PURPOSE: To assess the result of staged minimally invasive plate osteosynthesis (MIPO) for distal tibial fracture with an open wound or injured soft tissue. MATERIALS AND METHODS: In 20 patients (mean age, 47.8 year-old) with distal tibial fractures, there were 4 type A fractures and 16 type C fractures based on the AO classification system. Eight of the 20 patients had open fractures. MIPO was performed on average 23.9 days after bridging external fixation. At the final follow-up, we assessed the radiological results of bone union and alignment. Functional results were also evaluated by measuring the degrees of ankle motion and the American Orthopedic Foot & Ankle Society (AOFAS) scores. RESULTS: Seventeen of 20 cases (85%) achieved primary union at an average of 21.3 weeks. There were 3 cases of nonunion requiring a bone graft. The mean AOFAS score was 88.5 (range, 67~92) and the average range of ankle motion was 49.2degrees (plantarflexion: 37.4degrees, dorsiflexion: 11.8degrees). Complication included 2 cases of minor mal-alignment, 1 case of claw toe and 1 case of peroneal neuropathy. Patients over the age of 60 had lower functional results. Additional factors did not affect the final results. CONCLUSION: Staged MIPO may achieve satisfactory results in distal tibial fractures with soft tissue compromise, decreasing deep infections and soft tissue complications.
Animals ; Ankle ; Follow-Up Studies ; Foot ; Fractures, Open ; Hammer Toe Syndrome ; Humans ; Orthopedics ; Peroneal Neuropathies ; Tibial Fractures ; Transplants

Ethanol and its metabolite acetaldehyde increase transforming growth factor beta1 (TGF-beta1) expression in animal studies. TGF-beta1 is related with the hepatic stellate cell (the key element of hepatic fibrogenesis) and the radial glia (the key element of neuronal migration). Blood samples were collected from 41 patients with alcohol dependence, TGF-beta1 levels measured by ELISA were compared with 41 normal subjects. Plasma TGF-beta1 levels in the patients with alcohol dependence (1,653.11+/-532.45 pg/mL) were significantly higher than those of healthy subjects (669.87+/-366.53 pg/mL) (P=0.000). Patients with or without liver pathology showed no difference in TGF-beta1 (P=0.36). Increased TGF-beta1 may mediate deleterious effect of alcohol such as hepatic fibrosis and suppressed neuronal developments in alcohol dependence patients.
Adult ; Alcoholism/*blood ; Enzyme-Linked Immunosorbent Assay ; Humans ; Liver Diseases/pathology/ultrasonography ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Transforming Growth Factor beta1/*blood

OBJECTIVES: Recent studies have raised the possibility that nerve growth factor(NGF) is abnormally regulated in the central nervous system(CNS) of animal models with alcohol dependence. The possible alteration of NGF by prolonged alcohol intake may play an important role in alcohol-induced neurotoxicity. Carbohydrate-deficient transferrin(CDT) is regarded as a reliable biological marker of alcohol dependence. The goal of this study was to estimate the changes of %CDT and serum NGF level according to the duration of alcohol abstinence, and to identify whether %CDT level is associated with the serum NGF level in the patients with alcohol dependence. METHODS: The subjects were 24 patients with alcohol dependence. We used the Axis-Shield ASA to measure the %CDT level and the enzyme-linked immunosorbent assay(ELISA) to measure the serum NGF level. %CDT and NGF levels were measured immediately after the admission and at 2 weeks after the admission. RESULTS: Decreased %CDT were observed during the period of 2 weeks after the admission. NGF level was not significantly different after 2 weeks. The NGF levels were not correlated with %CDT. The possibility of %CDT as a predictor of alcohol-induced neurotoxicity was not confirmed. CONCLUSION: Serum NGF levels is not a reliable indicator of abstinence state in the patients with alcohol dependence. Further studies are needed to evaluate the relation between two indicators in regard to hematological and neurological changes in alcohol dependence.
Alcohol Abstinence ; Alcoholism* ; Biomarkers ; Humans ; Models, Animal ; Nerve Growth Factor* ; Transferrin*

