In-Ho Jeon

Perioperative morbidity and mortality of total hip replacement in liver transplant recipients: a 7-year single-center experience.

Objective This study aims to evaluate perioperative mortality and morbidity after total hip replacement in liver transplant recipients and suggesting safety guidelines. Background Hip replacement surgery is one of the most common elective surgeries even for organ transplant recipients. However, there is a paucity of literature addressing the morbidity and complications of hip replacement surgery for liver transplant recipients. Materials and Methods We analyzed retrospectively 33 arthroplasty cases in 20 liver transplant recipients carried out in a single center from 2005 to 2011. All perioperative clinical and laboratory data were evaluated together with early and late morbidity and mortality. Result Of 2253 liver transplant recipients, 20 (0.9%) patients underwent 33 total hip arthroplasties. Thirty-two arthroplasties were performed for avascular necrosis of the femoral head, whereas only one was performed for osteoarthritis. There was no death, liver failure, or infection within 30 days after surgery. Three patients showed elevated liver enzyme more than 5 times the normal value, but it eventually decreased to normal within 1 week. Of 33 cases of arthroplasty, postoperative blood transfusion was needed in 14 cases with 1 case receiving more than 4 U. On long-term follow-up, no patients have developed periprosthetic fracture, implant loosening, or liver failure. All patients showed good to excellent postoperative Harris hip score. Conclusion In this series, we can infer that hip replacement surgery in liver transplantation patients is safe and gives a reliably good result. Some preoperative conditions should be obtained to reduce postoperative morbidity.

Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors.

Background To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture. Methods A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into early and late categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement. Results Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003). Conclusions Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.

Non-tuberculous mycobacterial infection of the musculoskeletal system: pattern of infection and efficacy of combined surgical/antimicrobial treatment

Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal tissue is a rare disease. An early and accurate diagnosis is often difficult because of the indolent clinical course and difficulty of isolating pathogens. Our goal was to determine the clinical features of musculoskeletal NTM infection and to present the treatment outcomes. A total of 29 patients (nine females, 20 males between 34 and 85 years old, mean age 61.7 years; 34 to 85) with NTM infection of the musculoskeletal system between 1998 to 2011 were identified and their treatment retrospectively analysed. Microbiological studies demonstrated NTM in 29 patients: the isolates were Mycobacterium intracellulare in six patients, M. fortuitum in three, M. abscessus in two and M. marinum in one. In the remaining patients we failed to identify the species. The involved sites were the hand/wrist in nine patients the knee in five patients, spine in four patients, foot in two patients, elbow in two patients, shoulder in one, ankle in two patients, leg in three patients and multiple in one patient. The mean interval between the appearance of symptoms and diagnosis was 20.8 months (1.5 to 180). All patients underwent surgical treatment and antimicrobial medication according to our protocol for chronic musculoskeletal infection: 20 patients had NTM-specific medication and nine had conventional antimicrobial therapy. At the final follow-up 22 patients were cured, three failed to respond to treatment and four were lost to follow-up. Identifying these diseases due the initial non-specific presentation can be difficult. Treatment consists of surgical intervention and adequate antimicrobial therapy, which can result in satisfactory outcomes.Non-tuberculous mycobacterial (NTM) infectionnof the musculoskeletal tissue is a rare disease. An early and accurate diagnosisnis often difficult because of the indolent clinical course and difficultynof isolating pathogens. Our goal was to determine the clinical featuresnof musculoskeletal NTM infection and to present the treatment outcomes.nA total of 29xa0patients (nine females, 20 males between 34 and 85nyears old, mean age 61.7 years; 34 to 85) with NTM infection of thenmusculoskeletal system between 1998 to 2011 were identified andntheir treatment retrospectively analysed. Microbiological studiesndemonstrated NTM in 29xa0patients: the isolates were Mycobacteriumnintracellulare in six patients, M. fortuitum innthree, M.xa0abscessus in two and M. marinum innone. In the remaining patients we failed to identify the species.nThe involved sites were the hand/wrist in nine patients the kneenin five patients, spine in four patients, foot in two patients,nelbow in two patients, shoulder in one, ankle in two patients, legnin three patients and multiple in one patient. The mean intervalnbetween the appearance of symptoms and diagnosis was 20.8 monthsn(1.5 to 180). All patients underwent surgical treatment and antimicrobialnmedication according to our protocol for chronic musculoskeletalninfection: 20 patients had NTM-specific medication and nine hadnconventional antimicrobial therapy. At the final follow-up 22 patientsnwere cured, three failed to respond to treatment and four were lostnto follow-up. Identifying these diseases due the initial non-specificnpresentation can be difficult. Treatment consists of surgical interventionnand adequate antimicrobial therapy, which can result in satisfactorynoutcomes. Cite this article: Bone Joint J 2014;96-B:1561–5.

