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

Piriformis fossa is chosen for the entry point of the intramedullary nail insertion for the broken femoral shaft. To evaluate the correct entry point selection, the use of the usual operation table and short skin incision, we tried the percutaneous interlocking intramedullary nailing with retrograde guide wire insertion technique. The guide wire is inserted through the short skin incision on the anterior thigh and comes out through piriformis fossa easily. Through over the guide wire the femoral nail was inserted with only short skin incision. And the trick makes no difference except the convenience compared with the antegrade guide wire insertion technique. It is considered as a useful tip of the intramedullary nailing of the femoral shaft fracture.
Femur ; Fracture Fixation, Intramedullary* ; Operating Tables ; Skin ; Thigh

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

STUDY DESIGN: The preoperative and postoperative lateral radiograms and clinical results were analyzed in 22 cases of lumbar spinal stenosis with osteoporosis treated by posterior decompression and posterior lumbar interbody fusion. OBJECTIVES: To assess the efficiency of the cage-instrumented posterior lumbar interbody fusion in lumbar spinal stenosis with osteoporosis. SUMMARY OF LITERATURE REVIEW: Problems in surgical treatment of osteoporotic spinal stenosis were early screw loosening and early reversal to the original deformity because of insufficient mechanical stability in the bone-screw interface, and special strategy is essential for transpedicle screwing to sustain axial and screw cut-up load applied by flexion-extension motion in vivo. MATERIALS AND METHODS: We reviewed 22 cases of lumbar spinal stenosis with osteoporosis(Jikei grade I, II/III) from June 1996 to July 1998 with an average follow up period of 1.4 years. Inclusion criteria was combined segmental instability, deformity, spondylolisthesis and herniated nucleus pulposus with significant disc space narrowing. We asssessed the radiographic results of sagittal angle correction(SAC) of the instrumented segment and disc height restoration(DHR) on the preoperative, postoperative and last follow up lumbar lateral views, and clinical results according to the Kirkaldy-Willis criteria. RESULTS: Postoperative mean SAC gain was 10degree(p<0.05) and mean SAC loss at last follow up was 1.1degree(p>0.05). Postoperative mean DHR gain was 21.3%(p<0.05) and mean SAC loss at last follow up was 3.9%(p>0.05). The clinical result was analyzed as 2 excellent(9.1%), 16 good(72.7%), 4 fair(18.2%) and no poor. There were 2 intraoperative complications of a dural tear and a nerve root injury and 2 postoperative complications of a transient radiculopathy and a pseudoarthrosis. CONCLUSIONS: Cage-instrumented posterior lumbar interbody fusion can be an option for the lumbar spinal stenosis with osteoporosis requiring instrumentation because of instability, deformity or postdiscectomy anterior column deficiency.
Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Intraoperative Complications ; Osteoporosis* ; Postoperative Complications ; Pseudarthrosis ; Radiculopathy ; Spinal Stenosis* ; Spondylolisthesis ; Tears