One hundred and ninety-four consecutive patients with two hundred and one diaphyseal femur fractures were retrospectively reviewed to evaluate the frequencies, types and the results of treatments for the associated ipsilateral knee ligaments and menisci injuries from Oct. 1990 to Feb. 1997 at Eulji Medical Center. Fifteen patients had associated ipsilateral knee ligament injuries. There were eleven(73.3%) males and four(26.7%) females with an average age of 35.7(17-68) years. Thirteen(86.7%) patients were injured by traffic accident. Ten patients were followed for average of 38 months(12-73 months). There were five(33.4%) partial and two(13.3%) complete tears of anterior cruciate ligaments, three(20.0%) partial and four(26.7%) complete tears of posterior cruciate ligaments, one(6.7%) partial and four(26.7%) complete tears of medial collateral ligaments, one(6.7%) complete and three(20.0%) partial tears of lateral collateral ligaments, five(33.3%) tears of medial menisci and four(26.7%) tears of lateral menisci. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Better range of knee motion and HSS knee score was obtained when both the femur and ligament injuries were surgically managed. The invention of the MRI and the development of arthroscopic techniques have made it easy to diagnose and take care for ligament injuries. Early diagnosis and proper treatment on ruptured ligaments and tom meniscus combined with diaphyseal femur fractures seem to be important for good prognosis.
Accidents, Traffic ; Anterior Cruciate Ligament ; Collateral Ligaments ; Early Diagnosis ; Female ; Femoral Fractures* ; Femur ; Humans ; Inventions ; Knee* ; Lateral Ligament, Ankle ; Ligaments* ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prognosis ; Retrospective Studies

STUDY DESIGN: This is a review of the literature about radiographic positioning for patients with sagittal imbalance. OBJECTIVES: We wanted to verify the optimal radiographic positioning for patients with sagittal imbalance. SUMMARY OF LITERATURE REVIEW: The standing lateral whole spine radiograph for identifying the sagittal alignment has a different value for the SVA according to the radiographic positioning. MATERIALS AND METHODS: This is a review of the literature. RESULTS: The fists-on-the clavicle position or the cross-arm position not only represents a functional standing position, but it also causes a less negative shift of the SVA in patients with sagittal imbalance. Both the extended hip and knee positions are necessary to exclude a compensation mechanism of the lower extremity. CONCLUSIONS: The optimal radiographic positioning is essential to examine the degrees of sagittal imbalance.
Clavicle ; Compensation and Redress ; Hip ; Humans ; Knee ; Spine

Fractures, Compression

Demand for surgical management of adult spine deformity has increased due to a recent increase in the elder population, development of surgical techniques, and increased desire for a better quality of life. More surgeries led to more and various complications. Complications of surgery for adult spine deformity have been reported from 37% to 53% depending on the types of disease, cause, and patient. This rate is higher than complications from general spine surgeries. Complications of surgery for adult spine deformity include; infection, excessive bleeding, nerve injury, pseudarthrosis, adjacent segment disease, and iliac screw complication. Factors influencing these complications include; old age, diabetes, steroid use, and osteoporosis. Proximal junctional kyphosis (PJK) is an abnormal kyphosis at the proximal level of the instrument after spine deformity surgery. Risk factors for PJK include; injury of paravertebral muscles and posterior ligament complex, over- and under-correction of coronal sagittal imbalance, age older than 55 years, and osteoporosis. There is a high risk of unexpected complications during surgery for adult spine deformity. Patients with degenerative spine sagittal imbalance are more prevalent in Korea than in Western countries. They tend to be old, have underlying diseases and osteoporosis, making them susceptible to complications related to instrumentation. Postoperative satisfaction tends to be low thus surgeons need to take care when selecting surgical methods and fusion level.
Adult* ; Congenital Abnormalities* ; Hemorrhage ; Humans ; Korea ; Kyphosis ; Ligaments ; Muscles ; Osteoporosis ; Pseudarthrosis ; Quality of Life ; Risk Factors* ; Spine*

Particulate wear debris(polyethylene, polymethylmethacrylate and metal particles, or combination of these) can initiate aseptic loosening. To eliminate polyethylene debris and reduce the total amount of wear, metal on metal bearings(Metasul) which were made of a wrought Co-28Cr-6Mo-0.2C alloy, were introduced. From May 1994 total hip replacements using a Metasul metal on metal articulation were performed by the authors. 34 patients with 40 hips with minimum follow-ups during 24 months were analysed in this study. The mean follow up period was 31 months(ranging from 24 to 47 months). We used Armor cups and standard cups as acetabular comporients and SL stems, CLS stems and cone stems as femoral components. Preoperative average Harris hip score of 48 points became postoperatively 93(from minimum 81 to maximum 100). And there were slight and occasional thigh pains in 2 cases(5%). There were no revisions for the early aseptic loosening of femoral stems or stem failures. Radiologic evaluation which revealed mild calcar atrophy was developed in 33 cases(82.5%), revealing cortical hypertrophy in 10 cases(25%). Osteolysis was not noted around the prosthetic stem nor around the cup. Radiolucent lines were found in 9 cases of femoral components(22.5%) and in 1 case of acetabular component(2.5%) and subsidence of more than 3mm in 1 case of femoral components(2.5%) were also found. There was 1 case of definitive loosening of acetabular component(2.5%). These also showed that endosteal bone formation adjacent to femoral prosthesis was developed in 22 cases(55%) but no distal pedestal and stem shift occurred. The short-term but satisfactory results of the contemporary metal on metal articulation investigated in this study were encouraging and warrant continued study.
Acetabulum ; Alloys ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Atrophy ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Osteogenesis ; Osteolysis ; Polyethylene ; Polymethyl Methacrylate ; Prostheses and Implants ; Thigh

