No abstract available.
Knee*

The etiology of spontaneous hemarthrosis of the knee joint in elderly pattents is still unknown. This report discusses seven spontaneous hernarthroses, three that were managed witla conservative measures such as aspiration, rest and knee immobilization because of poor general condition and four in which arthroscopic evaluation and treatment were performed. These patients were elderly indi.viduals without an obvious history of trauma. The roentgenograms of each involved knee demonstrated degenerative osteoarthritic changes of knee joint. Arthroscopic examination revealed denuded articular cartilage and subchondral bone exposure in four operative cases and degenerative meniscal tear in one case of four. These patients underwent mthroscopic debridement and did not experience recurrenees of the hemarthrosis. We think that the origin of the bleeding was most likely from the subchondral cancellous bone which was exposed due to degenerative change of the knee joint and the senile changes of the vessels around the knee joint with aging process may contribute the spontaneous bleeding into the knee joints.
Aged* ; Aging ; Cartilage, Articular ; Debridement ; Hemarthrosis* ; Hemorrhage ; Humans ; Immobilization ; Knee Joint ; Knee*

The goal of fracture treatment is to restore the patient to pre-injury function level. But the outcome assessment after orthopedic interventions has usually focused on physician-defined parameters of technical success, such as fracture union, alignment and range of motion rather than patient function and quality of life. However, the correlation among improvements in these parameters and functional status, psychosocial well being is inconsistent and weak in the elderly. Therefore authors assessed the functional status after surgical intervention of hip fractures in the elderly with functional recovery score(FRS). Independence in basic activities of daily living, in instrumental activities of daily living, in mobility, freedom from pain and intact memory were assessed in 133 hip fractures in the elderly. The hip fractures in the elderly resulted in 24.8% loss of function after the first year. The older the age, the more the loss of function after surgery of hip fractures. The more functional loss was observed in female patients and in patients with poor postoperative radiological results, but statistically insignificant (P>0.05). The more functional loss was observed in patients with underlying medical disease preoperatively and it was statistically significant (P<0.05). We recommend the evaluation of functional status in the elderly after hip fractures.
Activities of Daily Living ; Aged* ; Female ; Freedom ; Hip Fractures* ; Hip* ; Humans ; Memory ; Orthopedics ; Quality of Life ; Range of Motion, Articular

PURPOSE: To evaluate the clinical results of the treatment of the percutaneous Kirschner wire fixation of bony mallet finger using an 18 gauge needle. MATERIALS AND METHODS: From September 2002 to September 2009, we performed closed reduction using an 18 gauge needle and percutaneous fixation with Kirschner wire for 15 cases of bony mallet finger and followed up at least 1 year. The fractures were classified by the Wehbe and Schneider's method. Indications of operative treatment were fractures involving more than 30% of articular surface, fracture fragments displaced more than 3 mm, or subluxation of the distal interphalangeal joint. The results were evaluated by the Crawford criteria. RESULTS: All the fractures united, with an average healing time of 5.3 weeks(4-6 weeks). According to Crawford criteria, 10 cases were excellent, 5 cases were fair at a mean follow-up of 13 months. There were no pin tract infections and migrations of the pin. CONCLUSION: Percutaneous Kirschner wire fixation of mallet finger using an 18 gauge needle is an easy technique which can achieve anatomical reduction and diminish operation-related complications.
Fingers ; Follow-Up Studies ; Joints ; Needles

