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.

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*

The Formosan sika deer (Cervus nippon taiouanus) is an endemic subspecies in Taiwan. The original wild deer has been extinct since the late 1960s. The largest captive population is located at the Taipei Zoo. Except for infectious disease outbreaks, no systemic medical research has been reported for this subspecies. This study was conducted to analyze the medical status of the captive Formosan sika deer population, including the hematological and serum chemistry characteristics. To accomplish this, medical records for 34 Formosan sika deer from January 2003 to January 2014 were acquired and analyzed. The most common illness and cause of death was trauma, followed by gastrointestinal and respiratory disease, respectively. The hematologic and serum chemical values of healthy adults were quite different from those of sika deer (Cervus nippon yesoensis). This study provides a closer medical understanding of this subspecies and the results will facilitate its management.
Adult ; Cause of Death ; Chemistry ; Deer* ; Disease Outbreaks ; Gastrointestinal Diseases ; Humans ; Medical Records ; Retrospective Studies* ; Taiwan

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

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

STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to analyze the treatment outcome and the risk factors for adjacent segment disease after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Biomechanical alterations likely play a primary role in causing adjacent segment disease. Radiographically apparent, asymptomatic adjacent segment disease is common after lumbar fusion, but this does not correlate with the functional outcomes. MATERIALS AND METHODS: We reviewed 544 patients who underwent lumbar fusion at a minimum of 5-year follow-up between March 1993 and August 2006. Risk factors analysis was performed for 48 of 544 patients with adjacent segment disease and who were needed a second operation, and the treatment outcomes were assessed for 46 patients with a minimum 1-year follow-up after the second operation. The average interval to the second operation was 4.5 years, and the average follow-up after the second operation was 34.5 months. The treatment outcome was assessed by using the modified Brodsky criteria and the reoperation rate was assessed in relation to several risk factors. RESULTS: Excellent and good operative results were obtained in 29 cases (63%) and bony fusion was achieved in 41 cases (89%). Of the risk factors we examined, multi-level fusion, a high grade of initial radiographic degeneration, the loss of physiologic lumbar lordosis and the involvement of degenerative scoliosis were associated with a high reoperation rate, with statistical significance. Age, gender, the initial diagnosis, the upper placement of the proximal screws and the extent to the sacrum were not correlated with the reoperation rate. CONCLUSION: The treatment outcome was relatively satisfactory; however, the factors influencing the treatment outcome of the second operation still need to be considered. The fusion level, the initial radiographic degeneration, the preservation of lumbar lordosis and the involvement of degenerative scoliosis are considered to be risk factors for the failure of lumbar fusion.
Animals ; Follow-Up Studies ; Humans ; Lordosis ; Reoperation ; Retrospective Studies ; Risk Factors ; Sacrum ; Scoliosis ; Treatment Outcome

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the complications, clinical outcome and any correlative risk factors of degenerative spinal deformity surgery in elderly patients. SUMMARY OF LITERATURE REVIEW: There is some controversy regarding the postoperative complications and the factors influencing them in the elderly patients who had undergone degenerative spinal deformity surgery. MATERIALS AND METHODS: Seventy eight patients, who underwent posterior decompression and posterolateral fusion requiring a minimum 3 level fusion for a degenerative spinal deformity associated with spinal stenosis between May, 2001 and May, 2006, were reviewed after a follow-up period of at least 1 year. This study compared the postoperative complications and clinical outcomes of patients over 65 years (group A) with patients between 50~64 years (group B). The risk factors that could influence the complications and clinical outcomes were evaluated and analyzed statistically. RESULTS: The postoperative complication rate was 53% in group A and 40% in group B without statistical significance. However, group A had a significantly higher frequency of minor complications than group B, particularly in urinary retention and postoperative delirium. There was an association between diabetes and deep wound infection as a major complication in groups A and B. Being male was a risk factor for urinary retention and longer surgery time, and abundant blood loss was significant risk factors for postoperative delirium in group A. CONCLUSION: There were no significant differences in the treatment result for degenerative spinal deformity between patients older than 65 and younger than 65. It is considered that the blood sugar should be controlled strictly before and after surgery, and appropriate management is needed for postoperative delirium and urinary retention in elderly patients.
Aged ; Blood Glucose ; Congenital Abnormalities ; Decompression ; Delirium ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Treatment Outcome ; Urinary Retention ; Wound Infection