Arthrodesis is one of the last options available to obtain a stable, painless knee in patients who are unable to undergo reconstructive surgery due to a damaged knee joint. A variety of techniques have been used, including external fixation, internal fixation by compression plates, intramedullary fixation through the knee with a modular nail, and antegrade nailing through the piriformis fossa. Another option is the use of a short nail such as the Neff nail, the Wichita nail, or the Huckstep nail, but there are no commercial short nails available for use in Korea. This technical report describes a technique for knee arthrodesis using a retrograde femoral intramedullary nail.

Iliac vein compression syndrome, which results in thrombosis of the left iliac veins, was first described by May and Thurner in 1957. May– Thurner syndrome should be considered when deep vein thrombosis-like symptoms appear, especially in the left lower extremities without an invasive procedure. The authors encountered an interesting case of a middle-aged female patient, who presented with sudden pain, swelling and skin color changes to the left lower extremity after right total knee arthroplasty and was diagnosed May–Thurner syndrome by computed tomography venography. This case is of clinical significance in that the early diagnosis of May–Thurner syndrome in the left lower extremity was made, which might have been overlooked after right total knee arthroplasty. This case is reported with a review of the literature review.

Patellar tendon rupture is rare and is caused mainly by trauma, but it can also be caused by systemic disease or weakening of the tendon due to aging. Complete rupture may occur in the inferior pole of the patella, midsubstance of the tendon, and the tendon from the tibial tubercle. In addition, it can also appear as an avulsion fracture. The authors experienced a Z-shaped pattern of an acute patellar tendon complete rupture, including partial transverse ruptures of the inferior pole of the patella and the tendon from the tibial tubercle separately with a longitudinal tear. Satisfactory results were obtained through surgical treatment. The authors report this case with a review of the relevant literature.

PURPOSE: To analyze the midterm results of the treatment with a retrograde nail for periprosthetic fractures of the femur following total knee arthroplasty. MATERIALS AND METHODS: Between Jan 1998 and Jan 2004, 11 cases in 11 patients were treated for the periprosthetic fractures following total knee arthroplasty. The mean follow-up was 42.0 (30~98) months and the mean age was 66.0 (57~79) years old. 2 were males and 9 patients were females. In all cases, retrograde nailing was done for the periprosthetic fractures. Postoperative range of motion, HSS knee rating score, femorotibial angle, the time required for union, complications were evaluated. RESULTS: Postoperative range of motion was 103.6° degrees on an average, HSS knee rating score was 83.5 points on an average at the last follow up. The mean angulation on radiograph was valgus 6.3°. The mean time required for union was 4 months. One had a newly fracture line at proximal part of supracondylar fracture, but there was no significant in clinical course. There was no prostheses required revision. CONCLUSION: It appears that retrograde nail is a reliable surgical technique for periprosthetic fractures of the femur following total knee arthroplasty with low complication rate. The midterm results in our study showed that none of the prostheses required revision.
Arthroplasty, Replacement, Knee* ; Female ; Femur* ; Follow-Up Studies ; Humans ; Knee ; Male ; Periprosthetic Fractures* ; Prostheses and Implants ; Range of Motion, Articular

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate and compare the factors affecting recovery of spinal cord injury following cervical and thoracolumbar spine injuries. SUMMARY OF LITERATURE REVIEW: Several authors have reported the factors to predict the prognosis of spinal cord injury, but the objective prognostic factors are still controversial. MATERIALS AND METHODS: From June 2006 to March 2013, a total of 44 patients with spinal cord injury were evaluated. Prognostic factors analyzed were sex, age, neurologic status, fracture type, time to operation, use of steroid, and signal change on MRI. We analyzed the relation between each factor and the neurologic recovery. The mean follow-up period was 12 months. The neurologic recovery was analyzed by the ASIA impairment scale at the first and the last neurologic examination. RESULTS: Among 44 patients, 15 sustained complete cord injury while 29 had incomplete cord injury. Significant neurologic recovery using the ASIA impairment scale was evaluated in the incomplete spinal cord injury group. Among this group, the prognosis for Brown-sequard syndrome is better than for central cord syndrome and anterior cord syndrome. There was no significant difference in other factors (fracture site, time to operation, use of steroid or signal change on MRI). CONCLUSIONS: The prognosis in spinal cord injury is determined by the initial neurologic damage and neurologic recovery is not related with the fracture type, time to operation, use of steroid and signal change on MRI.
Asia ; Brown-Sequard Syndrome ; Central Cord Syndrome ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Prognosis ; Retrospective Studies ; Spinal Cord Injuries* ; Spine

