• Clinics in Shoulder and Elbow
• /
• v.25 no.3
• /
• pp.202-209
• /
• 2022

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection. Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12-48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs. Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1-35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation were improved from 50.0°, 50.9°, 17.7°, and sacrum level before RTSA to 127.3°, 110.0°, 51.8°, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

• Clinics in Shoulder and Elbow
• /
• v.26 no.4
• /
• pp.397-405
• /
• 2023

Background: A precontoured plate rarely fits properly within the patient's clavicle and must be bent intraoperatively. This study aimed to determine whether anatomical reduction could be achieved using a plate bent before surgery. Methods: This study included 87 consecutive patients with displaced mid-shaft clavicle fractures who underwent plate fixation and were followed-up for a minimum of 1 year. After exclusions, 39 consecutive patients underwent fixation with a precontoured plate bent intraoperatively (intraoperative bending group), and 28 underwent fixation with the plate bent preoperatively (preoperative bending group). Using free software and a three-dimensional (3D) printer, ipsilateral clavicle 3D-printed models were constructed. Using plain radiographs, the distance between the edge of the lateral inferior cortex and the medial inferior cortex was measured. The angle between the line connecting the inferior cortex edge and the line passing through the flat portion of the superior cortex of the distal clavicle was measured. Results: Mean length differences between the ipsilateral and contralateral clavicle were smaller on both anteroposterior (AP; P=0.032) and axial images (P=0.029) in the preoperative bending group. The mean angular differences on both AP (P=0.045) and axial images (P=0.008) were smaller in the preoperative bending group. No significant differences were observed between the two groups in functional scores at the last follow-up. Conclusions: Smaller differences in length and angle between the ipsilateral and contralateral clavicle, indicative of reduction, were observed in the preoperative bending group. Using the precontoured technique with low expense, the operation was performed more effectively as reflected by a shorter operation time. Level of evidence: III.

• Investigative Magnetic Resonance Imaging
• /
• v.21 no.3
• /
• pp.177-182
• /
• 2017

Schwannomas are benign nerve sheath tumors that are typically located in soft tissue. Occasionally, schwannomas involve osseous structures. These intraosseous schwannomas are generally benign neoplasms that account for less than 0.2% of primary bone tumors. Schwannomas are very rarely observed in long bones. We present a case of a schwannoma affecting the proximal femur with a coincident subchondral fracture of the femoral head. A 38-year-old-male presented with left hip pain without deteriorating locomotor function. Plain film radiographs displayed a lobulating contoured lesion within the intertrochanteric portion of the femur. The magnetic resonance imaging (MRI) scans showed a tumor occupying the intertrochanteric region. Diffuse bone marrow edema, especially in the subchondral and head portions of the femur that was possibly due to the subchondral insufficiency fracture was also noted. The lesion was surgically excised and bone grafting was performed. Histologically, there was diffuse infiltrative growth of the elongated, wavy, and tapered cells with collagen fibers, which are findings that are characteristic of intraosseous schwannoma. Although very rare, intraosseous schwannoma should be included in the differential diagnosis of radiographically benign-appearing, non-aggressive lesions arising in the femur. The concomitant subchondral fracture of the femoral head confounded the correct diagnosis of intraosseous schwannoma in this case.

• The Journal of the Korean bone and joint tumor society
• /
• v.5 no.1
• /
• pp.17-22
• /
• 1999

Over 60 cases were enlisted, but only 31 cases among 24 patients were eligible with a minimum follow-up of 1 year and complete medical documents with imaging data. There were 18 boys and 6 girls, and 7 patients had bilateral lesions. The age of the patients ranged from 2 to 20 years(mean:10.5 years). At their first visit, most lesions had a highly characteristic location and radiographic appearance of radiolucent lesion(s) ranging from 1 to 3cm, except for one case of 5.5 cm in the posteromedial comer of distal femoral metaphysis. The margins were generally well-defined, although some were ill-defined. After reviewing our cases from the viewpoint of clinical course and radiographic patterns, we divided these lesions into two types. Type I is the osteolytic lesion excavated into the posteromedial aspect of the distal femur without cortical defect; and type II is the buldged out lesion of the femur with cortical irregularity into the surrounding soft tissues. Both types have distinctive clinical courses. Type I lesions were easy to make a definite diagnosis with plain radiographs alone, but in type II, it was sometimes very difficult to differentiate it from malignant tumors or chronic localized osteomyelitis. For this lesion, Gd-enhanced MRI was the most effective method for differential diagnosis. In this study, biopsy was not necessary to confirm the diagnosis. Clinical symptoms of type I were very minor or even absent. Many of them were accidentally found after minor trauma around the knee joint. Clinical symptoms disappeared far earlier than radiographical lesions. No treatment such as restriction of activity or drugs was necessary. For type II, the clinical symptoms were more accentuated and lasted longer, and it was necessary to restrict the activity for a certain period in many cases. However, all were self-limited.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.4
• /
• pp.347-353
• /
• 2010

