Nicolau syndrome is a rare adverse reaction to a variety of intra-muscular drug preparations. The typical presentation is pain around the injection site soon after injection, followed by erythema, livedoid patch, hemorrhagic patch, and finally, necrosis of skin, subcutaneous fat, and muscle tissue. The phenomenon has been related to the administration of a variety of drugs, including non-steroidal anti-inflammatory drugs, corticosteroids, and penicillin. We report a case with typical features associated with diclofenac injection for pain control in a patient who had undergone bilateral total knee arthroplasty.
Adrenal Cortex Hormones ; Arthroplasty ; Diclofenac ; Drug Compounding ; Erythema ; Humans ; Knee ; Muscles ; Necrosis ; Penicillins ; Skin ; Subcutaneous Fat

Background: In kinematically aligned total knee arthroplasty (KA-TKA), the cylindrical axis (CA) is very important in restoring the native joint line and kinematics of the pre-arthritic knee. This study aimed to determine the accuracy of patient-specific instrument (PSI) for restoring the CA for femoral bone resection in KA-TKA. Methods: Thirty KA-TKAs were performed using a computed tomography (CT)-based PSI system. Data from preoperative CT were reconstructed into three-dimensional (3D) models using 3D-planning software. The CA was created by connecting the centers of each virtual sphere to the medial and lateral femoral condyles using computer software. Femoral bone resection of the distal and posterior condyles was performed parallel to the sagittal planes of the CA. The thickness of the CA-referenced bone resection was determined based on the thickness necessary for the respective regions of the femoral component. The PSI was manufactured to locate the guide pin for a conventional cutting block. The accuracy of PSI for KA-TKA was evaluated as the absolute error between the preoperatively predicted thickness and the intraoperative measurements in each of the four regions, as well as the difference in error between distal-medial (DM) and posterior-medial (PM) and between distal-lateral (DL) and posterior-lateral (PL). Results: The differences in thickness of bone cut in the DM, DL, PM, and PL were 0.79 ± 0.39 mm (range, –1.20 to 1.50), 0.70 ± 0.42 mm (range, –1.50 to 1.50), 0.80 ± 0.46 mm (range, –0.80 to 1.50), and 0.75 ± 0.47 mm (range, –2.10 to 1.40), respectively. There was no significant difference in the thickness error between DM and PM (p = 0.959) and between DL and PL (p = 0.812). Conclusions In KA-TKA, PSI was effective for accurate femoral bone resection based on virtually planned thickness.

BACKGROUND: The aim of this study was to analyze regional differences in the stress distribution within the distal femur in advanced osteoarthritis (OA). METHODS: Distal femoral specimens with primary OA were obtained from 10 female donor cadavers (mean age, 65 years; range, 53–79). As controls, distal femurs without OA were obtained from 10 age- and sex-matched female cadavers (mean age, 67 years; range, 58–81). The articular surface of the distal femur was divided into anterior, middle, and posterior regions on each condyle. Mechanical properties and microstructure were assessed for each region with micro-computed tomography and finite element model analysis. RESULTS: The control group showed differences in stress distribution among 6 regions on the distal femur (P=0.037), but there was no regional difference in stress distribution among 6 regions on the distal femur in the advanced OA group (P=0.179). CONCLUSIONS: Regional stress distribution in the distal femur was different between advanced OA and normal groups. There were no regional differences in stress distribution in the advanced OA group. Altered loading patterns, bone remodeling, and chemical composition will affect stress distribution.
Bone Remodeling ; Cadaver ; Female ; Femur* ; Finite Element Analysis ; Humans ; Osteoarthritis* ; Tissue Donors

There are numerous reports of fractures associated with total knee arthroplasty. But, to our knowledge, isolated posterior malleolus fracture associated with TKR has not previously been reported. Here, we report a case of isolated posterior malleolar fracture that occurred with total knee arthroplasty. The patient was informed that data concerning the case would be submitted for publication.
Ankle Fractures ; Ankle ; Arthroplasty ; Humans ; Knee ; Osteoporosis ; Publications

Of the drugs developed to prevent and treat osteoporosis, bisphosphonate has played a very important role in preventing osteoporotic fractures. However, case reports describing atypical femoral fractures in patients using long-term bisphosphonates have emerged. The majority of atypical femur fractures occurs in the lateral aspect of the subtrochanteric or femur diaphysis, which is explained by accumulation of tensile stress in these areas. Although the superior cortex of the femur neck withstands maximum tensile stress, to our knowledge, there have been only two reports (three cases) of atypical femoral neck fracture. In addition, none of those case reports revealed detailed pathology related to suppressed bone turnover rate. We encountered an incomplete femoral neck fracture and diagnosed it as “atypical” on the basis of the patient’s lack of trauma and medication history and pathological findings. For patients with groin pain, minimal or no trauma, and a history of long-term bisphosphonate use, an atypical femoral neck fracture should be considered.

