PURPOSE: This study compared the results between PFN (Proximal Femoral Nail) and DHS (Dynamic Hip Screw)in the treatment of a peritrochanteric fracture of the proximal femur. MATERIALS AND METHODS: 33 patients with peritrochanteric fractures treated with PFN for a minimum follow-up of at least 12 months were analyzed retrospectively. The patients with PFN group (n=33, group I) were taken from operations between Jan. 2003 and Dec. 2004, and the DHS group (n=34, group II) were used as the control group. Both groups were compared with regard to the operation time, blood loss, transfusion, ICU care, drain amount, duration of admission, complications, the neck shaft angle, the sliding length of lag screws, radiological union, and the functional recovery grade using Jensen and Palmar and Parker's method. RESULTS: The mean operative times were 105 (group I) and 157 minutes (group II), blood losses were 540 and 840cc, transfusion volumes were 1.5 and 2.2 pints, ICU care was 6 and 30%, drain amounts were 36 and 203 cc, admission duration was 25 and 33 days, complications were 15 and 17%, reoperations by the failure of the reduction were 2 cases(6%) (group I) and 0 (group II), difference in the neck shaft angles were 3.70 and 3.87degrees, sliding length of the lag screws were 1.9 and 6.9 mm, radiological union was achieved in 17.5 and 18.9 weeks, function scores were 1.81 and 1.94, and the mobility scores were 6.51 and 6.16, respectively. These results show that there were advantages of PFN in terms of the operative times, blood loss, transfusion, ICU care, drain amounts, admission duration, sliding length of the lag screws and radiological union with statistical significance (p<0.05). CONCLUSION: Good clinical results can be achieved with PFN compared with the DHS for the treatment of peritrochanteric fractures of the proximal femur.
Femur* ; Follow-Up Studies ; Hip* ; Humans ; Neck ; Operative Time ; Retrospective Studies

PURPOSE: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types. MATERIALS AND METHODS: There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (<50) results. Radiographic outcome measurements included fracture alignment (neck-shaft angle), loosening of screw, fixation and hardware failure, and malunion and nonunion. RESULTS: Overall, the average ASES score was 80.2 (range 46.0 to 98.0). There were 15/22 (68.2%) excellent, 6/22 (27.3%) satisfactory, and 1/22 (4.5%) poor results. All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. When comparing patients with two-part fractures (n=11) with patients having three-part fractures (n=11), there were statistically significant differences with ASES outcome measures (p<0.05). But, there were no statistically significant differences in age-related analysis (p>0.05). CONCLUSION: Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.
Aged ; Elbow ; Humans ; Humeral Head ; Humerus* ; Neck ; Necrosis ; Outcome Assessment (Health Care) ; Shoulder

Muscle herniation is a relatively common disorder in the extremities, particularly in the lower extremity where the tibialis anteior muscle is the most commonly affected. Usually muscle herniation is asymptomatic or mild but a few patients complain of cramping or severe pain. We report a case of a bilateral hernia of the tibialis anterior muscle that was confirmed by dynamic ultrasonography.
Diagnosis* ; Extremities ; Hernia ; Humans ; Lower Extremity ; Muscle Cramp ; Ultrasonography*

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the clinical outcomes and roentgenographic changes after an percutaneous endoscopic discetomy of an intervertebral disc herniation of the lumbar spine. SUMMARY OF LITERATURE REVIEW: Percutaneous endoscopic discectomy can preserve normal posterior element in the treatment for herniated intervertebral disc of lumbar spine. MATERIALS AND METHODS: Fifty two patients (41 men, 11 women), who had been treated with percutaneous endoscopic discectomy due to a herniated intevertebral disc of the lubar spine and were followed at least 1 year, were enrolled in this study. The mean age was 26.5 years (21~45) and the mean follow-up period was 42 months (12~76). Fifteen, 28 and 9 herniated discs were extracted from L3-L4, L4-L5 and L5-S1, respectively. RESULTS: After the percutaneous endoscopic discectomy, excellent and good results were obtained in 71% (37 cases) of patients but 9% (5 cases) of patients reported poor results. A roentgenographic assessment at the final follow-up showed no instability and no degenerative spondylotic finding. However, the intervertebral disc space was decreased in only 1 case. CONCLUSION: An percutaneous endoscopic discectomy is an effective method for treating a herniated intervertebral disc of the lumbar spine. However, prudent patient selection is very important for achieving good results.
Diskectomy* ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Intervertebral Disc* ; Male ; Patient Selection ; Retrospective Studies ; Spine*

