No abstract available.
Decompression* ; Ossification of Posterior Longitudinal Ligament*

BACKGROUND: Pencil-point needle currently are used for spinal anesthesia because of an alleged lowered incidence of postdural puncture headache. Although the direction of the side hole is one of the important factors that might affect the level and the duration of anesthesia, those data are not readily available. The aim of this study was to assess if the side hole direction of pencil-point needle during hyperbaric tetracaine injection affects the level and the duration of anesthesia. METHODS: We induced spinal anesthesia in 80 young men presenting for elective orthopedic surgery. Patients were allocated randomly with the side hole direction of the 25 gauge pencil-point needle in one of the four directions; cephalad, caudad, left lateral, right lateral. Hyperbaric 0.5% tetracaine 15~17 mg (3 to 3.4 ml) was injected with the speed of 0.75 ml/sec. Maximum sensory block level, time to maximum sensory block level, duration of sensory block (2 segments regression time) were assessed by a blinded observer with the pin-prick test and degree of motor block were measured by Bromage motor scale. Data were analysed using the Kruskal-Wallis test followed by the Mann-Whitney U test and chi-square test as appropriate (SAS v. 6.04). RESULTS: Time to maximum sensory block level was significantly fast in group 'cephalad'. Other values have no statistical differences. Post-spinal headache was observed in one case in group 'caudad'. CONCLUSIONS: Using the pencil-point needle, the time to maximum sensory block level was fast in group cephalad but there were no differences in the maximum sensory block level and the duration of sensory block among the four groups.
Anesthesia ; Anesthesia, Spinal* ; Headache ; Humans ; Incidence ; Male ; Needles* ; Orthopedics ; Post-Dural Puncture Headache ; Tetracaine*

A case of frontal ganglioglioma coexisting with pituitary adenoma is reported. A 37-year-old male presented with chief complaint of headache for 2 months. A neurological examination of the patient revealed no deficit. Brain MRI showed a well enhanced lobulated mass on left frontal lobe and another homogeneously enhanced mass on intrasellar and suprasellar portion. The frontal mass was grayish in color and rubbery hard in consistency on operative field, having relatively good boundary from the adjacent normal brain tissue. The sellar mass was 3X3cm in size and compressed optic chiasm. Histological diagnosis of frontal mass was ganglioglioma and sella mass showed typical features of pituitary adenoma.
Adult ; Brain ; Diagnosis ; Frontal Lobe ; Ganglioglioma* ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Optic Chiasm ; Pituitary Neoplasms*

Cartilage-forming tumors are benign cartilaginous tumors that rarely affect the spinal canal. They account for 2% of all spinal tumors and 2.6% of all benign bone tumors, and involvement of the vertebral column is found in 3-5% of the cases. Pathologically, they may be classified as chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma. This oncotype may remain asymptomatic or may present as a hard paravertebral swelling, or -more rarely- be accompanied by a slowly developing neurologic syndrome. We report the case of a 38 -year- old man in whom pain in the left buttock and left leg developed. Surgery involved a left partial hemilaminectomy and the mass was totally excised.
Buttocks ; Chondroblastoma ; Chondroma ; Fibroma ; Leg ; Osteochondroma* ; Spinal Canal ; Spine*

We reported a girl diagnosed Schinzel-Giedion syndrome with severe psychomotor retardation and malformation that was characterized by mid face retraction, scoliosis, skull anomaly, wide cranial fontanels, brain cortical atropy, atrial septal defect, and hydronephrosis. Urinary tract infection, respiratory tract infection, and seizure were common. The neurodevelopment therapy was not effective and developmental stage was not improved. Spasticity was the only findings which was improved.
Brain ; Cranial Fontanelles ; Female ; Heart Septal Defects, Atrial ; Humans ; Hydronephrosis ; Muscle Spasticity ; Respiratory Tract Infections ; Scoliosis ; Seizures ; Skull ; Urinary Tract Infections

