PURPOSE: To evaluate the reliance of standard AP radiograph and Ferguson radiograph in assessment of instrumented lumbosacral fusion mass with interobserver and intraobserver reproducibilities. MATERIALS AND METHODS: Postoperative standard AP radiograph and Ferguson radiograph were used to evaluate the fusion mass at the lumbosacral region of 44 consecutive patients who underwent posterolateral L4-S1 or L5-S1 instrumented fusion with pedicle screws & autogenous iliac bone graft. Ferguson radiograph was performed with the x-ray beam oriented toward the cranial portion at 40degree relative to the x-ray table. All observations were performed independently by three observers, blinded to the history, diagnosis, and patient identity. The fusion mass was graded as solid, pseudarthrosis or questionable. A second review was repeated at 2 weeks after index review. Interobserver and intraobserver reproducibilities were analyzed with Fleiss'method. RESULTS: Ferguson radiographs were more reliable than standard AP radiographs in detecting the fusion mass. Kappa values with the interobserver reproducibility were higher in Ferguson radiographs than in the standard AP radiographs. Kappa values with the intraobserver reproducibility of all three observers were higher in Ferguson radiographs than in the standard AP radiographs. The questionable fusion masses in the standard AP radiographs were revealed solid or pseudarthrosis in Ferguson radiographs in 67%. CONCLUSIONS: Ferguson radiograph is a more reliable method than standard AP radiograph in evaluating instrumented posterolateral fusion mass in lumbosacral region.
Diagnosis ; Humans ; Lumbosacral Region ; Pseudarthrosis ; Transplants

No abstract available.
Apoptosis* ; Osteoarthritis*

Experimental study was conducted to prove the effect of pulsed electromagnetic field (PEMF) on the production of Nitric oxide (NO) from the cultured rat osteoblast-like cells. Calvarium of thirty Sprgue-Dawley rats was digested by sequential collagenase and cultured in-vitro. The osteoblast cell phenotype was confirmed by expression of osteoclacin by immunohistochemistry. PEMF was generated and applied to cultured osteoblast cells. Production of NO was measured by Greiss reaction. Ten minute exposure of PEMF to ostoeblast cell showed increased NO content at 24 and 48 hours(p<0.05). Cultures with different duration of PEMF exposure (10, 20, 30 60 minutes) demonstrated similar responses. In conclusion. this study proved that NO can be generated with PEMF which support the notion that NO can be a possible mediator of PEMF on bone metabolism.
Animals ; Collagenases ; Electromagnetic Fields* ; Immunohistochemistry ; Magnets* ; Metabolism ; Nitric Oxide* ; Osteoblasts* ; Phenotype ; Rats* ; Skull

Experimental study was conducted to prove the effect of pulsed electromagnetic field (PEMF) on the production of Nitric oxide (NO) from the cultured rat osteoblast-like cells. Calvarium of thirty Sprgue-Dawley rats was digested by sequential collagenase and cultured in-vitro. The osteoblast cell phenotype was confirmed by expression of osteoclacin by immunohistochemistry. PEMF was generated and applied to cultured osteoblast cells. Production of NO was measured by Greiss reaction. Ten minute exposure of PEMF to ostoeblast cell showed increased NO content at 24 and 48 hours(p<0.05). Cultures with different duration of PEMF exposure (10, 20, 30 60 minutes) demonstrated similar responses. In conclusion. this study proved that NO can be generated with PEMF which support the notion that NO can be a possible mediator of PEMF on bone metabolism.
Animals ; Collagenases ; Electromagnetic Fields* ; Immunohistochemistry ; Magnets* ; Metabolism ; Nitric Oxide* ; Osteoblasts* ; Phenotype ; Rats* ; Skull

