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Vesicocutaneous Fistula Presenting Groin Abscess and Chronic Osteomyelitis in Pubic Bone.

Sang Bum KIM ; Woong Kyo JUNG ; Dong Ik SONG ; Soon Hyuck LEE

Clinics in Orthopedic Surgery.2009;1(3):176-179. doi:10.4055/cios.2009.1.3.176

The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.
Abscess/complications/*diagnosis ; Cutaneous Fistula/complications/*diagnosis/radiography/surgery ; Groin ; Humans ; Male ; Middle Aged ; Osteomyelitis/complications/*diagnosis/radiography ; Pelvis/radiography ; *Pubic Bone/surgery ; Urinary Bladder Fistula/complications/*diagnosis/radiography/surgery

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Pseudoaneurysm of the Medial Superior Genicular Artery after Arthroscopic Partial Meniscectomy.

Kee Byoung LEE ; Si Young SONG ; Duck Joo KWON ; Jun SHIN ; Sang Hoon PAIK

Clinics in Orthopedic Surgery.2009;1(3):173-175. doi:10.4055/cios.2009.1.3.173

We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization.
Adult ; Aneurysm, False/*etiology ; Arteries ; Arthroscopy/*adverse effects/methods ; Humans ; Knee/*blood supply ; Male ; Menisci, Tibial/*surgery

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The Surgical Treatment for Spinal Intradural Extramedullary Tumors.

Dong Ki AHN ; Hoon Seok PARK ; Dae Jung CHOI ; Kwan Soo KIM ; Tae Woo KIM ; Soon Youl PARK

Clinics in Orthopedic Surgery.2009;1(3):165-172. doi:10.4055/cios.2009.1.3.165

BACKGROUND: We wanted to investigate the results of surgical treatment and analyze the factors that have an influence on the neurologic symptoms and prognosis of spinal intradural extramedullary (IDEM) tumors. METHODS: The spinal IDEM tumor patients (11 cases) who had been treated by surgical excision and who were followed up more than 1 year were retrospectively analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The pathological diagnosis, the preoperative symptom duration, the tumor location on the sagittal and axial planes and the percentage of tumor occupying the intradural space were investigated. In addition, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the MRI was checked to evaluate whether or not the tumor had recurred. RESULTS: The most common diagnosis was schwannomas (73%), followed by meningiomas (18%). The percentage of tumor occupying the intradural space was 82.9 +/- 9.4%. The VAS score was reduced in all cases from 8.0 +/- 1.2 to 1.2 +/- 0.8 (p = 0.003) and the Nurick's grade was improved in all cases from 3.0 +/- 1.3 to 1.0 +/- 0.0 (p = 0.005). The preoperative symptoms were correlated with only the percentage of tumor occupying the intradural space (VAS; r2 = 0.75, p = 0.010, Nurick's grade; r2 = 0.69, p = 0.019). One case of schwannoma recurred. CONCLUSIONS: The degree of neurologic symptoms was correlated with the percentage of tumor occupying the intradural space. All the tumors were able to be excised through the posterior approach. The postoperative neurologic recovery was excellent in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.
Adult ; Aged ; Female ; Humans ; Laminectomy/methods ; Magnetic Resonance Imaging ; Male ; Meningioma/diagnosis/pathology/surgery ; Middle Aged ; Neurilemmoma/diagnosis/pathology/surgery ; Prognosis ; Retrospective Studies ; Spinal Neoplasms/diagnosis/pathology/*surgery ; Spine/pathology/surgery

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Stress Fracture of the Proximal Fibula in Military Recruits.

Seoung Hwan HONG ; In Tak CHU

Clinics in Orthopedic Surgery.2009;1(3):161-164. doi:10.4055/cios.2009.1.3.161

BACKGROUND: We wanted to report on stress fracture of the proximal fibula and to suggest the pathomechanism of this fracture. METHODS: Between April 2004 through April 2005, the military recruits who complained of leg pain during the 6 weeks basic training in the Republic of Korea Marine Corps education and training group were evaluated according to their clinical manifestations and plain radiographs. RESULTS: Twelve recruits of 635 recruits who complained leg pain were diagnosed as having fibular stress fracture. Eleven cases (10 recruits) appeared at the junction of the proximal and middle 1/3 of the fibula and 2 cases (2 recruits) were in the middle 1/3 of the fibula, as assessed radiologically. Tenderness was the most reliable clinical manifestation. All the fractures occurred after repetitive walking or jumping in a squatting position. Conservative treatments that included bed rest, immobilization and non-steroidal anti-inflammatory drugs administration according to the symptom severity were satisfactory. CONCLUSIONS: Proximal fibular stress fracture is not rare in military recruits. The shearing force on the proximal fibula and the repetitive stress by walking or jumping in a squatting position contribute to the stress fracture of the proximal fibula.
Fibula/*injuries/radiography ; Fractures, Stress/*etiology/radiography ; Humans ; Male ; *Military Personnel ; Physical Exertion ; Republic of Korea ; Resistance Training/adverse effects ; Young Adult

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Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty.

