BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.
Arthrography* ; Dislocations ; Follow-Up Studies ; Humans ; Incidence ; Joint Instability ; Recurrence ; Retrospective Studies ; Shoulder*

OBJECTIVE: To investigate the clinical results of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of the rheumatoid arthritis, using the fixation method with 2 crossed screws. METHODS: 19 cases of the rheumatoid hallux valgus deformity were tried to treat with the first metatarsophalangeal arthrodesis, using 2 crossed screws. The follow-up period was averaged in 16 months. The subjective and objective findings were evaluated. Radiologically measurements for the hallux valgus angle, 1, 2 intermetatarsal angle and dorsiflexion angle were measured. RESULTS: Cases, of which the first metatarsophalangeal joint successfully fixated with 2 crossed screws, were 14 (73.7%). 5 failed fixations with 2 crossed screws due to breakage of the cortical bone were immediately refixed with fixation methods (the dorsal plating for three cases, additional K-wire fixation for one, and threaded Steinmann pins fixation for one case). After the arthrodesis of the first metatarsophalangeal joint, the subjective signs in pain, function and alignment were improved as all above fair grade. The radiological fusion was observed at average 8 weeks after the operation in all cases. The hallux valgus angle and 1, 2 intermetatarsal angle were reduced from 45.6+/-7.5degrees and 16.2+/-5.2degrees to 14.2+/-2.0degrees and 10.9+/-2.5degrees respectively. The dorsiflexion angle was measured in 20.5+/-2.2degrees after the fusion. CONCLUSION: To correct the rheumatoid hallux valgus deformity, the arthrodesis of the first metatarsophalangeal joint with 2 crossed screws is a method for the satisfactory results, once the fixation is achieved. However, other fixation procedures should be prepared in case of the failed fixation, which could be happened intraoperatively.
Arthritis, Rheumatoid ; Arthrodesis* ; Congenital Abnormalities ; Follow-Up Studies ; Hallux Valgus* ; Hallux* ; Metatarsophalangeal Joint*

The traditional drug for anticoagulation in those with a high risk of thrombosis is a vitamin K antagonist, such as warfarin. On the other hand, this drug has several limitations and hemorrhagic complications. Recently, novel or non-vitamin K-dependent antagonist oral anticoagulants (NOACs) have been developed to solve these problems. This paper presents a case of adaptation of NOAC for a warfarin anticoagulated patient with traumatic ongoing hemorrhages with a discussion of the clinical implications of NOAC.
Anticoagulants* ; Hand ; Hemorrhage* ; Humans ; Thrombosis ; Vitamin K ; Warfarin*

Objective: This study aimed to determine the serum Dickkopf 1 (DKK1) levels in ankylosing spondylitis (AS) patients and decipher the mechanism of tumor necrosis factor (TNF)-mediated DKK1 regulation in human AS enthesis cells. Methods: The sera were obtained from 103 patients with AS and 30 healthy controls (HCs). The enthesis of facet joints were obtained from 4 AS patients and 5 controls. The serum levels of DKK1 were measured using ELISA and compared between AS and HCs. The impact of TNF on DKK1 expression in human primary spinal enthesis cells was evaluated using various molecular biology techniques and bone formation indicators. Results: AS patients showed higher serum DKK1 levels than HCs after adjusting for age (917.4 [615.3∼1,310.0] pg/mL vs. 826.2 [670.3∼927.8] pg/mL, p=0.043). TNF treatment promoted bone formation and DKK1 expression in both control enthesis cells and those of AS. This enhanced bone formation by TNF was pronounced in AS-enthesis than those of controls. Mechanically, TNF induced NF-κB activation upregulates the DKK1 transcript level. While, NF-κB inhibitor led to downregulate DKK1 expression in the enthesis. Besides, DKK1 overexpression promoted bone formation in enthesis. Conclusion TNF induced DKK1 expression in the enthesis through NF-κB activation. TNF-induced DKK1 expression may play a bone formation in the radiologic progression of ankylosing spondylitis.

Purpose: This study examined the risk factors contributing to subsequent hip fractures in patients with osteoporotic hip fractures. Materials and Methods: Between March 2008 and February 2016, 68 patients sustained a subsequent contralateral hip fracture after surgery for a primary osteoporotic hip fracture (Study group). The patients were compared with 475 patients who had been followed up for a minimum of one year with a unilateral osteoporotic hip fracture (Control group). The demographic data, bone mineral density (BMD), osteoporosis medication, osteoporotic fracture history, comorbid disease, type of surgery, preoperative, postoperative ambulatory capacity, and postoperative delirium in the two groups were compared. Results: The demographic data, BMD, osteoporosis medication history, comorbid disease, type of surgery, and postoperative delirium were similar in the two groups. At three months after the primary surgery, the poor ambulatory capacity was significantly higher in the study group than the control group (p<0.001). Conclusion The ambulatory capacity after primary surgery is an important risk factor in the occurrence of subsequent hip fractures after osteoporotic hip fracture. Cause analysis regarding the poor ambulatory capacity after surgery will be necessary, and the development of a functional recovery program and careful management of the walking ability recovery will be needed.

