Epidural steroid injection is a procedure in which steroids are injected into the epidural space of the spine. Its effectiveness has been demonstrated in numerous systematic reviews. In South Korea, the guidelines recommend administering the procedure three times at intervals of at least one week. In some patients, however, symptoms can recur even after three injections, leading them to receive the procedure multiple times a year. The authors report a case of a 59-year-old male patient who developed a secondary adrenal insufficiency and multiple osteoporotic compression fractures in the T8, T11, T12, L3, and L4 vertebral bodies after receiving eight epidural injections of 10 mg dexamethasone over 10 weeks for back pain and left lower extremity radiating pain which occurred without trauma. This paper reports this case along with a review of the relevant literature.

Myasthenia gravis is an autoimmune disease in which autoantibodies affect the neuromuscular junction, leading to muscle loss. Steroids are the primary immunosuppressive treatment for this condition. Since steroids affect the immune system and are effective in most subtypes of myasthenia gravis, they are often used for long-term maintenance treatment. This increases the probability of steroidassociated side effects such as decreases in bone mineral density and increased risk of fractures. The authors successfully treated an 18-year-old female who had been using steroids for a long time after being diagnosed with myasthenia gravis using teriparatide for osteoporotic multi-segment thoracolumbar compression fractures that occurred without trauma with satisfactory outcomes. Since there have been no reports of osteoporotic multi-segmental thoracolumbar compression fractures and treatment in juvenile myasthenia gravis patients caused by long-term steroid use, we report this case along with a review of the literature.

The Allis maneuver is the most commonly used method for reducing posterior hip dislocation. The authors experienced an iatrogenic proximal tibiofibular fracture in a 91-year-old male who underwent total hip arthroplasty while reducing posterior hip dislocation with the Allis maneuver. The hip was safely reduced under spinal anesthesia with a fracture table. Open reduction and internal fixation with a locking plate were done for the proximal tibia fracture.

The Allis maneuver is the most commonly used method for reducing posterior hip dislocation. The authors experienced an iatrogenic proximal tibiofibular fracture in a 91-year-old male who underwent total hip arthroplasty while reducing posterior hip dislocation with the Allis maneuver. The hip was safely reduced under spinal anesthesia with a fracture table. Open reduction and internal fixation with a locking plate were done for the proximal tibia fracture.

The Allis maneuver is the most commonly used method for reducing posterior hip dislocation. The authors experienced an iatrogenic proximal tibiofibular fracture in a 91-year-old male who underwent total hip arthroplasty while reducing posterior hip dislocation with the Allis maneuver. The hip was safely reduced under spinal anesthesia with a fracture table. Open reduction and internal fixation with a locking plate were done for the proximal tibia fracture.

An avulsion fracture of the anterolateral tibial epiphysis or Tillaux fracture is commonly seen in adolescents, reported first by Paul Jules Tillaux in 1892. Adolescent Tillaux fracture occurs during the period when the lateral physis is still open and the anterior-inferior tibiofibular ligament is stronger than the physis, so rarely occurs in adults. An avulsion fracture of the posterior inferior tibiofibular ligament, Volkmann fracture, occurs counterpart of Tillaux fracture. In this study, a tennis player injured during sliding and diagnosed as the rare simultaneous Tillaux-Chaput fracture and Volkmann fracture, is reported with the mechanism of injury, clinical importance of syndesmosis, sprain, and fracture of the ankle joint.

INTRODUCTION: Cardiac myxoma is the most common cardiac tumour. In this study, we summarise our 17-year experience with the clinical presentation of cardiac myxoma at National Heart Centre Singapore, Singapore. METHODS: Between January 2000 and December 2016, retrospective data was reviewed for all consecutive patients who underwent surgical resection of cardiac myxoma. Patients' clinical characteristics were reviewed and described. RESULTS: A total of 67 (18 male, 49 female; mean age 53.1 ± 13.5 years) patients underwent cardiac myxoma resection. There were 19 (28.4%) patients with asymptomatic cardiac myxoma. There were no significant differences in gender; body habitus and myxoma size; and haemoglobin, white blood cell or platelet counts between patients with symptomatic and asymptomatic myxoma. However, the number of asymptomatic cardiac myxomas seemed to follow an increasing trend from 19.4% (period 2000-2008) to 36.1% (period 2009-2016), suggestive of an 'era effect'. CONCLUSION In our study, a majority of patients were women, with a wide age range of 18-78 years. The diagnosis of asymptomatic cardiac myxoma was present in 28.4% of patients, with an increasing trend for incidence over the years. This is possibly due to increased opportunistic screening (with electrocardiography and clinical examination) as well as higher usage of medical imaging.

Methods: Consecutive patients whose BMD had been checked using dual-energy X-ray absorptiometry at Gwangmyung Sungae Hospital were recruited. Patients were divided into two groups according to the presence of type 2 DM. Risk factors of OVCF including age, BMI, current smoking status, current alcohol consumption, and presence of osteoporosis were analyzed separately in the type 2 DM group and control group. Results: A total of 1,130 patients were enrolled in this study. The mean age was 63.2 years. BMI was positively correlated with lumbar BMD in the control group (r =0.284) and in the diabetic group (r =0.302). In subgroup analysis, BMI and age were significant risk factors of OVCF in the type 2 DM group. In multiple linear regression analysis, type 2 DM (β =0.035; 95% confidence interval [CI], 0.005–0.065; p =0.024) and BMI (β =0.015; 95% CI, 0.012–0.018; p <0.001) were positively correlated with lumbar BMD, and age was negatively correlated with BMD (β =−0.006; 95% CI, −0.007 to −0.004; p <0.001). Conclusions BMI was positively correlated with lumbar BMD and was higher in type 2 diabetic patients. Age was negatively correlated with lumbar BMD.

Methods: In this study, 30 patients with DS with checked standing dynamic radiographs of the lumbar spine in Gwangmyeong Sungae Orthopedic Clinic were recruited. Standing lateral radiographs were evaluated in extension, 45° of flexion (mid-range) and 90° of flexion (terminal-range) of the lumbar spine. Instability was defined as sagittal translation greater than 3 mm from the extension position. Patients were divided into three groups: a control group, an MI group, and a terminal-range instability (TI) group. Radiographic outcome (stenosis grade) and clinical outcome were compared between the three groups. Results: The average sagittal translation of the lumbar spine was 5.2 mm in extension, 6.6 mm in mid-range, and 7.2 mm in endrange. MI was observed in eight patients (26.2%) and TI was seen in 12 patients (40%). Of eight patients with MI, three patients did not have instability at terminal-range (occult patients) and five patients had instability at terminal-range (typical patients). Body weight and body mass index (BMI) was significantly higher in the MI group as compared to the control group. BMI was positively correlated with slippage to mid-range. There was no significant difference in stenosis grade, Visual Analog Scale, and Oswestry Disability Index. In the TI group, there was no significant difference in radiographic clinical parameters as compared to the control group. Conclusions MI was demonstrated in 25% of DS patients. Mid-range motion was increased with BMI. Mid-range lateral radiography can reveal occult instability in patients with DS, particularly in obese patients.