Kyung Jae LEE ; Byung Woo MIN ; Ki Cheor BAE ; Chul Hyun CHO ; Doo Hyun KWON

Clinics in Orthopedic Surgery.2009;1(3):155-160. doi:10.4055/cios.2009.1.3.155

BACKGROUND: This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. METHODS: Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. RESULTS: There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. CONCLUSIONS: The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty.
Adult ; Aged ; Amides/administration & dosage ; Analgesia/*methods ; *Arthroplasty, Replacement, Hip ; Clinical Protocols ; Female ; Humans ; Injections, Intra-Articular ; Length of Stay ; Male ; Methylprednisolone/administration & dosage ; Middle Aged ; Morphine/administration & dosage ; Narcotics/administration & dosage ; Pain/prevention & control ; Pain Measurement ; Pain, Postoperative/prevention & control

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Treatment of Femoroacetabular Impingement with Surgical Dislocation.

Ho Hyun YUN ; Won Yong SHON ; Ji Yeol YUN

Clinics in Orthopedic Surgery.2009;1(3):146-154. doi:10.4055/cios.2009.1.3.146

BACKGROUND: The authors report the results of femoroacetabular impingement (FAI) treated with a surgical dislocation. METHODS: From April 2005 to May 2007, 15 FAI hips were treated with a surgical dislocation. The male/female ratio, mean age and mean symptom duration was 12/2, 35.8 years and 2.3 years, respectively. Radiographs and MR arthrograms were taken. The clinical evaluation involved changes in the pre- and postoperative Harris hip score (HHS). RESULTS: There were 12 hips (80%) with at least one structural abnormality in the radiographs, with 11 (79%) labral tears and 8 (73%) abnormally high angles in the MR arthrograms. We performed 15 osteochondroplasties, 12 labral repairs, 12 acetabuloplasty, and 3 debridements. The mean HHS improved from 76 to 93 points. Three non-unions of the trochanteric osteotomy sites were encountered as complications. CONCLUSIONS: Radiographs and MR arthrograms are important for making a proper diagnosis of FAI and planning treatment. A surgical dislocation can be used to treat FAI but further technical improvements will be needed for fixation of the greater trochanteric osteotomy sites.
Acetabulum/surgery ; Adult ; Female ; Femoracetabular Impingement/radiography/*surgery ; Femur Head/surgery ; Humans ; Ligaments, Articular/surgery ; Male ; Middle Aged ; Orthopedic Procedures/methods ; Osteotomy ; Treatment Outcome ; Young Adult

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Anatomic Reconstruction of the Distal Radioulnar Ligament for Posttraumatic Distal Radioulnar Joint Instability.

Kyu Nam SEO ; Min Jong PARK ; Hong Je KANG

Clinics in Orthopedic Surgery.2009;1(3):138-145. doi:10.4055/cios.2009.1.3.138

BACKGROUND: To analyze clinical outcomes after anatomical reconstruction of distal radioulnar ligaments in patients with chronic post-traumatic instability of the distal radioulnar joint. METHODS: Anatomical reconstruction was performed in 16 patients with subluxation or dynamic instability of distal radioulnar joint following trauma. Osteotomy was performed simultaneously in 10 patients with radial malunion. The average follow-up period was 18.9 months. For clinical outcome assessment, we performed the anteroposterior stress test, measured the range of motion and grip strength, and performed radiological examination. For assessment of the pain and function, we used the Patient Rated Wrist Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the Modified Mayo Wrist Score. RESULTS: Anteroposterior stress test performed at the last follow-up showed normal in 12 patients, mild laxity in 3, and residual subluxation in one. The average Patient Rated Wrist Evaluation was 9.1 for pain and 11.2 for function. The average Disabilities of the Arm, Shoulder and Hand score was 10.5. The average Modified Mayo Wrist Score was 92.8; there were 10 excellent, 5 good, and 1 poor case. The average grip strength improved from 69.7 1b to 80.9 1b. A revision osteotomy was performed on the patient with residual subluxation in order to obtain normal alignment of the joint. CONCLUSIONS: Anatomical reconstruction of the distal radioulnar ligaments is recommended to restore distal radioulnar joint stability. In addition to ligament reconstruction, realignment of the distal radioulnar joint seems critical when the instability is combined with malunion of the radius.
Adolescent ; Adult ; Female ; Hand Strength ; Humans ; Joint Instability/*surgery ; Ligaments, Articular/*surgery ; Male ; Middle Aged ; Osteotomy/methods ; Pain Measurement ; Radius/surgery ; Range of Motion, Articular ; Treatment Outcome ; Ulna/surgery ; Wrist Injuries/*surgery ; Wrist Joint/*surgery ; Young Adult

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Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases.

