Polyethylene wear is one of the major problems following total knee arthroplasty. Many factors affect the degree and the pattern of polyethylene wear. We experienced three cases of early catastrophic poly- ethylene wears. All cases showed flexion contracture with severe genu varum deformity and total knee arthroplasty was performed with Advantim total knee prostheses in all cases. Postoperatively, bony align- ment and ligament balancing were good in all cases. However, in 12 to 22 months later, lateral subluxa- tion and valgus instability were developed with early catastrophic polyethylene wear especially in the medial compartments. Flat surface geornetry of polyethylene might be responsible for the development of lateral subluxation and early catastrophic wears. From these experience, we concluded that the mediolat- eral as well as anteroposterior dishing is essential for the stability of the artificial joint and prevention of early rapid wear of polyethylene articular inserts following total knee arthroplasty.
Arthroplasty ; Congenital Abnormalities ; Contracture ; Genu Varum ; Joints ; Knee ; Knee Prosthesis ; Ligaments ; Polyethylene*

PURPOSE: To avoid prolonged recovery time and scar tenderness in open carpal tunnel release and possible nerve or tendon injuries by bulky instruments in endoscopic techniques, we tried to percutaneously release the transverse carpal ligament using simple, thin instruments. MATERIALS AND METHODS: We performed carpal tunnel release percutaneously through a single small incision on the wrist with curved mosquito and meniscectomy hook knife under general or regional anesthesia in 41 wrists of 27 patients during the last 5 years and followed up for at least one year. Before and after release, endoscopic examinations were done to rule out space occupying lesions or other anormalies and to confirm complete release. RESULTS: According to the Cseuz's criteria, 38 cases (93%) showed excellent or good results, which was compatible to open or endoscopic technique with special instruments and there was no major neurovascular injury except one superficial palmar arch laceration associated with the second palmar incision in complicated case. CONCLUSIONS: From earlier experience, we learned that this simple technique may be used successfully with low cost without any fear of complication.
Anesthesia, Conduction ; Cicatrix ; Culicidae ; Humans ; Lacerations ; Ligaments ; Tendon Injuries ; Wrist

Schwannomas are benign, slow-growing peripheral nerve sheath tumors commonly occurring in the head, neck, and flexor regions of the extremities. Although most schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. Reporting pathologists should be aware that schwannomas can exhibit a broad spectrum of morphological patterns. Clinical and radiological examinations can show correlation and should be performed, in conjunction with ancillary tests, when appropriate. Furthermore, deferring a definitive diagnosis until excision may be necessary for small biopsy specimens and frozen sections. This report underscores these challenges through examination of two unique schwannoma cases, one predominantly cellular and the other myxoid, both of which posed significant challenges in histological interpretation.

PURPOSE: We evaluated oncologic outcomes of chondrosarcomas and analyzed the disease-free survival rate of chondrosarcomas according to the various factors. MATERIALS AND METHODS: We performed a retrospective study for the disease-free survival rate of 48 chondrosarcomas, 44 of which underwent surgical treatment and followed up more than 18 months since 1993, and in the remaining 4 cases, the patients died before 18 months after surgery. The vsariables were location, tumor volume, histologic grade, stage, age at presentation and treatment performed. The mean follow up period was 43.8 months (1-196 months). RESULTS: The overall disease-free survival rate was 77.1% at mean 43.8 month follow up. The 5 year- and 10 year disease-free survival rates were 64% and 58% respectively. The histologic grade, stage, age at presentation revealed statistical significance on disease-free survival. All 9 patients treated with extended curettage for grade 1 central chondrosarcomas revealed disease-free survival with excellent functional outcome. CONCLUSION: The disease-free survival rate of chondrosarcomas mainly depended on histologic grade, stage and age at presentation. Local recurrence and distant metastasis also revealed statistically significant differences of disease-free survival rate. Comparing to wide resection, extended curettage for low-grade central chondrosarcomas in extremities were efficient methods with similar survival rate and less functional losses and complications.
Chondrosarcoma ; Curettage ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden

An impairment is defined as "a loss, loss of use, or derangement of any body part, organ system or organ function". The impairment evaluation should be performed by physicians. To determine permanent impairment associated with medical condition a standard method should be used. It is a general principle that an evaluation of permanent impairment only be performed when the physician considers the person to have reached a state of maximum medical improvement. Maximum medical improvement is considered when the person's condition has been medically stable and is unlikely to change by more than 3% of whole body impairment within the next 12 months. The physician must use the entire clinical skill and judgment to perform the proper impairment evaluation. A report of the evaluation of permanent impairment should be accurate, comprehensive and fair. The physicians are reminded that they have a duty to act in an ethical, professional and considerate manner when examining the person for the purpose of assessing the permanent impairment.
Clinical Competence ; Humans ; Judgment