Objective : Iliac screw fixation has been used to prevent premature loosening of sacral fixation and to provide more rigid fixation of the sacropelvic unit. We describe our technique for iliac screw placement and review our experience with this technique. Methods : Thirteen consecutive patients who underwent spinopelvic fixation using iliac screws were enrolled. The indications for spinopelvic fixation included long segment fusions for spinal deformity and post-operative flat-back syndrome, symptomatic pseudoarthrosis of previous lumbosacral fusions, high-grade lumbosacral spondylolisthesis, lumbosacral tumors, and sacral fractures. Radiographic outcomes were assessed using plain radiographs, and computed tomographic scans. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and questionnaire about buttock pain. Results : The median follow-up period was 33 months (range, 13-54 months). Radiographic fusion across the lumbosacral junction was obtained in all 13 patients. The average pre- and post-operative ODI scores were 40.0 and 17.5, respectively. The questionnaire for buttock pain revealed the following : 9 patients (69%) perceived improvement; 3 patients (23%) reported no change; and 1 patient (7.6%) had aggravation of pain. Two patients complained of prominence of the iliac hardware. The complications included one violation of the greater sciatic notch and one deep wound infection. Conclusion : Iliac screw fixation is a safe and valuable technique that provides added structural support to S1 screws in long-segment spinal fusions. Iliac screw fixation is an extensive surgical procedure with potential complications, but high success rates can be achieved when it is performed systematically and in appropriately selected patients.

• Archives of Plastic Surgery
• /
• v.38 no.2
• /
• pp.194-198
• /
• 2011

Purpose: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. Methods: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. Results: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. Conclusion: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.

• Journal of Veterinary Clinics
• /
• v.26 no.6
• /
• pp.632-636
• /
• 2009

Three dogs presented to the Veterinary Medical Teaching Hospital of the University of Konkuk and Hangang Animal Hospital with a history of perineal swelling. No tenesmus, stranguria, or any clinical signs other than the swelling was observed by the owners in three dogs. On physical examination, the swelling was observed unilaterally in two dogs and bilaterally in a dog. Digital palpation to the swelling confirmed reducible perineal herniation in two dogs and irreducible perineal herniation in a dog. Plain radiographs revealed that no pelvic or abdominal contents other than the fat were displaced into subcutaneous perineal region in three dogs. Internal obturator transposition herniorrhaphy was performed for correction of perineal herniation in three dogs. Contralateral herniation involving fat was noted after surgery in a dog. The follow-up information was based on physical examination by veterinarians or telephone interview with owners. The owners reported that there was no evidence of complications related to surgery such as sciatic nerve injury, rectal prolapse, wound dehiscence, or perineal hernia recurrence in all dogs.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.sup1
• /
• pp.51-54
• /
• 2001

Objective : Authors analyzed clinical outcomes of cranioplasty according to the materials used for covering defects of the skulls. Methods : From January 1997 to February 2000, there were forty one patients undergone cranioplasty at our institution. We used refrigerated autogenous bone flaps in 19 cases(group A) and methyl methacrylate(MMA) in 22 cases(group B). The medical records and plain skull radiographs of the patient were reviewed. Results : There were thirty men and eleven women. Mean follow up period was 12 months(From operation to last Outpatient department follow up). The mean operative time of the group A($136.8{\pm}3$ minutes) was shorter than the group B($172.7{\pm}2$ minutes, Mann-Whitney test, p=0.001). In group A, the degree of satisfaction was good in 8 cases, fair in 10, and poor in 1. In the group B, there were fair in 13 and poor in 9. So the cosmetic result was superior in the group A(Chi-square test, p=0.00). The complications were occured in one case of flap infection in the group A and 6 in the group B(one stitch abscess, 4 infected flaps, one subgaleal hematoma). Conclusion : Cranioplasty using refrigerated autogenous bone flap showed shorter operative time, better cosmetic results, and less complication rate than those using MMA.

• Clinics in Shoulder and Elbow
• /
• v.22 no.2
• /
• pp.87-92
• /
• 2019

Background: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. Methods: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft $f{\ddot{u}}r$ Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20-87 years), and mean follow-up period was 2.3 years (range, 1.0-6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. Results: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). Conclusions: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.33 no.1
• /
• pp.91-98
• /
• 2006

Supernumerary teeth are teeth which result from the continued budding of the enamel organ of the preceding tooth or from excessive proliferation of cells. They are most often found in the maxillary anterior region. And they can be responsible for a variey of irregularities in the primary and transitional dentition. There are two morphological types of supernumerary teeth, supplemental and rudimentary. Supplemental teeth have normal shape and size. In contrast, rudimental teeth have abnormal shape and smaller size. Supplemental supernumerary teeth are most common in permanent lateral incisor area. Its extraction must be decided more carefully with differential diagnosis between normal teeth, because it has normal shape and size. We reports 3 cases of the normal incisor shaped teeth in the maxillary anterior region. In all cases, we used the 3D Dental-CT as well as the conventional plain film such as periapical, occlusal, and panoramic radiograph. Consequently, 3B Dental-CT was valualble to figure out the exact position and morphology of supernumerary teeth, to do more conservative surgery and to reduce surgery stress and time.