Ischial bursitis is a relatively common cystic lesion that is palpable as a mass in the buttocks. On the other hand, hemorrhagic ischial bursitis accompanied by vascular injury is uncommon, and it can be challenging to diagnose clinically or radiologically. This paper reports a 74-year-old male patient with a cystic lesion in the right ischial tuberosity that occurred after a fall from a ladder 2 months earlier. The initial diagnosis of ischial bursitis was suggested, but conservative treatment did not lead to improvement. Subsequent follow-up showed that the condition was a hemorrhagic ischial bursitis with vascular damage involving a branch of the internal pudendal artery. The patient experienced improvement after undergoing percutaneous embolization.

Purpose: This study examined the patient-reported outcome scores at mid-term follow-up after arthroscopic labral preservation in patients with borderline hip dysplasia. Materials and Methods: Data were collected retrospectively from patients who underwent arthroscopic labral preservation. Among the 61 patients classified with hip dysplasia, patients with arthritis beyond Tönnis grade II were excluded, Patients with subchondral bony exposure were excluded even if they had arthritis of Tönnis grade I. Forty-two patients with borderline hip dysplasia were enrolled among patients whose lateral center edge angle (LCEA) was between 18° and 25°. The PRO scores including the modified Harris hip score (mHHS), hip outcome score activities of daily living (HOS-ADL), hip outcome score sport-specific subscale (HOS-SSS) and visual analog scale (VAS), were collected and compared preoperatively, and then at one year and a minimum of five years after surgery. Results: The mean preoperative LCEA and Tönnis angle were 20.9° (range, 18° to 25°) and 6.3° (range, 0° to 18°), respectively. The mean follow-up was 64.8 (range, 60 to 84) months. The mean mHHS increased from 73.5 before surgery to 86.2 in the fifth year after surgery (p<0.01), the mean HOS-ADL from 70.5% before surgery to 84.9% in the fifth year after surgery (p<0.01), and the mean HOS-SSS from 51.4 before surgery to 69.4 in the fifth year after surgery (p<0.01). The mean VAS score improved from 6.3 before surgery to 1.5 in the fifth year after surgery (p<0.01). Conclusion Arthroscopic labral preservation performed in appropriately selected patients with borderline dysplasia showed good results at mid-term follow-up. In borderline hip dysplasia without the progress of osteoarthritis and subchondral bone exposure, arthroscopic labral preservation may be considered a good and less invasive option.

Reverse total shoulder arthroplasty (RTSA) is an effective surgical method for rotator cuff tear arthropathy, irreparable cuff tear, complex fracture of the proximal humerus, and revision after anatomical total shoulder arthroplasty. As the scope of application and the number of trials have increased recently, there have been reports of scapular notching, glenoid loosening, infection or peri-scapular fractures. On the other hand, there are no reports of concomitant fractures of the coracoid and acromion after RTSA. The authors experienced two cases with concomitant fractures of the coracoid and acromion after RTSA. This paper reports these cases with a literature review and discusses the causes.

Background: The purpose of this study was to evaluate clinical and radiological outcomes at skeletal maturity after a calcaneo-cuboid-cuneiform osteotomy (triple C osteotomy) for symptomatic flatfoot deformity compared with healthy young adult controls. Methods: Nineteen patients (30 feet) who undergone a triple C osteotomy for idiopathic symptomatic flatfeet from July 2006 to April 2013 were compared with 19 controls (38 feet). Radiographic measurements at preoperative examination, 1-year postoperative follow-up, and follow-up at skeletal maturity were evaluated. Functional outcomes were assessed by using the validated visual analog scale foot and ankle (VAS-FA) and the modified American Orthopaedic Foot and Ankle Surgery (AOFAS) score. Results: In the triple C osteotomy group, 11 of 12 radiographic measurements were significantly improved at 1 year postoperatively and the last follow-up (p < 0.001). There was no recurrence at skeletal maturity (p > 0.05). There were no significant differences in nine of 12 radiographic measurements between the triple C osteotomy group at maturity and the control group (p > 0.05). Average VAS-FA and AOFAS scores were significantly improved at the time of skeletal maturity (p < 0.001). Conclusions Surgical correction of symptomatic flatfoot deformity in childhood resulted in favorable outcomes after the triple C osteotomy. Deformity correction was also maintained during follow-up at skeletal maturity.

