PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.
Child ; Cohort Studies ; Femur ; Fibula ; Fractures, Open ; Humans ; Leg ; Lower Extremity* ; Orthopedics ; Prognosis ; Tibia ; Transplants

PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.
Child ; Cohort Studies ; Femur ; Fibula ; Fractures, Open ; Humans ; Leg ; Lower Extremity* ; Orthopedics ; Prognosis ; Tibia ; Transplants

BACKGROUND: We investigated the causes of impingement between the patella bone and the bearing post during high flexion in cruciate-substituting total knee arthroplasty and proposed a treatment strategy. METHODS: This prospective cohort study included 218 cases that had undergone cruciate-substituting total knee arthroplasty from February 2014 to January 2015; a single surgeon performed the operation using the same method without patellar resurfacing in all patients. RESULTS: In these patients, the occurrence of impingement was determined by performing more than 120° high knee flexion after inserting a bearing perioperatively. The incidence of impingement was significantly associated with bearing design, femoral implant size, patella bone length, and patella inferior pole angle (p < 0.05). The impingement was resolved by resection of the lower articular side of the patella bone. CONCLUSIONS: In the cruciate-substituting high-flexion total knee arthroplasty, impingement between the patella bone and bearing post was more common in patients with mobile bearing, small-size femoral component, and a long patella or a large inferior pole angle. In cases of intraoperative impingement between the patella bone and the bearing post, resection in the lower portion of the patella prevented impingement of the bearing with soft tissue or the patella by widening the space between the patella and the bearing post, which in turn prevented postoperative reduction in range of motion.
Arthroplasty* ; Cohort Studies ; Humans ; Incidence ; Knee* ; Patella* ; Prospective Studies ; Range of Motion, Articular

BACKGROUND: We investigated the causes of impingement between the patella bone and the bearing post during high flexion in cruciate-substituting total knee arthroplasty and proposed a treatment strategy. METHODS: This prospective cohort study included 218 cases that had undergone cruciate-substituting total knee arthroplasty from February 2014 to January 2015; a single surgeon performed the operation using the same method without patellar resurfacing in all patients. RESULTS: In these patients, the occurrence of impingement was determined by performing more than 120° high knee flexion after inserting a bearing perioperatively. The incidence of impingement was significantly associated with bearing design, femoral implant size, patella bone length, and patella inferior pole angle (p < 0.05). The impingement was resolved by resection of the lower articular side of the patella bone. CONCLUSIONS: In the cruciate-substituting high-flexion total knee arthroplasty, impingement between the patella bone and bearing post was more common in patients with mobile bearing, small-size femoral component, and a long patella or a large inferior pole angle. In cases of intraoperative impingement between the patella bone and the bearing post, resection in the lower portion of the patella prevented impingement of the bearing with soft tissue or the patella by widening the space between the patella and the bearing post, which in turn prevented postoperative reduction in range of motion.
Arthroplasty* ; Cohort Studies ; Humans ; Incidence ; Knee* ; Patella* ; Prospective Studies ; Range of Motion, Articular

BACKGROUND: We investigated whether the patellar tilt angle influences the maximum knee flexion after total knee arthroplasty (TKA) performed by using a posterior cruciate ligament-substituting (PS) fixed-bearing prosthesis in patients with relatively loose or tight flexion gap. METHODS: In this prospective cohort study, we followed up 169 patients for at least 2 years after TKA using PS fixed-bearing prosthesis. The patients were divided into two groups according to the flexion gap value—calculated by subtracting the thickness of the final bearing from the flexion gap measured intraoperatively under 200-cN·m force after patellar reduction and insertion of the final femoral and tibial components—into a relatively tight group (group T; 3–6.5 mm) and a relatively loose group (group L; 7–11 mm). Patellar tilt angles and maximum non–weight-bearing active knee flexion angles were assessed postoperatively. Group T was further divided into subgroup Tn if the patellar tilt angle was < 5° and subgroup Tw if the angle was ≥ 5°. Pearson correlation test was used for the correlation analysis of the flexion gap, patellar tilt angle, and postoperative flexion range. RESULTS: The mean postoperative flexion was 137.3° in group T and 137.5° in group L. The mean patellar tilt angle was 6.5° in group T and 6.9° in group L. In group T, a strong negative correlation (r = −0.78, p < 0.05) was observed between the patellar tilt and postoperative flexion range. However, further analysis revealed that only the subgroup Tw showed a strong negative correlation (r = −0.76, p < 0.05). Significant correlations were not found in the subgroup Tn and group L. CONCLUSIONS: In TKA where a relatively tight flexion gap (≤ 6.5 mm) is created because of concerns about postoperative flexion instability due to a loose flexion gap, the patellar tilt angle should be < 5° for maximal postoperative knee flexion.
Arthroplasty, Replacement, Knee ; Cohort Studies ; Humans ; Knee ; Prospective Studies ; Prostheses and Implants ; Range of Motion, Articular