PURPOSE: To evaluate the effectiveness of iliosacral screw fixation with anterior plating in the management of an unstable pelvic ring injury. MATERIALS AND METHODS: Nineteen patients with an unstable pelvic ring injury were enrolled in this retrospective study. All patients were followed up for at least 1 year. The mean age of the patients was 43 years. According to the AO-OTA classification, there were five B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by plating, ilio-sacral screw fixation was performed percutaneously under the C-arm guide. RESULTS: All cases united except for 1 case of nonunion at the pubic ramus. The radiology results showed 9, 7, 2 and 1 case of anatomic, nearly anatomic, moderate and poor reduction, respectively. Sixteen out of 19 patients had a good or excellent functional result. Two moderate and one poor result were from an unsatisfactory reduction in a type C injury with the residual neurological signs. Screw misplacement with neurological compromise occurred in one patient but there were no adverse sequelae after its removal. Regarding the complications, there were two cases of screw loosening, two cases of anterior metal failures, and 1 case of a deep infection. CONCLUSION: Percutaneous ilio-sacral screwing with anterior plating may be a useful method for treating unstable pelvic ring injuries, and the reduction quality and neurological signs are important.
Classification ; Humans ; Retrospective Studies

OBJECTIVES: Biochemical markers can provide an objective evidence of heavy alcohol drinking. The purpose of this study was to compare and evaluate the usefulness of biological markers detecting alcohol dependence, such as mean corpuscular volume(MCV), gamma-glutamyl transferase(GGT), and carbohydrate-deficient transferrin(CDT) in the patients of an alcohol counseling center. METHODS: This study was done with 64 patients with alcohol dependence and 36 healthy subjects. Relative values(%) of CDT were determined in their sera with turbidimetric immunoassay(Bio-Rad %CDT assay, Axis-Shield ASA, Oslo, Norway), and were compared with conventional markers of alcohol consumption, GGT and MCV. RESULTS: Among the patients with alcohol dependence, 78.1% showed abnormal %CDT levels compared with GGT(61.9%) and MCV(20.7%). The areas under the receiver operating characteristic(ROC) curves(95% confidence interval) for %CDT, GGT, and MCV were 0.934(0.866-0.973), 0.871(0.789-0.930), and 0.575 (0.472-0.673), respectively. CONCLUSION: %CDT seems to be the most reliable biological marker for the detection and monitoring of alcohol consumption in the patients with alcohol dependence of the alcohol counseling center.
Alcohol Drinking ; Alcoholism* ; Biomarkers* ; Counseling* ; Erythrocyte Indices ; gamma-Glutamyltransferase ; Humans

PURPOSE: We analyzed the comparative results of limb alignment after total knee arthroplasty using conventional method and image-free navigation system. MATERIALS AND METHODS: Total knee arthroplasties were performed in sixty-four patients(74 knees) with conventional method(37 cases)(Group A) and Orthopilot 4.0 image-free navigation system(37 cases)(Group B). We measured the femoro-tibial angle, femoral and tibial component angle in coronal and sagittal plane using the weight bearing whole leg radiograph taken 1-month postoperatively. RESULTS: Mechanical femoro-tibial angle was 1.4 degrees of varus in conventional group (Group A) and 0.8 degrees of varus in the navigation group (Group B) on average. Femoral and tibial component angle in the coronal plane was mean 1.8 degrees of varus and 0.7 degrees of varus in group A, 0.3 degrees of valgus and 0.5 degrees of varus in group B on average. Average femoral and tibial component angle in sagittal plane was 0.3 degrees of flexion and 0.8 degrees of anterior tilt in group A, 0.7 degrees of flexion and 1.7 degrees of anterior tilt in group B. There were no statistically significant differences between two groups in the femoro-tibial angle, femoral and tibial component angle in coronal and sagittal plane. But the ranges of deviation from desired angle were smaller in Group B than Group A. Statistically significant different results of the limb alignment (femoro-tibial angle and femoral component angle in coronal plane) were observed in 5 cases with severely bowed femoral shaft in group B (average femoro-tibial angle 0.9 degrees and femoral component angle in coronal plane 0.9 degrees varus) than group A (average femoro-tibial angle 3.5 degrees and femoral component angle in coronal plane 3.9 degrees varus). CONCLUSION: Accuracy of limb alignment in total knee arthroplasty using navigation system was not statistically significant difference than using the conventional method, but had better results in the deviation of mechanical femoro-tibial angle and femoral component angle in coronal plane than the conventional method, especially in severely bowed femoral shaft.
Arthroplasty* ; Extremities* ; Knee* ; Leg ; Weight-Bearing