Rhabdomyolysis is an acute disorder resulting from skeletal muscle injury in which intracellular contents are released into extracellular space and plasma. The condition may result from drug or alcohol abuse, infection, collagen disease or intensive excersice, trauma and longstanding comatous mentality. We report a case of sciatic nerve palsy complicating gluteal compartment syndrome due to rhabdomyolysis.
Alcoholism ; Collagen Diseases ; Compartment Syndromes* ; Extracellular Space ; Muscle, Skeletal ; Plasma ; Rhabdomyolysis* ; Sciatic Nerve* ; Sciatic Neuropathy*

PURPOSE: The somatostatin has been suggested to play a role in the transmission of neurotransmitters and the modulation of pain. Therefore, this study was carried out to investigate the spatial and temporal alterations of sstr2 (somatostatin receptors 2) immunoreactivity after an ischemic injury in rats. MATERIALS AND METHODS: Fifty-five rats (Sprague-Dawley, 200-250 g) were assigned to the experimental group, the other five to the control group. In the experimental group, an occlusion of the left common iliac artery was made using an aneurysm clip. Ten groups were classified according to the time after ischemiareperfusion. Dorsal root ganglia (DRG) cells in the L4, L5, L6 levels of the spinal cord, from the rats were examined the sstr2 using an immunohistochemistry technique. RESULTS: The sstr2A/B immunoreactivity (IR) appeared in the DRG after ischemia-reperfusion. The number of sstr2A- and sstr2B-IR neurons were markedly lower in the group of rats 12 hours after ischemia-reperfusion. In the group of rats one day after ischemia-reperfusion, the sstr2A- and sstr2B-IR neurons began to recover in both number and immunoreactivity. Furthermore, 3 days after ischemia-reperfusion, sstr2A/B immunoreactivity decreased in number and immunoreactivity, and 7 days after ischemia-reperfusion, very weak immunoreactivity was observed in the cytoplasm. CONCLUSION: The sstr2A/B immunoreactivity of the DRG exhibited different appearance according to the post-traumatic compartment syndrome or ischemic injury of the leg. In addition, the chronological alterations of sstr2A and sstr2B immunoreactivities may be important in controlling the pain after a transient ischemia-reperfusion event.
Aneurysm ; Animals ; Compartment Syndromes ; Cytoplasm ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Iliac Artery ; Immunohistochemistry ; Leg ; Neurons ; Neurotransmitter Agents ; Rats* ; Receptors, Somatostatin* ; Somatostatin* ; Spinal Cord ; Spinal Nerve Roots*

PURPOSE: Somatostatin has been suggested to play a role in the transmission of neurotransmitters and in the modulation of pain. Of the different subtypes of somatostatin receptors 2, sstr2A and sstr2B are important in the modulation and transmission of pain. The present study was carried out to investigate sstr2 immunoreactivity in rat. MATERIALS AND METHODS: Dorsal root ganglia (DRG) cells at the L4-L6 levels of the spinal cord of 10 rats (Sprague-Dawley, 200-250 g) were examined for sstr2 by immunohistochemistry. RESULTS: In the control group, sstr2A immunoreactivity was strongly positive in the dense network within laminae I and II of the dorsal horn at spinal levels (L4-L6). In contrast to sstr2A, sstr2B immunoreactivity was observed throughout laminae III-VI. In the DRG, sstr2A and sstr2B immunoreactivities were mainly found in medium-sized neurons. CONCLUSIONS: The distribution of sstr2A immunoreactive cells among sstr2 in the dorsal root ganglia (L4-6) resembles that of somatostatin. Incontrast to sstr2A, sstr2B immunoreactivity showed a different distribution. The presence of sstr2A at laminae I and II, and sstr2B at laminae III-VI of the dorsal horn may modulate sensory functions at these different regions of the spinal cord. Considering different actions according to the receptors of the neurotransmitter, the functions of the isoforms of sstr2 appear variable in terms of modulating and transmitting pain.
Animals ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Horns ; Immunohistochemistry ; Neurons ; Neurotransmitter Agents ; Protein Isoforms ; Rats* ; Receptors, Somatostatin* ; Sensation ; Somatostatin* ; Spinal Cord ; Spinal Nerve Roots*