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the efficiency of undercorrection and transpedicular screw fixation through a posterior approach in osteoporotic spine fractures with a thoracolumbar kyphotic deformity. SUMMARY OF LITERATURE REVIEW: The surgical treatment of osteoporotic spine fractures with a thoracolumbar kyphotic deformity requires extensive surgical procedures to obtain complete restoration of the sagittal alignment, but it has a few technical limitations due to insufficient mechanical stability at the bone-screw interface. A special strategy is essential for transpedicular screw fixation for osteoporotic spine fractures with a thoracolumbar kyphotic deformity. MATERIALS AND METHODS: We reviewed 14 osteoporotic spine fracture cases, with a thoracolumbar kyphotic deformity, which had undergone undercorrection and transpedicular screw fixation through a posterior approach, between March 2000 and June 2003, with an average follow-up period of 15. 2 months. According to the Jikei grade of the osteoporosis, 9 and 5 cases were grades 2 and 3, respectively. As a radiographic assessment, we measured the kyphotic angles of the fused segments on the preoperative, postoperative and last follow up thoracolumbar lateral views on standing using Cobb's method, and also assessed the kyphotic angle correction (KAC). The clinical results were evaluated at the last follow-up. RESULTS: The kyphotic angles at the preoperative, postoperative and last follow-up were 33.5 degrees +/- 9.3, 22.4 degrees +/- 6.9 and 24.7 degrees +/- 6.8, respectively. We obtained a mean KAC gain of 11.1 degrees postoperatively (p<0.05), but a loss of 2.3 degrees at the last follow-up (p>0.05). The clinical results were analyzed as good, fair and poor in 8, 5 and 1 case, respectively. Fusions were achieved in all cases. CONCLUSIONS: Undercorrection and transpedicular screw fixation for a thoracolumbar kyphotic deformity in osteoporotic spine fractures can be one of the alternatives to avoid fixation failure and an extensive surgical procedure.
Congenital Abnormalities* ; Follow-Up Studies ; Kyphosis ; Osteoporosis ; Retrospective Studies ; Spine*

Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys. The overall testicular salvage rate with acute torsion is only 20 to 50 per cent. However, up to 50 percent of the patients with acute torsion have experienced previous episodes of acute testicular pain. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. interspersed with long interval without symptoms. Most males with testicular torsion have aberrant anatomy for the testes to be more susceptible to torsion. Bell-clapper deformity and long mesorchium have been typically described at exploration. On reviewing the medical records. elective orchiopexy was performed on l2 patients under the diagnosis of intermittent testicular torsion during the recent 5 years at Yonsei University Hospital. The features and pathological anatomy of intermittent testicular torsion in these l2 patients are described. Awareness of intermittent testicular torsion as a definite entity and early elective orchiopexy will improve testicular salvage rate.
Adolescent ; Congenital Abnormalities ; Diagnosis ; Humans ; Male ; Medical Records ; Orchiopexy ; Spermatic Cord Torsion* ; Testis

The chondrogenic potential of free autogenous periosteal grafts for osteochondral defects was investigated at the Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine. Five millimeter diameter of circular full-thickness defects were made in patellar groove of both femur in 64 adolescent rabbits and the rectangular periostei, prepared from the proximal tibiae, were placed over the defects of patellar groove and sutured(cambium layer, facing joint surface) and the rabbits were allowed to move actively. A serial gross and histologic examinations of neochondrogenesis were done during 8 weeks. The results were as follows. l. At 2 weeks after operation, neochondrogenesis was hardly seen either in the graft group or in the control group. The defects were partially filled with some fibrous tissue. 2. After 6 weeks of operation, all defects in the graft group(postop 6 weeks and 8 weeks) were filled with hyaline cartilage cells but only 38% (postop 6 weeks) and 44% (postop 8 weeks) of the control group were filled with hyaline cartilage cells. 3. The cartilages, formed at 6 and 8 weeks, were more mature and better than those formed at 4 weeks. 4. The newly formed hyaline cartilage of the graft group filled the defect earlier and were better than those of the control group. 5. The chondrocytes in the newly formed tissue were originated from the cambium layer of periosteal grafts. 6. Free autogenous periosteal grafts can repair a full-thickness defect in a joint surface by producing tissue that resembles articular cartilage grossly and histologically.
Adolescent ; Cambium ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Femur ; Gangwon-do ; Humans ; Hyaline Cartilage ; Joints ; Rabbits ; Tibia ; Transplants