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.
Anesthesia, General ; Calcium Hydroxide* ; Calcium* ; Debridement ; Female ; Humans ; Mandibular Nerve* ; Molar ; Neuroma ; Osteotomy ; Paresthesia ; Prognosis

PURPOSE: Increasing use of computer aided design-computer aided manufacturing (CAD-CAM) system and number of design software made design of restoration easy and quick. Outcome of restoration has been dependent on dental technician's wax up proficiency, dentists can design restoration for themselves now. This study aims to investigate the outcome of restoration designs, according to handling skill of CAD-CAM design tool. MATERIALS AND METHODS: A patient's mandibular right 1st molar was prepared. After taking impression, stone model was made, scanned the stone model with 3 shape intra-oral scanner, stereolithography (STL) file was extracted. With 3shape dental designer, one dental technician with more than 5 years work experience (designer 0) and three dental technicians with less than 2years work experience (designer 1, 2, 3-group DT) and 4 1st year residents (designer 4, 5, 6, 7-group RT) designed gold crown on the same STL file. Designed crown's MD (mesio-distal) and BL (bucco-lingual) diameter, height of crown, inter-cuspal distance, number of occlusal contact points were compared. Statistical analysis was carried out, test of normality within each group, using independent t-test. Number of contact points were compared, using Wilcoxon signed-rank test. RESULTS: There was no significant difference between group DT and group RT. Number of contact points also resulted in no significant difference. CONCLUSION: The outcome of each designed crowns showed no statistical differences, in values which can be expressed as numbers. Subjective factors were different. With increasing proficiency in handling designing software, fabrication of restorations according to each designer's occlusal concept can be made easy.
Computer-Aided Design* ; Crowns* ; Dental Technicians ; Dentists ; Humans ; Molar ; Occupational Groups*

OBJECTIVES: Delirium is commonly seen in clinical settings, and it can substantially influence the prognosis of patients. In this study, we investigated delirium with respect to its severity, classification and characteristics on each subtype. METHODS: Severity of delirium was examined in delirium patients, who were referred to the department of psychiatry in a general hospital for multidisciplinary treatment. After classification based on subtypes, factors influencing these aspects of delirium were examined. RESULTS: Among the 193 consultation-liaison patients referred to the department of psychiatry in a general hospital, 61 patients (31.6%) were diagnosed with delirium. Compared to patients in the non-delirium group, patients in the delirium group were older, had a shorter education period, and medical history of surgery. Among the delirium patients, the hyperactive subtype was found to be the most common (57.4%) and patients with the mixed subtype showed the highest severity score for delirium symptoms. In addition, the patient with the hypoactive subtype had a higher frequency of medical history of depression compared to those with the other subtypes. CONCLUSION: People with symptoms of hypoactive delirium can be misdiagnosed due to recurrence of depression, therefore, careful examination is required, particularly in patients with a history of depression.
Classification ; Delirium* ; Depression ; Education ; Hospitals, General ; Humans ; Prognosis ; Recurrence

Secondary aneurysmal bone cysts (ABCs) associated with Langerhans cell histiocytosis are rare. Although cases of ABCs arising from Langerhans cell histiocytosis in the skull have been reported in several studies, to the best of our knowledge, only two femur cases have been reported. In this case study, we described a 9-year-old boy with Langerhans cell histiocytosis of the femur. Magnetic resonance findings indicated internal multilocular cysts and multiple fluid–fluid levels, which are typical of ABCs. ABCs rarely occur in conjunction with Langerhans cell histiocytosis. Our findings may be helpful in the differential radiological diagnosis of pediatric bone tumors.

Lithium is the drug of choice for treating bipolar affective disorders. However, it has a narrow therapeutic index and acute and chronic toxicity can occur in patients with chronic ingestion. Chronic toxicity commonly presents as nephrogenic diabetes insipidus or thyroid dysfunction. Neurologic symptoms such as apathy, hyperreflexia, or clonus can also occur in acute toxicity. However, it rarely causes peripheral neuropathy. We experienced a case of lithium-induced peripheral polyneuropathy who had already nephrogenic diabetes insipidus and chronic kidney disease during 25 years of lithium ingestion due to bipolar disorder.
Apathy ; Bipolar Disorder ; Diabetes Insipidus ; Diabetes Insipidus, Nephrogenic* ; Eating ; Humans ; Lithium ; Mood Disorders ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Polyneuropathies* ; Reflex, Abnormal ; Renal Insufficiency, Chronic ; Thyroid Gland ; Upper Extremity*