PURPOSE: To analyze clinical, radiological and pathological features as well as clinical outcome after surgical treatment of patients with secondary chondrosarcoma arising from osteochondroma(tosis). MATERIALS AND METHODS: We retrospectively reviewed clinical records, radiographs, pathologic slides of 14 patients. Nine patients were male and five were female. The mean age was 34 years. The mean follow-up period was 54 months. RESULTS: All patients had a history of previous mass since childhood or puberty. Preexisted osteochondroma was single in 3 patients and multiple in 10. Remaining 1 patient had multiple osteochondromatosis with enchondromatosis. MRI clearly provided thickness of cartilage cap, which was over 2 cm except in 2 cases. Chondrosarcoma was grade 1 in all except 1 case, which was grade 2. Wide excision was performed in 10 patients, marginal excision in 3 and amputation in 1. Twelve patients were doing very well without evidence of disease. Among 3 patients with marginal excision, 1 patient had local recurrence and 1 patient died of disease. CONCLUSION: Comprehensive understanding of clinical, radiological and pathological features of secondary chondrosarcoma is warranted for accurate diagnosis. The best result can be expected with early recognition of malignant change of osteohcondroma(tosis) and wide excision.
Amputation ; Cartilage ; Chondrosarcoma ; Enchondromatosis ; Female ; Follow-Up Studies ; Humans ; Male ; Osteochondroma ; Osteochondromatosis ; Puberty ; Recurrence ; Retrospective Studies

PURPOSE: To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas. MATERIALS AND METHODS: Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation. RESULTS: The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis. CONCLUSION: Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.
Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Liposarcoma ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Selection Bias

PURPOSE: The purpose of this study was to determine whether the number of distal locking screws affected the final radiologic results after volar plate fixation for distal radius fractures. METHODS: We retrospectively identified 176 patients (male, 36; female, 140; average, 60 years) who had distal radius fractures treated with open reduction and volar plate fixation between 2011 and 2012. The number of screws used for distal fixation was determined according to the surgeon's preference and the type of plate used. Radiologic parameters and their displacements were measured postoperatively and at final follow-up. The results of using 4 or 5 distal locking screws were compared with those of using more than 6 distal locking screws. RESULTS: There was no significant displacement in fracture fragment when using 4 or 5 distal locking screws compared with using more than 6 distal locking screws. Mean displacement in ulnar variance was 0.6 mm in group with less than 5 screws, and the displacement was 0.4 mm in group with more than 6 screws (p=0.772). Secondary displacement was not correlated with fracture type or the number of distal locking screws. There was no fixation failure during the study period. CONCLUSION: It seems that 4 or 5 distal locking screws are strong enough to prevent a significant loss of fracture reduction. Filling every distal screw hole is not recommended to limit cost and avoid extensor tendon complications.
Female ; Follow-Up Studies ; Humans ; Radius Fractures* ; Retrospective Studies ; Tendons ; Palmar Plate*

Fungal endocarditis is a rare disease in infants, but it has been reported with increasing frequency among premature infants requiring neonatal intensive care. Congenital heart disease, pro- longed intravenous catheterization, the use of intravenous alimentation, broad-spectrum antibiotics administration and narcotic addiction are risk factors. Candida endocarditis is an unusual but severe complication of systemic candidiasis. Its occurrence has been related to the placement of a central venous catheter with its tip close to or within the right atrium and persistent candidemia. Embolization to major blood vessels is a common complication of Candida endocarditis and repeated pulmonary emboli are suspected to be cause of the repeated episodes of circulatory shock which finally leads to death. Thus, early diagnosis of Candida invasion and prevention of Candida endocarditis are essential for survival. We report a case of Candida endocarditis which was successfully managed with surgical removal and antifungal therapy. (J Korean Pediatr Soc 2000;43:832 836)
Anti-Bacterial Agents ; Blood Vessels ; Candida* ; Candidemia ; Candidiasis ; Catheterization ; Catheters ; Central Venous Catheters ; Early Diagnosis ; Endocarditis* ; Heart Atria ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Opioid-Related Disorders ; Rare Diseases ; Risk Factors ; Shock ; Tricuspid Valve*

PURPOSE: To evaluate the usefulness of computed tomography(CT) scanning in classification and selection of treatment method for distal radius fractures involving articular surfaces. MATERIALS AND METHODS: Plain radiographs and CT scans of 42 patients with intraarticular distal radius fractures was analysed for type of fractures and surgical indication and then the results were compared. RESULTS: Fracture types were changed in 15 of 42 patients. 10 patients with AO B1, B3, C1 or C2 type fractures were reclassified as C3 type, which suggested that CT scan revealed articular comminution more accurately. According to the assesment of plain radiographs, 16 patient needed surgical treatment. However additional 17(68%) patients were necessary operation on the bases CT scan evaluation. CONCLUSIONS: Evaluation of intraarticular fractures of distal radius using CT scan was useful for fracture classification and selection of treatment methods, which provided an accurate assessment of fracture patterns and reduction status.
Equidae ; Humans ; Intra-Articular Fractures ; Radius ; Radius Fractures