STUDY DESIGN: In this study, 18 patients undergoing posterior lumbar interbody fusion for multilevel lumbar spinal stenosis associated with degenerative scoliosis were reviewed retrospectively. OBJECTIVES: To assess the effectiveness of the cage-instrumented posterior lumbar interbody fusion in multilevel lumbar spinal stenosis associated with degenerative scoliosis. SUMMARY OF LITERATURE REVIEW: Degenerative lumbar scoliosis with the problems of neurogenic claudication, mechanical back pain and spinal deformity present a challenge for treatment. MATERIALS AND METHODS: We reviewed 18 surgical cases of multilevel lumbar spinal stenosis with degenerative scoliosis from March 1995 to April 2000 with an average follow up period of 2.9 years. We assessed the radiographic results of scoliotic angle correction and sagittal angle correction of the maximum curve and fused segment and disc height restoration. Clinical results were evaluated according to the Kirkaldy-Willis criteria. RESULTS: Mean scoliotic angle at preoperative, postoperative and final follow-up (maximum curve/fused segment) was 17.7-6.1-7.3degree /15.0-5.8-6.1degree respectively. Mean sagittal angle corresponding to each period was 12.1-34.1-32.7degree /8.3-27.0-26.0degree respectively. Mean disc height corresponding to each period was 22.9-42.4-40.5% respectively. The clinical result was analyzed as 15 satisfactory (83.3%), 3 fair (16.7%) and no poor. Fusion success was achieved in all patients. There were no serious complications except one case of fusion extension distally and no significant curve progression within follow-up period. CONCLUSIONS: The cage-posterior lumbar interbody fusion in multilevel lumbar spinal stenosis with degenerative scoliosis was effective for correction of scoliotic and sagittal deformity and restoration of disc height with resultant foraminal patency, provided relatively high clinical success and in situ fusion success in all cases even over multiple fusion levels, and can be an alternative among surgical treatments of this complex disease.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spinal Stenosis*

PURPOSE: The purpose of this study is to evaluate the clinical results of retrograde intramedullary fixation of metacarpal shaft fractures using two pre-bent Kirschner wires. MATERIALS AND METHODS: Between March 2006 and May 2008, 19 cases (17 patients) of metacarpal shaft fractures were treated with the retrograde intramedullary Kirschner-wire fixation and followed at least one year. The exclusion criteria were thumb metacarpal fractures, comminuted fractures and irreducible metacarpal spiral shaft fracture by closed manipulation. At final follow up all the cases were assessed with total active motion(TAM), rotational deformity, bony union and angular deformity based on the plain radiographes. RESULTS: At the last follow-up, all cases achieved bony union. Five cases showed less than 5degrees of dorsal angular deformity. The average union period was 6.3 weeks (range, 5-9weeks). Fifteen cases (79%) showed excellent results, four cases good results based on TAM. No case showed rotational deformity. Two cases had skin irritation by distal wire end, which was subsided after wire removal. CONCLUSIONS: In patients with a metacarpal shaft fracture, retrograde intramedullary fixation using two pre-bent K-wires can provide satisfactory clinical results.
Bone Wires ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Comminuted ; Humans ; Skin ; Thumb

PURPOSE: This study was performed to evaluate clinical and radiographical results of treatment of chronic lateral ankle instability with modified Brostrom procedure. MATERIALS AND METHODS: This is a retrospective study of 22 cases in 22 patients treated with modified Brostrom procedure under the diagnosis of chronic lateral ankle instability from May 2000 to August 2004. Average age was 32.3 years. Average follow-up period was 23 months. Preoperative and postoperative radiographs of ankle anteroposterior view, lateral view and varus stress view were analyzed. The clinical evaluation was performed according to the Americal Orthopaedic Foot and Ankle Society scales. RESULTS: After the modified Brostrom procedure, Americal Orthopaedic Foot and Ankle Society scales score was improved by average 28 points. Among the 22 cases, 13 cases were excellent, 3 cases good, 4 cases fair, and 2 cases poor with satisfaction of 73%. Five cases had intermittent ankle pain of whom 3 cases had difficulty during competitive sports activity. Lateral tilting of talus improved by average 5.4 degrees on varus stress view. CONCLUSIONS: The modified Brostrom procedure is one of the most effective methods for treating of chronic lateral ankle instability.
Ankle* ; Diagnosis ; Follow-Up Studies ; Foot ; Humans ; Retrospective Studies ; Sports ; Talus ; Weights and Measures