Purpose: To evaluate the timing of the improvement in surgical skills of the direct anterior approach for hip arthroplasty through an analysis of the clinical features and learning curve in 58 cases. Materials and Methods: From November 2016 to November 2018, 58 patients, who were divided into an early half and late half, and underwent hip arthroplasty by the direct anterior approach, were enrolled in this retrospective study. The operation time and complications (fracture, lateral femoral cutaneous nerve injury, heterotopic ossification, infection, and dislocation) were assessed using a chi-square test, paired t-test, and cumulative sum (CUSUM) test. Results: The mean operation times in total hip arthroplasty (26 cases) and bipolar hemi-arthroplasty were 132.1 minutes and 79.7 minutes, respectively, demonstrating a significant difference between the two groups. CUSUM analysis based on the results revealed breakthrough points of the operation time, decreasing to less than the mean operation time because of the 16th case in total hip arthroplasty and 14th case in bipolar hemiarthroplasty. Complications were encountered in the early phase and late phase: five cases of fractures in the early phase, no case in the late phase; eight and two cases of lateral femoral cutaneous nerve injury, respectively; three and two cases of heterotopic ossification, respectively; and one case of dislocation, one case of infection and three cases of others in the early phase. The CUSUM chart for the fracture rate during operation in the early phase revealed the following: five cases fracture (17.2%) in the early phase and no case in the late phase (0%). This highlights the learning curve and the need for monitoring the inadequacy of operation based on the complications. Conclusion Hip arthroplasty performed by the direct anterior approach based on an anatomical understanding makes it difficult to observe the surgical field and requires a learning curve of at least 30 cases.

PURPOSE: The purpose of this retrospective study was to evaluate clinical outcomes of endoscopic nerve decompression in patients with deep gluteal syndromes (DGS). MATERIALS AND METHODS: Between October 2013 and March 2015, 24 patients who underwent surgical treatment of DGS were retrospectively included in this study. The mean age was 47 years (range, 35 to 76 years), and there were 11 males and 13 females. The mean duration of pain was 12 months (range, 5 to 35 months) and the mean follow-up period was 32 months (range, 26 to 45 months). Clinical evaluations included the visual analog scale (VAS) pain score, modified Harris hip score (mHHS), and the symptom-rating scale. RESULTS: Significant improvement in symptoms following endoscopic decompression were achieved as measured using the VAS score (decrease in the mean from 7.1±0.9 to 2.5±1.5; P < 0.001) and mHHS (increase from 59.4±6.5 to 85.0±8.3; P < 0.001). CONCLUSION: Endoscopic sciatic nerve decompression was satisfactory for treating recalcitrant DGS, making it an effective treatment option to improve symptoms of DGS.
Decompression ; Female ; Follow-Up Studies ; Hip ; Humans ; Male ; Retrospective Studies ; Sciatic Nerve ; Visual Analog Scale

