PURPOSE: The purpose of this study is to elucidate the clinical feature of the hasbitual patella dislocation in the skeletally immature patients and evaluate the result of modified Galeazzi procedure. MATERIAL AND METHODS: From Aug, 1997 to Jan, 2002 we operated 9 knees in 7 patients. Mean age at surgery was 13.3 years. There were 3 males with 3 knees and 4 females with 6 knees. The lateral retinaculum was released and the medial retinaculum was reefed. Patella was tenodesed with semitenidinosus tendon. The operated knees were immobilized with plaster of cast for 3 weeks and progressive range of motion exercise with hinged brace was permitted. RESULTS: Based on the clinical and radiological evaluation, there were improved results. Especially congruence angle was decreased from preoperative +72 degrees to postoperative +20 degrees. There was 1 recurrence that had increased femoral anteversion and 1 arthrofibrosis that had past history of ipsilateral thigh infection. CONCLUSION: Satisfactory clinical results were obtained with modified Galeazzi procedure for treatment of habitual patella dislocation in skeletally immature patient.
Braces ; Dislocations* ; Female ; Humans ; Knee ; Male ; Patella* ; Range of Motion, Articular ; Recurrence ; Tendons ; Thigh

PURPOSE: To report the clinical, radiological and surgical findings of iliopsoas bursitis, and to suggest an indication for diagnosis and treatment. MATERIALS AND METHODS: We report two patients with iliopsoas bursitis who underwent THA in between June 1998 to June 2003. All presented with late onset hip joint discomfort, and their diagnosis were confirmed after interdepartmental consultations and with the help of investigations such as interventional angiography and MRI. Their signs, symptoms, investigations and surgical findings were reviewed retrospectively. RESULTS: Iliopsoas bursitis presented with hip pain, leg edema, palpable inguinal mass and ecchymosis, femoral nerve irritation and flexion contracture of hip. The radiographs provided no diagnostic clues but the MRI revealed a well marginated cystic lesion filled with fluid signals. Ultrasonography revealed the anatomic location that enabled guided aspiration and even ruled out vascular compromise. Two patients were treated with USG guided aspiration. One aspirate was serosanguinous and the other was old blood tinged fluid. One patient underwent surgical debridement of the cyst. Surgery revealed an intrapelvic hemorrhagic bursa with an ill-defined cystic wall and intramuscular extension into the iliacus. CONCLUSION: It is important for surgeons to rule out iliopsoas bursitis when a patient presents with vague hip pain after total hip arthroplasty without any evidence of infection or loosening. A diagnosis of iliopsoas bursitis can be made from the clinical features and ultrasonography.
Angiography ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Bursitis* ; Contracture ; Debridement ; Diagnosis ; Ecchymosis ; Edema ; Femoral Nerve ; Hip ; Hip Joint ; Humans ; Leg ; Magnetic Resonance Imaging ; Referral and Consultation ; Retrospective Studies ; Tolnaftate ; Ultrasonography

PURPOSE: To assess the suitability of the Korean KOOS (Knee injury and osteoarthritis outcome score) as a patient-centered clinical measurement of the validity, reliability and responsiveness to the treatment of knee injuries. MATERIALS AND METHODS: One hundred and eight patients who had experienced an arthroscopic ACL reconstruction or a menisectomy between Jan. 2002 and Jun. 2003 were examined immediately after surgery, and 6 and 12 months after surgery. The SF-36 and Lysholm knee scale were administered simultaneously to each case in order to calculate the inter-item correlation. RESULTS: Measurements of the test-retest reliability showed that all intra-class coefficients (ICC) were measured as r=0.75-0.89 and Cronbach's alpha was 0.73-0.81. Regarding the validity, there was a strong correlation with the SF-36 and the Lysholm, subscales (SF-36 vs KOOS: Physical functioning vs ADL (r=0.67)/Physical functioning vs Sports and recreational activities (r=0.61)/Bodily pain vs Pain (r=0.63)). In terms of the responsiveness, the average score measured preoperatively, and three, six and nine months showed a gradual increase. The effect size of pain, symptoms and ADL at postoperative 6 months was 0.8-1.1. A larger effect size was observed in the QOL (1.5) and sports and recreational function (1.3) at 3 months after surgery (n=25). CONCLUSION: The validity, reliability and responsiveness of the Korean KOOS was confirmed and is considered to be a useful clinical metrology for a knee injury.
Activities of Daily Living ; Humans ; Knee Injuries* ; Knee* ; Osteoarthritis* ; Sports