PURPOSE: To analyze the causes and the clinical results of treatment for the nonunion of femur shaft fractures that occurred after interlocking intramedullary nail fixation. MATERIALS AND METHODS: We reviewed 19 cases of aseptic nonunion of femur shaft fracture in 174 patients after interlocking IM nailing from March 1999 to February 2004 and followed up for more than one year. First we investigated the factors causing nonunion. For operative options, two methods about exchange nailing and exchange nailing with bone graft were performed. Finally clinical results were analyzed with bone union rate by treatment methods and compared with the nonunion factors statistically. RESULTS: According to the causes and types of nonunion, we performed larger IM nail change in 10 cases and IM nail change with bone graft in 9 cases. Bone union was achieved in all cases. Average bone union period were 18.5 weeks in exchange group and 16.1 weeks in exchange with bone graft group. There are significant difference between treatment methods statistically (p<0.05). Compared with the nonunion factors, initial open fracture and smoking groups showed late union rate statistically. CONCLUSION: Based on our analysis, IM nail change is a useful method for nonunion after initial IM nailing in femoral shaft fracture, and additional bone graft that according to the radiologic pattern and stability, especially the fracture gap is also a useful option for nonunion treatment.
Femur ; Fracture Fixation, Intramedullary* ; Fractures, Open ; Humans ; Methods ; Smoke ; Smoking ; Transplants

BACKGROUND: To evaluate the efficacy of arthrodiastasis for Legg-Calve-Perthes disease. METHODS: Arthrodiastasis was conducted using external fixator devices (Orthofix) in 7 patients at least 8 years of age with a diagnosis of Legg-Calve-Perthes disease. The average follow-up was 80 months (range, 32 to 149 months), and their average age was 9.1 years (range, 8 to 12 years). The results of treatment were evaluated by measuring the degree of hip pain and the range of motion of the hip at 6 months after the operation and comparing the values with preoperative measurements. Radiological recovery was evaluated by the epiphyseal index and compared with the preoperative values. At the final follow-up, clinical and radiological results were evaluated using the Iowa hip score and the Stulberg classification. RESULTS: On the clinical evaluation performed at 6 months after arthrodiastasis, the degree of pain decreased by 1.8 points on average, and the average flexion, internal rotation, and abduction increased by 35°, 16°, and 11°, respectively. Based on radiological findings, the epiphyseal index showed a remarkable increase of 6.6 on average (from 19 preoperatively to 26 postoperatively). At the final follow-up, the average Iowa hip score improved from 65 points preoperatively to 84 points. There were 1 Stulberg class I hip, 2 Stulberg class II hips, 3 Stulberg class III hips, 1 Stulberg class IV hip, and no Stulberg class V hip. CONCLUSIONS: We conclude that arthrodiastasis using an external fixator can be a relatively promising surgical procedure for the treatment of late-onset Legg-Calve-Perthes disease.
Classification ; Diagnosis ; External Fixators ; Follow-Up Studies ; Hip ; Humans ; Iowa ; Legg-Calve-Perthes Disease* ; Range of Motion, Articular

Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.
Cumulative Trauma Disorders/complications/*diagnosis ; Fibroma/*etiology ; Friction ; Humans ; Iliotibial Band Syndrome/complications/*diagnosis ; Knee Joint/*pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pain/etiology ; Tendons/*pathology