The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.
Abdominal Pain ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colostomy ; Compressed Air ; Diagnosis ; Dust ; Humans ; Laparotomy ; Male ; Middle Aged ; Prognosis ; Rectum ; Tears

PURPOSE: To determine the priority for the instrumental development of Total knee replacement arthroplasty(TKA) by assessment of patient interviews after TKA in Korea. MATERIALS AND METHODS: We assessed the responses of 168 patients with primary TKA a minimum of one year after surgery. In order not to limit their choices by using a survey, interviewees responded to two open-ended questions, "What was the best result achieved after TKA?" and "What was the result you most wished for but was not achieved after TKA?" RESULTS: All the patients expressed satisfaction with TKA except for 12 patients (7.1%) and for the question of the best result after TKA, 118 patients (70.2%) pointed out that pain relief was the most satisfactory. For the question of the most wished for function still to be restored after TKA, 59 patients (35.1%) answered "No inconvenience and no need" and the greatest proportion among the others who had a wish, 61 patients (36.3%) pointed to discomfort related to the degree of knee flexion with the response "Not easy to stand from the ground and to have deep knee flexion". The average knee flexion degree was 120.7degrees in the group who had a wish related to knee flexion but 127.5degrees in the "No need" group, and the difference was significant (P=0.004). CONCLUSION: Although there was a 93% satisfaction rate after TKA, the remaining function most wished for after TKA was to stand up from the ground easily, which is related to knee flexion degree. Therefore, we propose that the improvement of knee flexion after TKA should be the priority for instrumental development in Korea.
Arthroplasty, Replacement, Knee ; Surveys and Questionnaires* ; Humans ; Knee ; Korea ; Patient Satisfaction* ; Rehabilitation*

Artificial intelligence is a concept that includes machine learning and artificial neural networks and is characterized by the rapid analysis of large-scale data based on fast computation of computers. Various medical studies have been reported to estimate the diagnosis and prognosis of specific diseases using artificial intelligence technology. Recently, many medical studies using a convolutional neural network, which is particularly useful for imaging recognition and analysis, have been reported. For various diseases in orthopedic surgery, including spinal diseases, imaging data, such as simple radiographs, computed tomography, and magnetic resonance imaging, are essential for determining the diagnosis and treatment of patients. Therefore, compared to other fields of medicine, there are many disease entities where artificial intelligence can be applied to the diagnosis and treatment of orthopedic diseases. With the increasing importance of medical informatics, the introduction of artificial intelligence by orthopedic surgeons will positively contribute to the development of medicine. This review outlines artificial intelligence and introduces studies using machine learning to diagnose and predict spinal diseases.

Objective: This study aimed to determine the serum Dickkopf 1 (DKK1) levels in ankylosing spondylitis (AS) patients and decipher the mechanism of tumor necrosis factor (TNF)-mediated DKK1 regulation in human AS enthesis cells. Methods: The sera were obtained from 103 patients with AS and 30 healthy controls (HCs). The enthesis of facet joints were obtained from 4 AS patients and 5 controls. The serum levels of DKK1 were measured using ELISA and compared between AS and HCs. The impact of TNF on DKK1 expression in human primary spinal enthesis cells was evaluated using various molecular biology techniques and bone formation indicators. Results: AS patients showed higher serum DKK1 levels than HCs after adjusting for age (917.4 [615.3∼1,310.0] pg/mL vs. 826.2 [670.3∼927.8] pg/mL, p=0.043). TNF treatment promoted bone formation and DKK1 expression in both control enthesis cells and those of AS. This enhanced bone formation by TNF was pronounced in AS-enthesis than those of controls. Mechanically, TNF induced NF-κB activation upregulates the DKK1 transcript level. While, NF-κB inhibitor led to downregulate DKK1 expression in the enthesis. Besides, DKK1 overexpression promoted bone formation in enthesis. Conclusion TNF induced DKK1 expression in the enthesis through NF-κB activation. TNF-induced DKK1 expression may play a bone formation in the radiologic progression of ankylosing spondylitis.

Purpose: This study examined the risk factors contributing to subsequent hip fractures in patients with osteoporotic hip fractures. Materials and Methods: Between March 2008 and February 2016, 68 patients sustained a subsequent contralateral hip fracture after surgery for a primary osteoporotic hip fracture (Study group). The patients were compared with 475 patients who had been followed up for a minimum of one year with a unilateral osteoporotic hip fracture (Control group). The demographic data, bone mineral density (BMD), osteoporosis medication, osteoporotic fracture history, comorbid disease, type of surgery, preoperative, postoperative ambulatory capacity, and postoperative delirium in the two groups were compared. Results: The demographic data, BMD, osteoporosis medication history, comorbid disease, type of surgery, and postoperative delirium were similar in the two groups. At three months after the primary surgery, the poor ambulatory capacity was significantly higher in the study group than the control group (p<0.001). Conclusion The ambulatory capacity after primary surgery is an important risk factor in the occurrence of subsequent hip fractures after osteoporotic hip fracture. Cause analysis regarding the poor ambulatory capacity after surgery will be necessary, and the development of a functional recovery program and careful management of the walking ability recovery will be needed.