STUDY DESIGN: In-vitro experimental study. OBJECTIVES: To determine the proteoglycan synthesis of the rabbit nucleus pulposus cells in various concentration of extracellular collagen type I and II under the stimulation of TGF-beta1. SUMMARY OF LITERATURE REVIEW: Therapeutic effect of growth factor and gene therapy can be altered by composition of extracellular matrix. However, the effect of extracellular collagen types I and II on synthetic activity of intervertebral disc cells is not thoroughly studied before. MATERIALS AND METHODS: The nucleus pulposus cells were isolated and cultured from 10 skeletally mature rabbits. Cultures were trypsinized and incorporated into alginate beads with different concentration of extracellular collagen type I and II (0.5%, 1.0% and 1.5%). Those cultures with TGF-beta1 (10 ng/ml) served stimulated condition of matrix synthesis. Newly synthesized proteoglycans were assessed by 35 S-sulfate incorporation using chromatography on Sephadex G-25 in PD-10 columns. Scintillation count was normalized with DNA content by Hoechst dye method. RESULTS: In basal condition, difference in proteoglycan synthesis in given concentration of extracellular collagen type I and II were statistically insignificant. In stimulated condition with TGF-beta1, difference in proteoglycan synthesis in given concentration of extracellular collagen type I and II was also statistically insignificant. However, cultures in stimulated condition with TGF-beta1 showed increased amount of newly synthesized proteoglycans compared to those of basal condition regardless of the concentration of extracellular collagen type I and II (p < 0.05). CONCLUSION: Anabolic response of rabbit nucleus pulposus cells is relatively insensitive to extracellular matrix composition, which facilitates application of gene therapy in various conditions of disc degeneration.
Chromatography ; Collagen Type I ; Collagen* ; DNA ; Extracellular Matrix* ; Genetic Therapy ; Intervertebral Disc Degeneration ; Intervertebral Disc* ; Proteoglycans ; Rabbits ; Transforming Growth Factor beta1 ; Trypsin

This study was performed to investigate origins of the dorsal root ganglion cells containing calcitonin gene -related peptide (CGRP) which innervate the calcaneal tendon in the rat. We used the horseradish peroxidase (HRP) or fluoro -gold (FG) to trace retrogradely somatic afferents in dorsal root ganglion cells after unilateral injections into the rat calcaneal tendon. HRP or fluoro -gold labeled DRG cells for the calcaneal tendon were seen generaaly in lumbosacral (L1 to S1) DRGs ipsilaterally. In lumbosacral DRGs, the largest number of labeled cells were found in the L6 DRG. Many DRG cell bodies contained the CGRP throughout the L1~S1. A plenty of HRP -or FG -labeled cells innervating the calcaneal tendon were also identified to contain the CGRP in L1~S1 DRGs. These FG +/- CGRP DRG cells innervating the calcaneal tendon were primarily found in the L6 DRG. These results suggest that the main sensory DRG for the calcaneal tendon is the L6. This fact may be available in diagnosis and treatment of neurogenic pain in the calcaneal tendon.
Animals ; Calcitonin ; Diagnosis ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Horseradish Peroxidase ; Immunohistochemistry ; Rats* ; Spinal Nerve Roots* ; Tendons*

PURPOSE: This study was undertaken to determine the origins of dorsal root ganglion (DRG) cells containing calcitonin gene-related peptide (CGRP) which innervate the quadriceps femoris tendon in the rat. MATERIALS AND METHODS: DRG cells containing CGRP, which innervate the quadriceps femoris tendon, from 25 rats (Sprague-Dawley, 200-250 g) were examined using the retrograde tracing technique (neural tracers: horseradish peroxidase and fluorogold) combined with immunohistochemistry. RESULTS: Injection of horseradish peroxidase (HRP) or fluoro-gold (FG) into the quadriceps femoris tendon resulted in the ipsilaterally labelling of cells between L1 and L6 DRGs. However, a large number of the labelled cells innervating the quadriceps femoris tendon were found in the L3 and L4 DRGs. Many DRG cells were immunostained with CGRP antibody in the L1-6 DRGs. The number of CGRP immunoreactive cells in the lumbar DRGs was larger than in the sacral DRG. FG labelled cells containing CGRP immunoreactivity (FG+CGRP cells) were found in the lumbosacral DRGs. Many FG+CGRP cells innervating the quadriceps femoris tendon were located in the L3 and L4 DRGs. CONCLUSION: These results show that the main DRG origin for the sensory innervation of the quadriceps femoris tendon is L3 or L4. The neurogenic pain of the quadriceps femoris tendon may originate from this region, and suggests that this may be important for the release of neurogenic pain.
Animals ; Calcitonin Gene-Related Peptide ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Horseradish Peroxidase ; Immunohistochemistry ; Quadriceps Muscle* ; Rats* ; Spinal Nerve Roots* ; Tendons*