PURPOSE: We wanted to evaluate the results of medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty. MATERIALS AND METHODS: We reviewed 32 cases of medial epicondylar osteotomy for treating varus deformity, and these cases underwent operation from December 2004 to December 2007. The average age of the patients was 71.0-years-old and the average follow-up period was 23.5 months. The clinical outcomes were measured, including the Knee Society score (KSS), the function score (FS) and the range of the motion (ROM). The radiological outcomes were measured by anteroposterior simple radiographs for assessing the union state of the osteotomy site, and the valgus stress radiographs and the whole extremity radiographs were used for assessing the femorotibial angle, the mechanical axis angle and the alignment. RESULTS: The KSS improved from 46.5+/-7.6 to 89.1+/-5.9 points (p<0.001) and the FS increased from 39.5+/-9.2 to 84.2+/-8.5 points (p<0.001). The range of motion increased from 101.5+/-28.2degrees to 116.0+/-10.8degrees (p=0.006). Bony union occurred in 22 knees and fibrous union occurred in 10 knees. The femorotibial angle was corrected from varus 8.2+/-5.0degrees to valgus 5.6+/-1.5degrees (p<0.001) and the mechanical axis angle was revised from varus 13.9+/-4.5degrees to varus 0.7+/-1.6degrees (p<0.001). There were 27 neutral, 4 varus and 1 valgus alignment. On the valgus stress radiographs, the difference compared with the opposite side was 1.0+/-0.6degrees and there was no significant difference between the bony union group and the fibrous union group (p=0.175). CONCLUSION: Medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty could be a useful ligament balancing technique for achieving medial stability of the knee.
Arthroplasty ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Osteotomy ; Range of Motion, Articular

PURPOSE: To evaluate the clinical result of two stage reimplantation of infected total knee arthroplasties, using an antibiotics impregnated articulating cement spacer. MATERIALS AND METHODS: Out of total 7 cases with infected total knee arthroplasties, 4 cases treated with two stage reimplantation, using an antibiotics impregnated articulating cement spacer were included in this study. After the treatment of infected total knee arthroplasties, the treatment of infection was evaluated by physical examination, radiologic studies, and hematologic studies. The results were evaluated using the Hospital for Special Surgery Knee Score (HSS). RESULTS: As results, 4 infected knee cases treated with two stage reimplantation did not have reinfection at the time of the follow up, and physical, laboratory, and radiologic studies were all within normal range. The range of motion of the reimplanted knees were from -5degrees in extension to 130 degrees in flexion, with an average of 117 degrees. The average score of the Hospital for Special Surgery Knee Score was 87. CONCLUSION: In conclusion, two stage arthroplasties, using antibiotics impregnated articulating cement spacer was an effective therapy not only for the treatment of the infection after the total knee arthroplasty but also effectiveness for recovery of the knee function.
Anti-Bacterial Agents* ; Arthroplasty* ; Follow-Up Studies ; Knee* ; Physical Examination ; Range of Motion, Articular ; Reference Values ; Replantation*

BACKGROUND AND OBJECTIVES: For safe sinus surgery, it is essential to understand the anatomical structure and developmental state of the paranasal sinuses. Structural abnormalies such as aplastic and marked hypoplastic sinuses may not be amenable to sinus surgery or balloon sinuplasty. The purpose of this study is to evaluate the degree of pneumatization of the frontal and sphenoid sinuses in Korean adults. SUBJECTS AND METHOD: This retrospective study utilized CT images of 1190 sides from 595 Korean adults. The frontal sinus was classified into normal, hypoplasia, aplasia and unilateral hidden aplasia. The sphenoid sinus was evaluated the incidence regarding the aplasia and unilateral hidden hypoplasia. RESULTS: Bilateral frontal sinus hypoplasia was observed in 8.5% of women and 4.2% of men (p < 0.05), while unilateral frontal sinus hypoplasia was found in 3.5% of women and in 4.8% of men (p>0.05). Bilateral frontal sinus aplasia was observed in 7.1% of women and 2.9% of men (p < 0.05), while unilateral frontal sinus aplasia were found in 7.1% of women and in 5.4% of men (p>0.05). Unilateral hidden frontal sinus aplasia was observed in 1.7% of women and 1.5% of men (p>0.05). There was no bilateral sphenoid sinus aplasia and only one woman had unilateral sphenoid sinus aplasia. Unilateral hidden sphenoid sinus hypoplasia was observed in 1.4% of women and 2.9% of men (p>0.05). CONCLUSION: Bilateral frontal sinus hypoplasia and aplasia are more common in women than in men. Although the incidences of unilateral hidden frontal sinus aplasia and hidden sphenoid sinus hypoplasia are low, sinus surgeons should carefully review CT for sinus surgery or balloon sinuplasty.
Adult* ; Female ; Frontal Sinus ; Humans ; Incidence ; Male ; Methods ; Paranasal Sinuses ; Retrospective Studies ; Sphenoid Sinus* ; Surgeons

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.