STUDY DESIGN: To analyze the expression profile of tumor endothelial marker 7 (TEM7) in the spinal cord and dorsal root ganglion (DRG). PURPOSE: To investigate the expression profile of TEM7 in the spinal cord and DRG of adult and developing rats. OVERVIEW OF LITERATURE: Tumor endothelial marker 7 (TEM7) is a putative transmembrane protein that is highly expressed in the tumor endothelium and in cerebellar neurons. METHODS: In the present study, the expression profile of TEM7 in the spinal cord and DRG of the rat was investigated using in situ hybridization and immunohistochemical analysis. In addition, the secreted recombinant ectodomain of TEM7 was employed to label the expression of a putative ligand of TEM7 in the spinal cord and DRG. RESULTS: Specific TEM7 mRNA localization was observed in the motor neurons of the spinal cord and sensory neurons of the DRG. Glial cells and vascular endothelial cells did not show hybridization signals. Immunohistochemical analysis with a specific polyclonal antibody revealed a similar localization profile for TEM7 mRNA expression. In the spinal cord, weak labeling was observed in the gray matter. The TEM7 ectodomain localized the expression of a putative ligand of TEM7 in the neurilemmal structures and perineurium of the spinal nerve roots. In the DRG, ligand labeling was observed in the endoneurium and perineurium of the spinal nerves, and extracellular matrix around the sensory neurons. A developmental study has shown that TEM7 mRNA expression in the motor neurons of the spinal cord and DRG increased with age during postnatal development. Conclusion: These findings indicate that TEM7 plays a role as a transmembrane receptor in neuronal populations of the spinal cord and DRG.
Adult ; Animals ; Diagnosis-Related Groups ; Endothelial Cells ; Endothelium ; Extracellular Matrix ; Ganglia, Spinal* ; Humans ; In Situ Hybridization ; Motor Neurons ; Neuroglia ; Neurons ; Peripheral Nerves ; Rats* ; RNA, Messenger ; Sensory Receptor Cells ; Spinal Cord* ; Spinal Nerve Roots* ; Spinal Nerves

STUDY DESIGN: To determine the capability to predict the clinical manifestations and treatment outcomes of traumatic cervicothoracic cord injury patients based on MR images. OBJECTIVE: To determine the relationship between the differences in MR patterns and signal areas according to Maravilla and Cohen's classification and the PACS system compared with the Frankel classification, in patients that demonstrated neurologic improvement within 1 year. SUMMARY OF LITERATURE REVIEW: MR is the first imaging modality that directly visualizes the extent of spinal cord derangement, and thus, it has the potential to provide an accurate diagnosis of an injury and to determine the prognosis. MATERIALS AND METHODS: MR images were evaluated within 3 days of trauma in 36 spinal cord injury patients. The clinical follow-up period was more than 1 year. Quantitative analysis of spinal cord lesions was performed according to the PACS system. RESULTS: According to Maravilla and Cohen's classification, 36 cases were classified as follows: 8 cases of type I, 10 cases of type II, 9 cases of type III and 9 cases of type IV. There was 1 case of type I, 8 cases of type II, 5 cases of type III, and no cases of type IV, who demonstrated neurologic improvements of more than 1 grade in the Frankel classification. An analysis of the signal areas according to the PACS system demonstrated no cases of areas greater than 100 mm2, 5 cases of areas between 50 to 100 mm2, and 9 cases of areas less than 50 mm2 who demonstrated neurologic improvement. CONCLUSION: Classification according to the differences between MR imaging and MRI signal areas in patients with spinal cord injuries demonstrated the indicators of neurologic improvement; therefore, we MR imaging can be utilized as a prognostic factor in cases of spinal cord injuries.
Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Prognosis* ; Spinal Cord Injuries* ; Spinal Cord* ; Treatment Outcome*