BACKGROUND: Osteoporotic fracture is an important cause of disability in elderly women, and vertebral fractures are the most common of aU osteoporotic fractures. To prevent osteoporotic vertebral fracture, risk factor identification is necessary, therefore, we examined the relationship between the well-known risk factors for osteoporosis or falls and vertebral fracture. METHODS: A total 105 Korean women aged 50-76 and had postmenopausal osteoparosis were enrolled in this study. We examined the factors attributing to develop the osteoporotic vertebral fractures through comparing the arthropometric data, past and family histories of fractures, amount of exer#cise, risk factors for falls, biochemical markers, and bone mineral densities. RESULTS: 41 had one or more vertebral fractures and 64 had no vertebral fracture. Compared to women without vertebral fracture, women with vertebral fractures were older, smaller and showed higher waist-hip ratio and larger degree of kyphosis. History of previous fractures had a significant correlation with vertebral fractures and spending a few hours daily on the feet was a risk factor for osteoporotic vertebral fractures. Women who had no vertebral fracture had greater muscle mass of leg, walked faster, and tolerated more time in tandem position than who had any osteoporotic. vertebral fracture. Compared to the non-fractured group, serum albumin level was lower in the fractured group, and urine deoxypyridinoline/creatinine ratio, the bone resorption marker, was greater in the fractured group as predicted. Women without any fracture had greater bone mineral density of femoral neck and lumbar vertebrae. In Logistic regression analysis, waist-hip ratio, history of previous fractures, degree of kyphosis, and thigh circumference were the risk factors for the osteoporotic vertebral fracture. CONCLUSION: It could be possible to prevent osteoporotic vertebral fractures by efforts to identify and reduce the risk factors. But prospective studies should be performed regatding social and traditional characteristics of Korea.
Aged ; Biomarkers ; Bone Density ; Bone Resorption ; Female ; Femur Neck ; Foot ; Humans ; Korea ; Kyphosis ; Leg ; Logistic Models ; Lumbar Vertebrae ; Osteoporosis ; Osteoporotic Fractures ; Risk Factors* ; Serum Albumin ; Thigh ; Waist-Hip Ratio

PURPOSE: This study was designed to compare fracture healing in normal and ovariectomized rat, and to evaluate the effect of intermittent administration of parathyroid hormone on fracture healing in osteopenic animal model, MATERIALS AND METHODS: Four-months-old mature female Sprague-Dawley rats were randomly elivided into 5 groups. Group I underwent a sham operation, and others (Group II-V) were ovariectomized. At three months after ovariectomy or sham operation, standardized bilateral transverse tibial fractures were created and intramedullary nailings with Kirschner wire were performed. The rats were then treated with daily subcutaneous injection of placebo in Groups I and II, 17beta-estradiol in Group III, low doses of recombinant human PTH (1-84) in Group IV, and high doses of recombinant human PTH (1-84) in Group V for 4 weeks. At day 30 of post-fracture the animals were sacrificed and fracture healing was assessed with histologic/histomorphometric analysis and three-point bending mechanical testing. RESULTS: On histologic/histomorphometric evaluation of sham operation group, the fracture callus mainly consisted of dense trabecular bone. On the other hand, Groups II and III seemed to have much looser cancellous network, abundant in fibrous marrow. In parathyroid hormone-treated g roups, external callus consisted of more dense trabecular, woven bone than that of Groups II or III, and especially the high doses of parathyroid hormone-treated group was comparable to the sham operation group in terms of per cent trabecular bone volume (Group I>V>IV>III=II, P<0.05). Mechanical testing indicated that ultimate load was reduced in Group II and III compared to sham operated or parathyroid hormone-treated groups (Group I=V>IV>III=II, P<0.05). Other significant differences were the increase in absorbed energy at ultimate load of Groups I and V (Group I=V>IV=III=II, P<0.05), and increase in ultimate stress of Groups I and V (Group I=V>IV=II=III, P<0.05). CONCLUSIONS: On the basis of this study, it may be concluded that fracture healing is delayed in the ovariectomy-induced osteopenic rat model. Our experiment also showed dose-related stimulation of parathyroid hormone in the strength of fracture, and that antiresorptive agents such as estrogen had no effect. Further study is needed in large animal model, and attention should be focused on systemic/long-term effect of parathyroid hormone and its relationship with local growth factors in fracture healing.
Animals ; Bone Density Conservation Agents ; Bone Marrow ; Bony Callus ; Estrogens ; Female ; Fracture Fixation, Intramedullary ; Fracture Healing* ; Hand ; Humans ; Injections, Subcutaneous ; Intercellular Signaling Peptides and Proteins ; Models, Animal ; Ovariectomy ; Parathyroid Hormone* ; Rats* ; Rats, Sprague-Dawley ; Tibial Fractures