PURPOSE: The outcome of hip arthroscopy as a treatment of patients with hip dysplasia is variable. In patients with severe hip dysplasia, arthroscopy has the potential to exacerbate instability and unfavorable outcome. To the best of out knowledge, there has not been a report regarding arthroscopic treatment in patients with borderline hip dysplasia in Korea. We favorable outcome with using arthroscopy to treat symptomatic borderline hip dysplasia. MATERIALS AND METHODS: Between August 2010 and February 2015, 143 patients undergoing hip arthroscopy for intra-articular hip disorder were retrospectively enrolled. From this cohort, a borderline dysplasia group compromising 29 patient with lateral center edge angle (LCEA) >18° and <25° and a minimum of 1 years follow-up, was identified. Patient-reported outcome scores, including modified Harris hip score, the hip outcome score-activity of daily living, the sport-specific subscale, visual analogue scale (VAS) and satisfaction survey were obtained preoperatively and at postoperative 3 months, 6 months, 1 year, 2 years, and 3 years. Revision surgery and complications were recorded for each group. RESULTS: The mean age was 35.7 years (range, 16–63 years) years respectively. There were 16 females (55.2%) and 13 males (44.8%). The mean LCEA was 22.0° (range, 18°–25°) and the mean Tönnis angle was 6.1° (range, 0°–18°). The mean follow-up was 20.2 months (range, 12–39 months), and at the 1 year follow-up, there was significant improvement (p<0.001) in all patient reported outcome scores and VAS. Satisfaction survey showed an average score of 7.7. CONCLUSION: In patients with borderline hip dysplasia, if there is an occurrence of symptomatic labral tear, arthroscopic labral refixation has a good short-term result. Therefore, if patients have no response to conservative treatment or have severe pain, arthroscopic labral refixation is a useful treatment options to relieve symptom.
Arthroscopy* ; Cohort Studies ; Female ; Follow-Up Studies ; Hip Dislocation* ; Hip* ; Humans ; Korea ; Male ; Retrospective Studies ; Tears

Atlas fracture accounts for 1% to 3% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. Only a few cases involving complications after surgical treatment have been reported. We present a case of anterior atlas arch stress fracture accompanied by worsening neurologic symptoms following atlas posterior arch resection for cervical myelopathy with retro-odontoid pseudotumor.
Cervical Atlas ; Fractures, Stress* ; Motor Vehicles ; Neurologic Manifestations ; Spinal Cord Diseases* ; Spine

Norovirus and rotavirus are important causes of acute nonbacterial gastroenteritis in communities worldwide. Genotypes of norovirus and rotavirus in stool samples, which were collected from patients, was determined by RT-PCR and ELISA. A total 4,484 stool samples (461 outbreak cases) collected during January 2010-April 2013 were analyzed. Four hundred thirty eight of samples were positive for norovirus. Twelve samples were positive for Rotavirus. Norovirus genotypes identified were nine kinds of G I genotype (G I -1, G I -2, G I -3, G I -4, G I -6, G I -7, G I -9, G I -12, G I -13) and nine kinds of G II genotype(G II -2, G II -4, G II -5, G II -6, G II -7, G II -11, G II -12, G II -15, G II -16). Rotavirus genotypes were G2P[4]. The results might be useful information for evaluating the epidemiological status of viral diarrhea in Seoul, and providing a strategy to prevent human norovirus, rotavirus and other threats to public health in Korea.
Diarrhea ; Enzyme-Linked Immunosorbent Assay ; Gastroenteritis* ; Genotype ; Humans ; Korea ; Norovirus* ; Public Health ; Rotavirus* ; Seoul*

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the three-plus year follow-up results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with mid-term follow up periods. MATERIALS AND METHODS: 260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and post-operative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes. RESULTS: VAS (pre-operative to final follow-up) changed from 7.62+/-2.03 (5-10) to 3.19+/-1.94 (1-8) in group A, from 6.83+/-2.28(4-9) to 4.51+/-2.18(2-9) in group B and from 7.17+/-2.46 (5-10) to 4.63+/-1.97(1-9) in group C. Final follow-up ODI also decreased in group A (17.6+/-8.56%), group B (15.4+/-5.46%) and group C (24.7+/-7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, post-operative and final follow-up lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results. CONCLUSIONS: Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels.
Animals ; Follow-Up Studies ; Humans ; Ketones ; Lordosis ; Polyethylene Glycols ; Reoperation ; Retrospective Studies