Focal myositis, a benign myositis which mostly occurs at lower extremity, is a disease that is spontaneously improved by conservative treatments such as bed rest and administration of nonsteroidal anti-inflammatory drug. Focal myositis is known to occur mostly at lower extremity, but we could not find a report of occurrence around hip. Therefore, authors attempt to report clinical progression along with the literature review.
Bed Rest ; Hip ; Hip Joint* ; Lower Extremity ; Myositis*

PURPOSE: The aim of this study was to investigate the efficacy of low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolism in Korean patients who underwent hip fracture surgery (HFS). MATERIALS AND METHODS: Prospectively, a total 181 cases were classified into the LMWH user group (116 cases) and LMWH non-user group (65 cases). Each group was sub-classified according to fracture types as follows: 81 cases of intertrochanteric fracture (group A: 49, group B: 32) and 100 cases of neck fracture (group C: 67, group D: 33). We compared the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) according to LMWH use. RESULTS: Of the 181 cases, four DVTs were found in the LMWH user groups (1 in group A, and 3 in group C). One case of PE was found in LMWH non-user group D. The incidences of DVT and PE showed no statistically significant differences between the LMWH user and non-user groups (p=0.298 and 0.359, respectively). In subgroup analysis, no statistically significant differences were found between groups A and B and between groups C and D. CONCLUSION: The administration of LMWH was not effective in the prevention of venous thromboembolism and PE in the Korean patients who underwent HFS.
Aged ; Anticoagulants/*therapeutic use ; Female ; Heparin, Low-Molecular-Weight/*therapeutic use ; Hip Fractures/classification/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Pulmonary Embolism/etiology/*prevention & control ; Republic of Korea ; Venous Thromboembolism/*prevention & control ; Venous Thrombosis/etiology/*prevention & control

Kinematically aligned total knee arthroplasty (TKA) is a new alignment technique. Kinematic alignment corrects arthritic deformity to the patient's constitutional alignment in order to position the femoral and tibial components, as well as to restore the knee's natural tibial-femoral articular surface, alignment, and natural laxity. Kinematic knee motion moves around a single flexion-extension axis of the distal femur, passing through the center of cylindrically shaped posterior femoral condyles. Since it can be difficult to locate cylindrical axis with conventional instrument, patient-specific instrument (PSI) is used to align the kinematic axes. PSI was recently introduced as a new technology with the goal of improving the accuracy of operative technique, avoiding practical issues related to the complexity of navigation and robotic system, such as the costs and higher number of personnel required. There are several limitations to implement the kinematically aligned TKA with the implant for mechanical alignment. Therefore, it is important to design an implant with the optimal shape for restoring natural knee kinematics that might improve patient-reported satisfaction and function.
Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Congenital Abnormalities ; Femur ; Knee

OBJECTIVES: The purpose of this study is to develop a method of evaluation based on finite element analysis (FEA) using micro-CT images for the measurement of trabecular bone strength. METHODS: The primary compressive trabeculae were obtained from the human femoral head of three cadavers (21 year old male (M/21), 51 year old male (M/51), 51 year old female (F/51). All bone specimens were scanned using micro-CT at 24.9microm of spatial resolution under 70 kV's voltage and current of 141microA. The percent bone volume was calculated from the CTAn (SKYSCAN, Belgium) software, it's represented the bone mineral density (BMD). After scanning, the finite element model was reconstructed based on micro-CT images. All models were applied to be linear elastic, isotropic, and uniform with a tissue modulus of 5.17 GPa and a tissue Poisson's ratio of 0.3. RESULTS: The percent bone volume(%) were 31.819 (+/-0.648), 21.513 (+/-2.489), 20.280 (+/-1.891) and Bone strength (MPa) were 187.741 (+/-13.006), 61.585 (+/-11.094), 61.266 (+/-16.744) in M/20, M/51 and F/51. The trabecular bone strength of the primary compressive trabeculae in M/20 was 3 times more than the trabecular bone strength in M/51 and F/51. The percent bone volume in M/20 was 148% and 157% higher than the percent bone volume in M/51 and F/51. CONCLUSIONS: The finite element analysis is more sensitive than the percent bone volume in reflecting the morphometry index of primary compressive trabeculae. The high resolution FEA reconstructed from high resolution MRI or high resolution CT may improve the evaluation of trabecular bone strength in the medical field.
Bone Density ; Cadaver ; Female ; Finite Element Analysis ; Head ; Humans ; Male