PURPOSE: To investigate whether simple measurements made on conventional pelvis plain film could predict hip fractures independently of bone mineral density. MATERIALS AND METHODS: The authors analyzed the simple radiographs and dual x-ray absorptiometry scan of women over the age of 60 years who had sustained a neck fracture (n=40), trochanteric fracture (n=40) and non-fracture volunteers (n=40). RESULTS: In an age-adjusted univariate logistic regression model, the most reliable risk factor of hip fracture in bone mass was bone mineral density of the femoral neck. In the measurements of bone architecture, the most important risk factor was Singh index and in bone geometric measurements, it was hip axis length. There were no statistical differences in the measurements between neck fractures and trochanteric fractures. In a multivariate model, these three variables were shown to be significant improvements in the assessment of hip fracture risks. CONCLUSIONS: The authors concluded that simple measurements of proximal femoral geometry made on pelvic radiographs could predict hip fracture as well as bone density of the hip.
Absorptiometry, Photon ; Axis, Cervical Vertebra ; Bone Density ; Female ; Femur Neck ; Femur* ; Hip Fractures* ; Hip* ; Humans ; Logistic Models ; Neck ; Pelvis ; Risk Factors* ; Volunteers

PURPOSE: We intended to check the growth rates and phenotypic markers of chondrocytes in the dedifferentiated cells cultivated in various conditions in order to establish the ideal culture system for implantation. MATERIALS AND METHODS: Culturing rabbit chondrocytes from proximal tibia, we checked the phenotypes at first, second, and third week. Then we cultured the chondrocytes in different circumstances such as monolayer or three dimensional gel in the presence or abscence of TGF-B1, and checked the growth rates and phenotypic markers. RESULTS: There was no difference in growth rates and mRNA level of type I, type II collagen and aggrecan between the cells cultured in monolayer and three dimensional gel of collagen. However, the responses of the cells to TGF-B1, were quite different between these two groups. In monolayer culture, the expression of type I collagen was depressed by TGF-B1 while the growth rate was markedly increased. Oppositely in three dimensional culture, the mRNA level of type I collagen was markedly increased and the growth rate was completely suppressed by TGF-B1. The expression of type II collagen could be detected only in TGF-B1-treated cells cultured in three dimensional gel for 4 or more days. The mRNA level of aggrecan was also increased by TGF-B1, in the cells cultured in three dimensional gel. CONCLUSIONS: These results suggest that the number of chondrocytes can be efficiently expanded by culturing the cells in monolayer and the phenotypes of chondrocyte can be restored by culturing the cells in three dimensional gel containing TGF-B1. The application of semi-solid gel containing differentiated chondrocytes in physeal implantation should be further evaluated
Aggrecans ; Chondrocytes* ; Collagen ; Collagen Type I ; Collagen Type II ; Phenotype ; RNA, Messenger ; Tibia ; Transforming Growth Factor beta1*