PURPOSE: In the incidence of lateral retinacular release, patellar tracking and clinical results were analyzed according to the surgical approach of total knee arthroplasty. MATERIALS AND METHODS: 286 osteoarthritic knees (228 patients) who had undergone patellar non-resurfaced total knee arthroplasty were analyzed and divided into two groups. Group I was 171 cases with midvastus approach, and group II was 115 cases with medial parapatellar approach. On the basis of patellar subluxation degree with no thumb test, we were deciding on whether the lateral retinacular release was needed or not. We radiologically evaluated patellar tracking, and clinically evaluated the range of knee motion, flexion contracture, and anterior knee pain. RESULTS: The lateral retinacular release was performed in 6 cases(3.5%) from group I, and 18 cases(15.7%) from group II (p=0.001). Patellar maltracking was observed in 26 cases, which were 14 cases(8.2%) from group I and 12 cases(10.4%) from group II (p=0.517). On the other hand, patellar maltracking was found in only 2 cases(8.3%) from retinaculum released group, and in 24 cases(9.2%) from retinaculum non-released group (p=0.623). Surgical approach and lateral retinacular release had no influence on clinical results. CONCLUSION: Midvastus approach could reduce the need for lateral retinacular release, but it had no influence on patellar maltracking and clinical results.
Arthroplasty* ; Contracture ; Hand ; Incidence ; Knee* ; Thumb

PURPOSE: Elbow osteoarthritis with ulnar neuropathy was treated by a modified posteromedial approach, for decompression/transposition of the ulnar nerve and simultaneously with an Outerbridge-Kashiwagi procedure. The clinical result with these operative techniques is reported. MATERIALS AND METHODS: Average age of the patients was 51, which including 9 male and 2 female. There were 8 manual workers and one each of a clerk, a merchant and a house wife. The ulnar neuropathy was evaluated by the McGowan grading; one grade I, 4 grade II and 6 grade III. RESULTS: The ulnar nerve symptoms were relieved in all patients; 3 McGowan grade I, 5 grade II and 3 grade III, postoperatively. The pain subsided in all patients, with the exception of in one. The average range of motion was improved from 22.5-124degrees to 11.5-128.5degrees. CONCLUSION: A modified posteromedial approach is an effective method for both ulnar nerve decompression and the OK procedure, and provides an effective functional outcome.
Decompression ; Elbow* ; Female ; Humans ; Male ; Osteoarthritis* ; Range of Motion, Articular ; Spouses ; Ulnar Nerve ; Ulnar Neuropathies*

PURPOSE: This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture. MATERIALS AND METHODS: Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated. RESULTS: Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use. CONCLUSION: In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.
Ankle ; Anti-Bacterial Agents ; Classification ; Debridement ; Fracture Fixation, Intramedullary ; Fractures, Open* ; Inflammation ; Knee ; Retrospective Studies ; Tibia* ; Transplants

PURPOSE: This was a retrospective study to evaluate the results of intramedullary nailing in proximal shaft fracture of tibia. We analyzed those results according to AO classification and Poller screw. MATERIALS AND METHODS: Thirty-three proximal tibial shaft fractures (32 patients) were followed for more than one year. In AO classification, there were 6 cases of type A, 14 cases of type B, and 13 cases of type C. We used Poller screws in 14 operations. We evaluated translation, angulation and nonunion after surgeries. RESULTS: Twenty-eight cases (85%) were united primarily, but nonunions occurred in 5 cases. Malalignment (angulation>5degree or translation>5 mm) was found in 14 cases (42%). In Poller screw used and non-used groups, the malalignment was respectively showed in 2 cases (14%) and 12 cases (63%). According to AO classification, nonunion was found in only type B with 5 cases (36%). CONCLUSION: Intramedullary nailing of proximal shaft fracture of tibia showed relatively lower rate of primary union. Especially, when initial fractures have a butterfly fragment, it showed the higher rate of nonunion. Moreover, the malalignment rate was relatively higher, yet it is possible to reduce the rate of malalignment by using Poller screw.
Butterflies ; Classification* ; Fracture Fixation, Intramedullary ; Retrospective Studies ; Tibia*