Sung Jin SHIN ; Hong Seok KWAK ; Tae Joon CHO ; Moon Seok PARK ; Won Joon YOO ; Chin Youb CHUNG ; In Ho CHOI

Clinics in Orthopedic Surgery.2009;1(3):132-137. doi:10.4055/cios.2009.1.3.132

BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.
Acetabulum/surgery ; Adolescent ; Adult ; Cartilage, Articular/surgery ; Child ; Female ; Femur Head/surgery ; Hip Dislocation/surgery ; Hip Joint/abnormalities/*surgery ; Humans ; Male ; Osteotomy/methods ; Treatment Outcome ; Young Adult

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Bony Landmarks for Determining the Mechanical Axis of the Femur in the Sagittal Plane during Total Knee Arthroplasty.

Jai Gon SEO ; Byung Kuk KIM ; Young Wan MOON ; Jong Hyun KIM ; Byeong Ho YOON ; Tae Keun AHN ; Dong Hoon LEE

Clinics in Orthopedic Surgery.2009;1(3):128-131. doi:10.4055/cios.2009.1.3.128

BACKGROUND: There is no accepted landmark for the mechanical axis of the femoral axis in sagittal plane in conventional total knee arthroplasty. METHODS: As palpable anatomic landmarks of the femur, lateral epicondyle, and anterior margin of the greater trochanter were identified. The line connecting these two landmarks was defined as the "palpable sagittal axis". The mechanical axis of the femur was compared with the palpable sagittal axis and the distal femoral anterior cortex axis. These axes were also compared with sagittal bowing of the femur. RESULTS: The distal femoral anterior cortex axis and the palpable sagittal axis were flexed by 4.1degrees and 2.4degrees more than the sagittal mechanical axes, respectively (p < 0.05). However, the palpable sagittal axis was not correlated with sagittal bowing of the femur (Spearman's rs, 0.17; p = 0.14). CONCLUSIONS: The palpable sagittal axis showed a consistent relationship with the sagittal mechanical femoral axes regardless of the severity of the sagittal bowing of the femur.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Biomechanics ; Female ; Femur/anatomy & histology/*surgery ; Humans ; Knee Joint/anatomy & histology/surgery ; Male ; Middle Aged

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Mini-open Muscle Resection Procedure under Local Anesthesia for Lateral and Medial Epicondylitis.

Byung Ki CHO ; Yong Min KIM ; Dong Soo KIM ; Eui Sung CHOI ; Hyun Chul SHON ; Kyoung Jin PARK ; Eun Myung LEE

Clinics in Orthopedic Surgery.2009;1(3):123-127. doi:10.4055/cios.2009.1.3.123

BACKGROUND: This study examined the clinical results of surgical treatment using a mini-open muscle resection procedure under local anesthesia for intractable lateral or medial epicondylitis. METHODS: Forty two elbows (41 patients) were treated surgically for lateral or medial epicondylitis. The indication for surgery was refractory pain after six months of conservative treatment, or a history of more than three local injections of steroid, or severe functional impairment in the occupational activities. The treatment results were assessed in terms of the pain using the visual analogue scale (VAS), Roles & Maudsley score, and Nirschl & Pettrone grade. RESULTS: The preoperative VAS scores of pain were an average of 5.36 at rest, 6.44 at daily activities, and 8.2 at sports or occupational activities. After surgery, the VAS scores improved significantly (p < 0.01): 0.3 at rest, 1.46 at daily activities, and 2.21 at sports or occupational activities. The preoperative Roles & Maudsley score was acceptable in 6 cases, and poor in 36 cases, which was changed to excellent in 23 cases, good in 16 cases, acceptable in 3 cases after surgery. According to the grading system by Nirschl & Pettrone, 23 cases were excellent, 18 cases were good, and the remaining 1 case was fair. Overall, 41 cases (97.6%) achieved satisfactory results. Postoperative complications were encountered in three cases. Subcutaneous seroma due to the leakage of joint fluid in two patients was managed by additional surgery and suction drainage, and resulted in a satisfactory outcome. One patient complained of continuous pain on occupational activity, but her pain at rest was improved greatly. CONCLUSIONS: The mini-open muscle resection procedure under local anesthesia appears to be one of effective methods for intractable lateral or medial epicondylitis.
Adult ; *Anesthesia, Local ; Female ; Humans ; Male ; Middle Aged ; Muscle, Skeletal/*surgery ; Pain/etiology ; Pain Measurement ; Tennis Elbow/complications/*surgery ; Treatment Outcome

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