BACKGROUND: A large amount of attention in anorectal physiologic studies has been devoted to the diagnosis of fecal incontinence. The current study was designed firstly to assess the physiologic characteristics of fecal incontinence and secondly to analyze how the physiologic findings correlate with each other. METHODS: The physiologic findings of 47 patients (24 men and 23 women) were analyzed, retrospectively. Studies included anal manometry (n=38), anal electromyography/pudendal nerve terminal motor latency (PNTML) (n=30), and endoanal ultrasound (n=37). The degrees of continence were estimated by using continence grading scores (CGS) that ranged from 0 to 20 points based on the type and the frequency of incontinence. Control data were obtained from volunteers (n=23). RESULTS: The patients were categorized as having neurogenic (group I, n=25) or myogenic (group II, n=17) incontinence. Despite intensive investigations, unknown etiology was noted in 5 patients (10.4%). The CGS was not different between groups I and II. Pudendal neuropathy was found in 96% of group I and 37.5% of group II patients. Group I showed a higher value of PNTML than that of group II (2.96 1.0 msec vs. 2.07 0.48 msec, p=0.003). The CGS was proportional to the value of the PNTML in group I (r=0.476, p=0.01). However, no correlation was found between the mean PNTML and the CGS in group II. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction (MVC) between groups I and II. The MVC was inversely proportional to the CGS in group I (r= 0.616, p=0.02) and in group II (r= 0.664, p=0.02). No correlation was found between the PNTML and the manometric parameters. When we consider the presence of a defect or a scar as an abnormal anal ultrasound finding, such findings were more frequent in group II than in group I (group I, 20% vs. group II, 88%, p<0.001, Fisher's exact test). CONCLUSIONS: The value of the PNTML had relevance to the degree of symptoms in the patients with neurogenic incontinence. Specifically, the squeeze profiles of the manometric parameters were inversely related to the grade of incontinence. No correlation between the PNTML and the manometric parameters could be independently specified based on the etiology. Complementary examination by using the PNTML and anal ultrasound provided the only useful information to discriminate the etiology of incontinence.
Cicatrix ; Diagnosis ; Fecal Incontinence* ; Humans ; Male ; Manometry ; Physiology* ; Pudendal Neuralgia ; Retrospective Studies ; Ultrasonography ; Volunteers

PURPOSE: We tried to evaluate the usefulness of the arthroscopy in the operative treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS:Between March 2005 and May 2008, 9 patients with intra-articular calcaneal fractures (Tongue type or Sanders type IIC) were treated with arthroscopically assisted percutaneous reduction and screw fixation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), preoperative and postoperative Bohler's angle and the rate of complication were evaluated. RESULTS:AOFAS score at postoperative 1 year was 88.2 (range, 71-92), and mean VAS score was 2.8 (range, 1-4). Bohler angle was improved from preoperative mean 16.2 degrees to postoperative mean 29.7 degrees . There were no complications such as wound problem, infection or nerve injury. CONCLUSION: Subtalar arthroscopy provides precise view of posterior facet during the operation. Therefore, it can be a useful tool in treating intra-articular calcaneus fractures, especially tongue type and Sanders type IIC fractures.
Animals ; Ankle ; Arthroscopy ; Calcaneus ; Foot ; Humans ; Orthopedics ; Tongue

The morphological changes in the anterior horn of the L4 and L5 spinal segments were observed following anterior root avulsion in the adult male Sprague-Dawley rat (300~350 gm) at 5 days, 1 week, 2 weeks and 3 weeks postlesion. The animals were perfused with 4% paraformaldehyde, 0.15% picric acid in 0.1 M phosphate buffer solution and cryostat sections were prepared. Immunohistochemistry was used to identify changes of the phenotype in the anterior horn cells. Primary antibodies, goat anti-choline acetyltransferase (ChaT, 1 : 500, Chemicon), mouse antirat ED-1 (1 : 200, Serotec), rabbit anti-glial fibrillary acidic protein (GFAP, 1 : 200, DAKO) and rabbit anti-vascular endothelial growth factor (VEGF, 1 : 500, Santa Cruz Biotechnology) were used. Avidin-Biotin complex method was performed for immunohistochemical reaction and color reaction was developed with DAB-H2O2. Following results were observed in the anterior horn of lumbar spinal cord; 1. The number of ChaT-immunoreactive (ir) cells were reduced 20% level of control animals at 3 weeks after avulsion. 2. ED-1-ir microglia were significantly increased at 1 week and processes of ED-1-ir microglia surrounded around the axotomized neuronal cell bodies. 3. Gliosis defined by extensive GFAP immunoreactivity was observed both ipsilateral and contralateral side of lesion but the VEGF-ir cells were significantly increased in the ipsilateral side of lesion. Therefore, this study suggested that the majority of axotomized motor neurons were degenerated and the cellular proliferation and phenotype changes including glial cell activation were observed in the lumbar spinal cord after anterior root avulsion of adult rats.
Adult* ; Animals ; Anterior Horn Cells* ; Antibodies ; Cell Proliferation ; Choline O-Acetyltransferase ; Endothelial Growth Factors ; Gliosis ; Goats ; Horns ; Humans ; Immunohistochemistry ; Male ; Mice ; Microglia ; Motor Neurons ; Neuroglia ; Neurons ; Phenotype ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord* ; Vascular Endothelial Growth Factor A

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score <-3.0 and they were followed up for more than 6 months. The patient were divided into two groups. One group was treated with DHS only (Group 1, 38 cases), and the other was treated with DHS and TSP (Group 2, 32 cases). The two groups were compared clinically and radiologically. RESULTS: There was no difference in the prevalence of lag screw sliding. However, there were significant differences in the extent of sliding between the two groups, (an average of 8.8 mm p<0.05). There was a significant difference between two groups in the extent of lateralization of the great trochanter, (An average of 6.0 mm p<0.05). However, there was no difference in the leg length between two groups (p>0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.
Aged ; Femur* ; Hip Fractures* ; Hip Joint ; Hip* ; Humans ; Leg ; Osteoporosis ; Prevalence

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires