BACKGROUND: The purpose of this review was to assess the risk of infection-related complications following cemented and cementless hemiarthroplasty in elderly patients. METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with cementless hemiarthroplasty in patients with a femoral neck fracture and more than 65 years of age. Eight randomized controlled trials were available for analysis. A meta-analysis (with a fixed-effects model) and a meta-regression analysis (with continuous variables) were performed. RESULTS: The 8 trials included 1,204 hips (608 cemented and 596 cementless). There was no significant difference between the cemented and cementless groups regarding the incidence of deep infection, superficial infection, pneumonia, and urinary tract infection. The overall incidence of postoperative deep infection was 2.3% (14/608) in the cemented group and 1.2% (7/596) in the cementless group (relative risk, 1.74; 95% confidence interval, 0.74 to 4.14; I² = 0%; p = 0.206). No publication bias was found in the funnel plot. CONCLUSIONS: Results of our meta-analysis suggest that when selecting a fixation method for hemiarthroplasty, infection-related postoperative complications are not the determinant factor to consider.
Aged* ; Femoral Neck Fractures ; Hemiarthroplasty* ; Hip ; Humans ; Incidence ; Intraoperative Complications ; Methods ; Pneumonia ; Postoperative Complications ; Publication Bias ; Urinary Tract Infections

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case.
Adult ; Anterior Cruciate Ligament Reconstruction/*adverse effects ; *Compartment Syndromes ; Fasciotomy ; Humans ; *Iatrogenic Disease ; Male ; Necrosis ; *Postoperative Complications ; Republic of Korea ; Tibia/*surgery ; Tibial Arteries/*injuries

Human carboxylesterase 1 (CES1) is a serine esterase that hydrolyzes various exogenous compounds. Single nucleotide polymorphisms (SNPs) of CES1 may lead to inter-individual metabolic variability of its substrates. The allele and haplotype frequencies of known SNPs have been demonstrated to vary among ethnic groups. We analyzed genetic variations of CES1 in a Korean population. Direct sequencing of all exons and flanking regions of the CES1 gene was performed on samples obtained from 200 Koreans. We identified 41 SNPs. The most frequent SNPs was -914G>C (frequency: 99.5%), followed by 4256G>A (frequency: 65.8%), -75T>G (frequency: 59.3%). Haplotype analysis using the identified SNPs revealed fifteen haplotypes (> or =1% haplotype frequency) in our samples. The most frequent haplotype was Hap1 (frequency: 15.4%). Among the identified 41 SNPs, nine of which are novel variants and 14 SNPs were nonsynonymous variants. Using the functional predictive software PolyPhen-2, the G19V, E221G, and A270S variants were predicted to be most likely damaging to the function and structure of CES1. In-vitro analyses for two of these variants have been previously performed; however, functional evaluation of E221G (11657A>G, rs200707504) still needs to be conducted. Therefore, further studies are warranted to characterize the functional impact of E221G on CES1 activity.
Alleles ; Asian Continental Ancestry Group ; Carboxylesterase* ; Ethnic Groups ; Exons ; Genetic Variation ; Haplotypes ; Humans ; Polymorphism, Genetic* ; Polymorphism, Single Nucleotide ; Serine

PURPOSE: To validate the functional performance tests (FPTs) after anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Thirty men in their third decade after ACL reconstruction at 6 month follow-up and thirty healthy subjects were selected. Lysholm knee score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity score, KT-2000 arthrometer test, isokinetic strength test, functional performance tests (one leg hop test, co-contraction test, shuttle run test, carioca test) were performed in two groups. We evaluated the test-retest reliability of FPTs in healthy group and the between FPTs and other parameters in ACL reconstruction group. RESULTS: The test-retest result showed high correlation in co-contraction test (r=0.511), shuttle run test (r=0.746), carioca test (r=0.742). In the ACL reconstruction group, the IKDC score, Tegner activity score, extensor power at 60degrees/s, and one leg hop test also showed high correlation between each test. CONCLUSIONS: The three FPTs showed correlations with the established methods for determining return to sports activities after ACL reconstruction and had high test-retest reliability. Therefore we believe the three FPTs can be useful methods to assess knee function in athletes after ACL reconstruction.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Athletes ; Follow-Up Studies ; Humans ; Humulus ; Knee ; Leg ; Male ; Sports

We designed a study to evaluate the change of the proprioceptive function with joint position sense (JPS) during 1 year follow-up period after anterior cruciate ligament (ACL) reconstruction using hamstring autograft. Thirty-eight men who underwent ACL reconstruction were tested for International Knee Documentation Committee subjective knee score, Tegner activity score, Lysholm score, KT-2000 arthrometer, isokinetic strength test, functional performance test (carioca, co-contraction, shuttle run test, one-hop test) and JPS at preoperation, 6 months, and 12 months postoperation. The contralateral healthy knee was used as control. There were no significant differences of JPS between the involved knee and healthy knee at any time period. Repeated measures analysis of variance of the active JPS revealed that there was no significant difference during the follow up periods. The change patterns of passive JPS of extension and flexion were out of accordance with the improving clinical status following ACL reconstruction. Most of the clinical parameters did not show the significant correlation with active and passive JPS at any time period. In conclusion, JPS does not reflect the change of proprioceptive function following ACL reconstruction.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Follow-Up Studies ; Humans ; Joints ; Knee ; Male ; Proprioception

It is very rare that the bone scan after 72 hours from the trauma doesn't exhibit the increased radio-nuclide uptake in the patient with fracture. The purpose of this study is to report the case that indicate the false negative finding in the bone scan performed after 78 hours from the trauma in the 56-year-old man with L2 compression fracture, including a review of the relevant literatures.
Fractures, Compression ; Humans ; Middle Aged

PURPOSE: To evaluate the short-term results of medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot deformity. MATERIALS AND METHODS: Twenty four patients (25 feet) who had undergone medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot between July 2004 and May 2007 were included. The mean age was 43.6 years (16~78 years). The mean follow-up was 26 months (14~50 months). Clinical outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Six radiographic parameters were measured from weightbearing radiographs to assess the difference between preoperative and postoperative radiographs. RESULTS: The mean AOFAS score improved from 57.9 points preoperatively to 89.2 points at latest follow-up (p=0.000). The mean VAS improved from 62 points preoperatively to 23 points at latest follow-up (p=0.000). The mean talonavicular coverage angle on anteroposterior (AP) view changed from 20.2 degrees to 16.0 degrees (p=0.002). The mean calcaneal pitch angle on lateral view changed from 12.6 degrees preoperatively to 14.5 degrees at latest follow-up (p=0.001). Regarding these radiographic parameters, the difference between interobserver measurements was larger than that between pre- and post-operative measurements. The calcaneus was transferred medially by average 11.8 mm (p=0.003), which was 27.9% of the width of calcaneal tuberosity (p=0.000). The mean talo-first metatarsal angle on AP and lateral views, and navicular height on lateral view were not significantly changed. CONCLUSION: Medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot could lead to improve the clinical outcomes, although the restoration of medial longitudinal arch was not clinically significant.
Animals ; Ankle ; Calcaneus ; Displacement (Psychology) ; Flatfoot ; Follow-Up Studies ; Foot ; Humans ; Metatarsal Bones ; Osteotomy ; Weight-Bearing

PURPOSE: This study investigated the clinical course and prognostic factor of very low birth weight infants (VLBWI) with hemodynamically significant congenital heart defects (CHDs). METHODS: Medical records of 1,098 VLBWI with birth weight <1,500 g who had been admitted to the neonatal intensive care unit of Samsung Medical Center from October 1994 to December 2007 were reviewed retrospectively. The data for these patients with hemodynamically significant CHD (n=33) were compared with those without CHD (n=1,065). RESULTS: The incidence of CHD was 3.0% (33 patients) 7 patients (21%) had CHD combined with the congenital abnormalities or chromosomal disorders. The most common CHD was a ventricular septal defect. The incidence of intrauterine growth retardation was higher in patients with CHD than in patients without CHD (34% vs. 20%), but there were no significant differences in gestational age, birth weight, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, severe intraventricular hemorrhage (> or =Gr III), and periventricular leukomalacia. Cardiac surgery was performed on 13 patients (39%). Nine patients received staged operations, and 10 patients received early intervention. The overall mortality in patients who had CHD was higher than in the patients who did not have CHD (27% vs. 16%). In patients with CHD, congenital abnormalities or chromosomal disorders were more important factors for increased mortality (86% vs. 11%) than the degree of complexity of CHD (19% vs. 42%). CONCLUSION: The most important prognostic factors of VLBWI with CHD are the associated congenital abnormalities or chromosomal disorders.
Birth Weight ; Bronchopulmonary Dysplasia ; Chromosome Disorders ; Congenital Abnormalities ; Early Intervention (Education) ; Enterocolitis, Necrotizing ; Fetal Growth Retardation ; Gestational Age ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Medical Records ; Prognosis ; Retrospective Studies ; Thoracic Surgery

PURPOSE: To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures. MATERIALS AND METHODS: The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery. RESULTS: At the 6 months, one-level group showed the change of kyphotic angle of 17.5+/-2.4 degrees, which was different from two-level group of 5.2+/-0.8 degrees (p=0.000). CONCLUSION: In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.
Humans ; Retrospective Studies ; Spine

PURPOSE: To determine the clinical and radiographic results of arthroereisis using the Kalix(R) implant (Newdeal, Lyon, France) for the treatment of flexible flatfoot deformity. MATERIALS AND METHODS: From February 2005 to February 2007, we performed the subtalar arthroereisis on 8 patients (9 feet) of symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 14.5 years (11~29 years) old. We checked the functional status with AOFAS functional score pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-first metatarsal angle, calcaneal pitch angle in pre-operatively and at final follow-up. RESULTS: Mean follow up period was 34.4 months. Average AOFAS score improved from preoperatively 65.6 to postoperatively 94.8. Average lateral talo-first metatarsal angle reduced from 12.8degrees preoperatively to 1.6degrees at final follow-up. Average anterior to posterior talo-first metatarsal angle was reduced from 15.1degrees preoperatively to 8.3degrees at final follow-up. Average calcaneal pitch angle was increased from 9.5degrees preoperatively to 12.0degrees at final follow-up. CONCLUSIONS: Subtalar arthroereisis with Kalix(R) implant can be considered to be one of treatment options symptomatic flatfoot deformity patients.
Congenital Abnormalities ; Flatfoot ; Follow-Up Studies ; Foot ; Humans ; Metatarsal Bones ; Weight-Bearing