, 29 with ME caused by RVO and 30 with DME, who received intravitreal injection of bevacizumab. Fifty-one consecutive patients (59 eyes) with ME associated with RVO and DME were treated with intravitreal injections of 1.25-2.5 mg (0.05-0.1 ml) of bevacizumab. Ophthalmic evaluation was performed at baseline and at 1, 3, 6 months after each injection. Clinical evidence of toxicity and complications, changes of visual acuity with an ETDRS chart (LogMAR), and central macular thickness (CMT) using optical coherence tomography (OCT), were evaluated. RESULTS: The follow-up period was 7.3 months (7.3+/-0.31) and the mean number of injections was 1.2. The baseline mean LogMAR was 1.06+/-0.53 and mean CMT was 479.6+/-160.4 micrometer. At 1, 3 and 6 months, the mean LogMAR was 0.90+/-0.52, 0.80+/-0.39 and 0.78+/-0.39, respectively, and the mean CMT was 316.9+/-86.7 micrometer, 281.1+/-67.4 micrometer and 278.4+/-64.6 micrometer, respectively. No adverse incidents were observed, including cataract, retinal detachment, vitreous hemorrhage, and endophthalmitis, although transient increased intraocular pressure was observed. CONCLUSIONS: Intravitreal bevacizumab injections are safe and effective in ME caused by RVO and DME.
Antibodies, Monoclonal, Humanized ; Cataract ; Endophthalmitis ; Eye ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retinal Detachment ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitreous Hemorrhage ; Bevacizumab

PURPOSE: To estimate the annual incidence rate, evaluate any changes, analyze the microbiologic spectrum of infecting organisms, antibiotic susceptibility, and factors associated with visual outcomes of postoperative endophthalmitis following cataract surgery over an 8-year period. METHODS: A retrospective investigation of direction, sex, age, culture results, interval duration, and initial visual acuity of 29 patients with endophthalmitis following cataract surgery was conducted from January 2000 to December 2007. The study was divided into two 4-year periods, with patients categorized into either Group 1 or 2. RESULTS: The incidence rate was 0.359%, the major infective organism was Staphylococcus epidermidis, and no significant change was observed during the 8-year period. Vancomycin retained efficacy in all cases, but increased resistance occurred with ciprofloxacin during the 8 years. Increased visual acuity after treatment was greater in Group 2 and the interval from onset of ocular symptoms to ophthalmic consultation was shorter in Group 2, although a statistical significance was not demonstrated. CONCLUSIONS: Vancomycin remains effective for patients with endophthalmitis following cataract surgery. Patients who initially had good visual acuity showed greater improvement. However, sex, age, or whether or not the patients had a vitrectomy operation, were not statistically significant factors in the improvement of visual acuity.
Cataract ; Ciprofloxacin ; Endophthalmitis ; Humans ; Incidence ; Retrospective Studies ; Staphylococcus epidermidis ; Vancomycin ; Visual Acuity ; Vitrectomy