A new wide-angle arthroscopic system: a comparative study with a conventional 30° arthroscopic system

AbstractPurposenTo compare users’ hand movements in performing validated shoulder arthroscopic tasks between a 30° and a wide-angle arthroscopic system, using phantom models with an optical motion analysis system.MethodsTwelve orthopaedic residents were enrolled and randomly allocated into two groups. In order to compensate for any learning effect, a Latin square counterbalancing technique was used. An optical motion analysis system was used with markers affixed to pre-designed sites; each participant conducted four validated shoulder arthroscopic tasks using both arthroscopic systems. Each participant was instructed to perform the experiment three times with each arthroscope. The time taken, total path length, number of movements, and average acceleration were analysed.ResultsSignificant differences were observed for the time taken, number of movements, and average acceleration between the two arthroscopic systems (Pxa0<xa00.05 for all). However, the time taken was not significant. The mean total path length measured 53xa0±xa038xa0cm with the 30° arthroscope, while the mean with the wide-angle arthroscope was significantly shorter, at 36xa0±xa022xa0cm. The mean number of movements with the 30° and wide-angle arthroscopes were 1974xa0±xa01305 and 1233xa0±xa0990, respectively, while the average accelerations were 2.6xa0±xa01.3 and 1.2xa0±xa00.6xa0cm/s2, respectively. The mean time taken was 13xa0% faster when using the wide-angle arthroscopic system, although this was not statistically significant.ConclusionThe wide-angle arthroscopic system improved the arthroscope manoeuvre in terms of the total path length, number of movements, and average acceleration required for experimental arthroscopy. This system may help surgeons triangulate the arthroscope and surgical instruments during surgery by expanding the field of view.

Morphometric analysis of the proximal ulna using three-dimensional computed tomography and computer-aided design: varus, dorsal, and torsion angulation

AbstractPurposenThe proximal ulna, particularly the course of the posterior border, has a complex three-dimensional (3D) morphology which has been highlighted recently due to its clinical relevance in relation to surgical treatments. 3D computed tomography (CT) reconstruction and computer-aided design (CAD) based software can help to visualize the complex anatomy and thus aid the investigation of the more detailed morphology of the proximal ulna.MethodsnIn our current study, 3D CT reconstruction images of 20 cadavers were imported into the 3D CAD program. Three morphologic angle parameters of the proximal ulna were measured including the dorsal, varus and torsion angulation. The torsion angulation was measured using the flat spot of olecranon dorsal aspect. We measured the total length of the ulna and the distance between the olecranon tip and the apex of dorsal and varus angulation. Furthermore, the thickness of olecranon was also measured for all the specimens.ResultsnThe results showed that the mean dorsal, varus, and torsion angulation was 4.3° (range 2.6°–5.9°), 12.1° (range 7.9°–17.6°), and 22.5° (range 16.6°–30.5°), respectively. The average length ratio of the dorsal and varus angulation apex to the total ulnar length was 26.4xa0% (range 19.8–30.7xa0%) and 32.7xa0% (range 27.5–37.5xa0%), respectively. The average of olecranon thickness at the proximal tip, mid-olecranon fossa, and at coronoid tip level was 17.8xa0mm (range 14.1–22.8xa0mm), 19.7xa0mm (range 15.8–23.1xa0mm), and 35.1xa0mm (range 27.9–41.8xa0mm), respectively.ConclusionIn conclusion, variations in the proximal ulna have to be considered when anatomically contoured dorsal plates are applied. Knowledge of the 3D morphologic anatomy of the proximal ulna would provide important information on fracture reductions, and the design of a precontoured dorsal plate or a prosthetic ulnar stem.

Fracture dislocation of the proximal humerus with ipsilateral shaft fracture: a report of two cases

We report two cases of ipsilateral proximal humerus fracture dislocation and shaft fracture in young adults. Fractures were treated with prosthetic replacement for the proximal humerus and open reduction and internal fixation for the shaft fracture due to the extent and complexity of the injury.