STUDY DESIGN: A retrospective study was performed in patients with one level cervical disc herniation who had undergone anterior discectomy and fusion with or without plate fixation. OBJECTIVES: This study was performed in order to analysis the result of anterior discectomy and fusion, and to assess the benefits of the supplemental anterior cervical plate in the treatment of one level cervical disc herniation. MATERIALS AND METHODS: 35 surgically treated patients for one level disc herniation were reviewed. The Smith Robinson with autologous iliac crest bone graft was performed in both groups. Group A consisted of 14 patients who had supplemental anterior cervical fixation performed. Group B consisted of 21 patients treated without plate fixation. Radiologic parameters included the bone union and changes of intervertebral space. Clinical results were classified using the criteria of Robinson. RESULTS: In radiologic analysis, decreases in intervertebral space were common in group B, especially in older than 61 years old age group, and the bone union time was same in both groups. The overall clinical success rate was 86% in group A and 90% in group B. This difference between group A and group B is not significant. CONCLUSIONS: When selectively used in osteoporotic patient, supplemental anterior cervical plate fixation allows an early return to activities of daily living for patients and prevent deformities in graft bone. However, further studies are needed to confirm this result. Although many advantages of anterior plate stabilization have been previously reported, the plate osteosynthesis after one level fusion for radiculopathy was not thought to be a major advantage.
Activities of Daily Living ; Congenital Abnormalities ; Diskectomy* ; Humans ; Middle Aged ; Radiculopathy ; Retrospective Studies ; Transplants

PURPOSE: To estimate the prognosis of surgical treatment through the comparative analysis of patients who had reoperation for failed lumbar disc surgery space (FLDS). MATERIALS AND METHODS: 31 patients who had a surgical operation for sciatica due to recurrent disc herniation or fibrous tissue adhesion were analyzed. Clinical features and surgical results of both groups were evaluated. RESULTS: In clinical analysis, a positive SLR test of less than 40, pain upon coughing, and a reduced walking capacity were common in recurrent herniation. Satisfactory postoperative results were achieved in 12 cases (80%) of the recurrent disc herniation group, 2 cases (50%) of the diffuse type and in 8 cases (67%) of the focal type of fibrous tissue adhesion group. CONCLUSION: In term of clinical signs, the SLR test is one of the most important factors in differentiating the preoperative cause of FLDS. Although them was no difference in the statistics, the surgical outcome in patients with focal root compression is more satisfactory than in the diffuse type in the fibrous tissue adhesion group.
Cough ; Humans ; Prognosis ; Reoperation ; Sciatica ; Tissue Adhesions ; Walking

STUDY DESIGN: Literature review. OBJECTIVE: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine. SUMMARY OF LITERATURE REVIEW: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. MATERIALS AND METHODS: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. RESULTS: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. CONCLUSIONS: Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.
Fluoroscopy ; Injections, Intra-Articular ; Ligaments ; Methods ; Muscles ; Posture ; Radiation Exposure ; Sacroiliac Joint ; Spine ; Ultrasonography ; Zygapophyseal Joint

OBJECTIVE: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine.SUMMARY OF LITERATURE REVIEW: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. MATERIALS AND METHODS: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. RESULTS: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. CONCLUSIONS Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.

A 24-year-old male patient was initially evaluated for persistent back pain. The visual analogue scale (VAS) score was 7 points. Physical examination revealed a decreased range of lumbar spinal motion, which caused pain. Simple X-ray revealed Meyerding grade 1 spondylolisthesis at L4 on L5, with mild dome-shaped superior endplate and consecutive multilevel spondylolysis at T12-L5. Standing anteroposterior and lateral views of the entire spine revealed normal balance of sagittal and coronal alignment. A computed tomography scan revealed bilateral spondylolysis at T12-L4, left unilateral spondylolysis at L5, and spina bifida at L5 to sacral region. Magnetic resonance imaging revealed mild dural ectasia at the lumbar region. Due to the absence of any neurological symptoms, the patient was managed conservatively. He was rested a few weeks with corset brace and physiotherapy. After treatment, his back pain improved, VAS score changed from 7 to 2, and he was able to return to normal activity.
Adult ; Back Pain/etiology ; Humans ; *Lumbar Vertebrae/pathology/radiography ; Magnetic Resonance Imaging ; Male ; *Spinal Dysraphism ; *Spondylolisthesis/pathology/radiography ; *Spondylolysis/pathology/radiography ; *Thoracic Vertebrae/pathology/radiography ; Young Adult