PURPOSE: The purpose of this study is to evaluate the effectiveness of low-dose gabapentin for interdigital neuroma. MATERIALS AND METHODS: Between April 2000 and June 2003, 32 patients (39 feet) with interdigital neuroma were treated with using low-dose gabapentin. Two of the 32 patients were male, and thirty were female, and the average age was 47.4 years. The follow-up was 6 to 44months (mean 15.1 months). All cases were diagnosed by physical examination and ultrasonography or MRI. Low-dose gabapentin (300-600 mg) was prescribed and shoe modification was recommended. The patients were evaluated through questionnaire. RESULTS: Neuroma was found in twenty one cases at the third intermetatarsal space, and thirteen at the second intermetatarsal space. The sensitivity of ultrasonography was 96% and that of MRI was 79%. Overall satisfaction was rated as excellent or good by 18 cases (57%). Average pain relief ratio was 50.3%, and in 14 cases, more than 80% of pain relief was noted. Nine (28%) of 32 patients showed they had no activity restrictions, such as daily activities or work, whereas 8 (25%) had mild restrictions and 15 (47%) had major restrictions. Twelve of 15 patient with major restrictions had been treated operatively (neurectomy; 10 cases, decompression; 2 cases). One case had gastrointestinal problem. CONCLUSION: Low-dose gabapentin for interdigital neuroma was one of the effective conservative treatments. The operation may be preserved for patient with the persist symptoms, nevertheless the conservative treatments and use of low-dose gabapentin.
Decompression ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma* ; Physical Examination ; Shoes ; Ultrasonography

PURPOSE: The result of cementless total knee arthroplasty with posterior cruciate ligament retention in rheumatoid arthritis patients was evaluated. MATERIALS AND METHODS: Thirty patients (fifty knees) followed up after cementless total knee arthroplasty with posterior cruciate ligament retention was evaluated clinically and radiologically. Average follow up was 9.2 years(5.1~14.3). RESULTS: The mean HSS knee score improved from 47.4 preoperatively to 81.8 postoperatively, and the mean range of motion of 89.7 degrees preoperatively to 101.2 degrees postoperatively. The mean tibiofemoral angle was 4.9 degrees valgus. Posterior instability was observed in 1 case(2%) at the most recent follow up. Radiolucent line was observed in 41 cases(82%), and osteolysis was observed around tibial component in 13 cases(26%), and around femoral component in 4 cases(8%). Eight cases(16%) of revision was due to 1 case of aseptic loosening and osteolysis each, and the other due to polyethylene wear of patellar or tibial component. CONCLUSION: Although there are osteopenia in rheumatoid arthritis compared to osteoarthritis, cementless total knee replacement with posterior cruciate retention showed stable fixation. However, the new method for initial fixation of tibial component is needed because osteolysis around tibial component tended to start around cancellous screws.
Arthritis, Rheumatoid* ; Arthroplasty* ; Arthroplasty, Replacement, Knee ; Bone Diseases, Metabolic ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis ; Osteolysis ; Polyethylene ; Posterior Cruciate Ligament ; Range of Motion, Articular

Kienböck’s disease is an avascular necrosis of the lunate that can be accompanied by a lunate fracture. Although numerous studies on Kienböck’s disease have been conducted, its natural history is incompletely understood and there is no consensus for treatment. Various wrist arthroscopic surgeries have been attempted owing to the increasing interest in wrist minimal-invasive surgery. Traditionally, the Lichtman classification, based on the osseous status, is used widely to assess Kienböck’s disease. On the other hand, age, vascular condition, and cartilage status are also important when making a treatment plan for Kienböck’s disease. This article introduces a new classification and treatment algorithm combining osseous, vascular and cartilage classifications. Moreover, the roles and limitations of arthroscopy in this new algorithm are reviewed, and the author’s preferred treatment protocol based on staging is introduced.

Malignant laryngeal tumors include a variety of histologic types with different biologic features, each calling for a different therapeutic approach and giving rise to a different prognosis. We experienced a case of laryngeal adenosquamous carcinoma which is an extremely rare neoplasm in larynx. The lesion is histologically distinctive because of the presence of mixed areas of unequivocal adenocarcinoma and squamous cell carcinoma. Differential diagnosis include adenoid squamous cell carcinoma and mucoepidermoid carcinoma. It is found that combined surgery and additional radiation therapy is necessary because the biologic behavior and prognosis of this neoplasm are considered as more aggressive and worse than that of conventional squameus cell carcinoma.
Adenocarcinoma ; Adenoids ; Carcinoma, Adenosquamous* ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Diagnosis, Differential ; Larynx* ; Prognosis

PURPOSE: The purpose of this study was to evaluate the outcomes of revision osteosynthesis using Herbert screw fixation combined with autogenous cancellous bone grafting for scaphoid nonunions after failed primary surgery. MATERIALS AND METHODS: Twelve patients who underwent revision osteosynthesis for a scaphoid nonunion after a mean of 13.6 months following primary surgical failure were studied. There were 9 waist fractures and 3 proximal fractures. The revision osteosynthesis was performed using autogenous iliac cancellous bone grafting combined with Herbert screw fixation. RESULTS: Union was achieved in 11 of 12 cases. The results of eleven united cases were clinically satisfactory at the mean follow up of 16.9 months after revision. The motion range of wrist joint improved: average flexion was 51degrees, average extension was 65degrees, average radial deviation 15degrees, and average ulnar deviation was 21degrees. CONCLUSION: Herbert screw fixation and autogenous iliac cancellous bone grafting was proved to be a useful method as a revisional operation for a scaphoid nonunion after failed primary surgery.
Bone Transplantation ; Follow-Up Studies ; Humans ; Wrist Joint

PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.
Adult ; Cubital Tunnel Syndrome/*diagnosis/physiopathology/*surgery ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Hand/surgery ; Hand Strength ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/*methods ; Prospective Studies ; Recovery of Function ; Surveys and Questionnaires ; Treatment Outcome ; Ulnar Nerve/physiopathology/*surgery ; Young Adult

PURPOSE: This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis. MATERIALS AND METHODS: Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score. RESULTS: Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported. CONCLUSION: Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.
Arm ; Contracture ; Dissociative Disorders ; Elbow ; Elbow Joint ; Follow-Up Studies ; Hand ; Humans ; Humerus ; Internal Fixators ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Transplants

PURPOSE: We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach. METHODS: This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes. RESULTS: After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion. CONCLUSION: Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable.
Dislocations ; Humans ; Necrosis ; Transplants

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.
Child ; Forearm/*pathology/*surgery ; Humans ; Male ; Pseudarthrosis/*pathology/*surgery ; Ulna/*pathology/*surgery

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.
Child ; Forearm/*pathology/*surgery ; Humans ; Male ; Pseudarthrosis/*pathology/*surgery ; Ulna/*pathology/*surgery