The lateral ankle ligaments consisted of the anterior talofibular, posterior talofibular and calcaneofibular ligaments. This study was to investigate the dimensions and anatomic variations of these ligaments and correlate with MR images. Sixty seven ankles of Korean adults were used. Among these 37 ankles were only disseted and 30 ankles were dissected after getting MR images. The anterior talofibular ligament consisted of two bands in 72.4%. The length and thickness of this ligament were 20.9mm and 1.8mm, respectively. The widths were 7.0 mm in the upper band and 4.7 mm in the lower band. The talofibular ligament appeared as a hypointense thick band or several lines in MR images. This ligament was observed in 100% of the axial MR sections and 82.8% of the coronal sections. The posterior talofibular ligament showed single thick band in 53.2% while others showed as two bands. The length, width, thickness and the angle between the horizontal plane and the posterior talofibular ligament were 21.8 mm, 7.3 mm, 3.4 mm and 22.6degrees, respectively. In coronal MR images this ligament appeared as a hypointense and heterogeneous thick band between the lateral malleolus and the talus. All anterior and posterior talofibular ligaments were observed in axial MR images with at least one same MR plane showing the two ligaments together. The length, width and thickness of the calcaneofibular ligament were 25.3 mm, 5.2 mm and 2.3 mm, respectively. It was composed of two bands in 8.5%. The angles to the coronal and sagittal planes and this ligament were 20.7degrees(range 5degrees~60degrees) and 27.0degrees(range 7degrees~50degrees), respectively. The calcaneofibular ligament was seen as a hypointense short line or dot depending on the cut plane. It was observed in 72.4% of the axial MR images and in 75.9% of the coronal images but was better imaged in the coronal planes.
Adult ; Ankle* ; Humans ; Lateral Ligament, Ankle ; Ligaments* ; Magnetic Resonance Imaging* ; Talus

Biologic resurfacing of the damaged joints is an area of great interest and clinical promise because of the limited potential ofdamaged articular cartilage healing. Several methods such as spongiolization. joint dehridement and ahrasion of suhchondral hone. perichondral grafts, and osteochondral grafts have heen used to repair cartilage defects, but the results were not satisfactory. Rccently autologous chondrocyle transplantation with a pcrioslcal patch was paid an altention for its advantage , the regeneration with hyalin cartilage. But it have many disadvantages such as too expensive cost. second staged operation, and technically difficult to isolatc chondrocytes from a small volume of donor site, so we performed that a definecl cartilaee delect in the ribbit patella was treated with transplanta1ion of in virto expanded allogenic chondrocvtes and then compared with an autologous chondrocytes transplantation. Adult rabbits were used to transplant autogenously and allogenously and allogenically harvested and in vitro cultured chondrocytes into patellar chondral lesions that had been made previously 3x 3mmin size , extending down to the calcified zone. Chondrocytes were isolated in the femoral condyle of the opposite knee or othe rabbit knee. And then enzymatic digestion ( collagenase A and DNase I ) was performed for 5 hours room temperature in a spinner bottle and cells were seeded in a 25cm2 culture flask in Dulheccos modified essential medium (DMEM), supplemented with l0% fetal hovine serum (FBS). The culture medium was changed twice weekly. After 14 days of culture, the cells were isolated hy irypsinization and transplanted into previously made chondral defects with an autogenous periosteal patch taken from the medial aspect of tibia. Healing ol' the defects was assessed by gross examination, immunohistochemical stain, and light microscope with hematoxylin-eosin stain at 8, 16, and 24 weeks. Allogenic and autologous chondrocytes transplantation significantly increased the amount of newly tormed repair tissue compared to that found in control knees in which the Jesion was solely covered hy a periosteal patch. The repair tissue, however, had a tendency of incomplete bonding to adjacent cartilage. This study shows that allogenic and autologous articular chondrocytes that have heen expanded for 2 weeks in vitro can stimulate the healing phase of chondral lesion. There is no signilicant diffcrence hetween allogenic and autologous chondrocytes transplantation.
Adult ; Cartilage ; Cartilage, Articular ; Chondrocytes* ; Collagenases ; Deoxyribonuclease I ; Digestion ; Humans ; Hyalin ; Joints ; Knee ; Patella* ; Rabbits ; Regeneration ; Tibia ; Tissue Donors ; Transplants