Comparative analysis of visual field and image distortion in 30° and 70° arthroscopes

PurposeThere have been very few attempts to compare the visual fields and image distortion in arthroscopes. To better understand the images generated using existing arthroscopes, we performed image-mapping experiments to assess field of view and image distortion. The purpose of this study was to quantify and compare the visual fields obtained using 30° and 70° arthroscopes and assess image distortion in each arthroscope.MethodsA complete arthroscopy system was used in this study. To perform this quantitative analysis, we created a customized measurement device that consisted of three parts: (1) distance marker, (2) chessboard pattern, and (3) angle marker. Three observers collectively assessed the appropriate position of the arthroscope during simulation. For each scope, ten simulations were performed at distances between 1 and 3xa0cm. Using the obtained arthroscope images, field of view and image distortion were measured and calculated.ResultsThe field of view of the 70° arthroscope was 5, 10, and 15xa0mm wider in diameter in comparison with the 30° arthroscope at 1, 2, and 3xa0cm, respectively. Moreover, the 70° arthroscope had less 0.66, 0.13, and 0.26xa0pixels of root-mean-square distance than the 30° arthroscope at 1, 2, and 3xa0cm, respectively. The 70° arthroscope also contained 0.78xa0pixels less at the maximal error than the average 30° arthroscope. Therefore, the 70° arthroscope demonstrated less distortion than the 30° arthroscope. There was no significant difference between the two scopes with respect to median curvature measurement at 1-cm distance.ConclusionThe 70° arthroscope demonstrates technical advantages over the 30° arthroscope, including a wider field of view and a less image distortion at the periphery. A wide angle and less image distortion can help better orient the surgeon within the joint cavity when a panoramic picture is needed to repair rotator cuff tears, in case of hip arthroscopy, or while treating the lesions of posterior horn of medial meniscus.

The use of continuous negative pressure after open debridement for septic arthritis of the shoulder

AIMSnThe treatment of septic arthritis of the shoulder is challenging. The infection frequently recurs and the clinical outcome can be very poor. We aimed to review the outcomes following the use of continuous negative pressure after open debridement with a large diameter drain in patients with septic arthritis of the shoulder.nnnPATIENTS AND METHODSnA total of 68 consecutive patients with septic arthritis of the shoulder underwent arthrotomy, irrigation and debridement. A small diameter suction drain was placed in the glenohumeral joint and a large diameter drain was placed in the subacromial space with continuous negative pressure of 15 cm H2O. All patients received a standardised protocol of antibiotics for a mean of 5.1 weeks (two to 11.1).nnnRESULTSnNegative pressure was maintained for a mean of 24 days (14 to 32). A total of 67 patients (98.5%) were cured without further treatment being required. At a mean follow-up of 14 months (three to 72), the mean forward flexion was 123° (80° to 140°) and the mean external rotation was 28°(10° to 40°) in those with a rotator cuff tear, and 125° (85° to 145°) and 35° (15° to 45°) in those without a rotator cuff tear.nnnCONCLUSIONnContinuous negative pressure, following open arthrotomy, irrigation and debridement, was effective in treating septic arthritis of the shoulder. The rate of recurrence was significantly lower than with conventional treatment involving arthroscopic or open debridement reported in the literature. Functional outcomes, even in patients with rotator cuff tears, were excellent.nnnTAKE HOME MESSAGEnContinuous negative pressure is effective in treating septic arthritis of the shoulder. Cite this article: Bone Joint J 2016;98-B:660-5.

Decellularized Nerves for Upper Limb Nerve Reconstruction: A Systematic Review of Functional Outcomes.

BACKGROUNDnThis is a systematic review for evaluating the evidence for functional outcomes after decellularized nerve use in clinical setting. Decellularized nerves are allografts whose antigenic components have been removed, leaving only a scaffold that promotes the full regeneration of axons.nnnMETHODSnLiterature research was performed using the PubMed/MEDLINE database for English language studies with the keywords decellularized nerve and processed nerve allograft. Inclusion criteria were prospective and retrospective case reviews in clinical settings. Exclusion criteria were case reports and case series.nnnRESULTSnWe retrieved six level VIII studies and one level VI study (classified according to the Jovell and Navarro-Rubio scale) with a total of 131 reconstructions. The basic data ranges of the studies were as follows: patient age, 18 to 86 years; duration between initial injury and nerve reconstruction procedure, 8 hours to 4 years; and follow-up period, 40 days to 2 years. The maximum lengths of the nerve gap for chemically washed decellularized nerves and cryopreserved decellularized nerves were 50 and 100u2009mm, respectively. Quantitatively, the functional outcome ranges were as follows: static two-point discrimination, 3 to 5u2009mm; and moving two-point discrimination, 2 to 15 mm. For motor assessment, all patients had au2009>u2009M3 Medical Research Council score. It is also important to notice that a large variability occurs in almost every factor in the reviewed studies.nnnCONCLUSIONnOur study is the first to summarize the clinical results of decellularized nerves. Decellularized nerves have been used to bridge nerve gaps ranging from 5 to 100u2009mm with associated satisfactory outcomes in static and moving two-point discriminations.

Results of Abductor Pollicis Longus Suspension Ligamentoplasty for Treatment of Advanced First Carpometacarpal Arthritis

Background Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty. Methods The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs. Results The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71° preoperatively to 82° postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously. Conclusions The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.