Jae Jun Yang

Pseudoaneurysm of the Anterior Tibial Artery After Ankle Arthroscopy Treated with Ultrasound-Guided Compression Therapy: A Case Report

Most pseudoaneurysms forming after arthroscopic surgery have involved the popliteal vessels after knee arthroscopy1,2. However, the cases of five patients who had a pseudoaneurysm of the anterior tibial artery after ankle arthroscopy have been reported in the English-language literature and were found after a search of the PubMed database with use of three keywords: pseudoaneurysm, ankle, and arthroscopy1,3-6. Although the cases of two patients involved anticoagulation therapy5 and hemophilia3, which increase the risk of arterial injury, iatrogenic trauma may have occurred during portal placement or operative procedures, such as synovectomy and osteophyte resection. All five patients described in the literature were treated by different surgical techniques. We present the case of a patient who had delayed detection of an anterior tibial artery pseudoaneurysm with osseous erosion after ankle arthroscopy. The condition was treated effectively with ultrasound-guided compression therapy. The patient was informed that data concerning the case would be submitted for publication, and he consented. A twenty-five-year-old man, in good general health, presented with a four-year history of pain and swelling in the anterolateral aspect of the right ankle. In addition, the ankle had sustained recurrent plantar flexion and inversion sprains that had been treated conservatively with rest, compression, and intermittent splinting. Physical examination revealed tenderness and moderate swelling of the anterolateral aspect of the right ankle with a positive anteromedial rotatory drawer maneuver7. Stress radiographs demonstrated a positive anterior drawer sign, and magnetic resonance imaging showed increased signal intensity in the anterior talofibular ligament and anterolateral synovitis of the right ankle. The patient underwent ankle arthroscopy with a 4.0-mm, 30° arthroscope with use of standard anteromedial and anterolateral portals under tourniquet control and noninvasive distraction of up to 20 lb (9 kg) with an …

Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty

The efficacy and accuracy of computer navigation have been proved during recent years. But most of recent studies focused on the coronal alignment in total knee arthroplasty and less on sagittal alignment. We retrospectively compared the results of the radiographs of 35 primary TKAs using a non-image based navigation system and 36 primary TKAs using fluoroscopy-assisted conventional technique. To compare the radiographic results, the following parameters were measured: mean mechanical femorotibial angle, mean femorotibial anatomical angle, mean coronal femoral component angle, mean coronal tibial component angle, mean sagittal femoral component angle, and mean sagittal tibial component angle. The navigation TKA showed better accuracy and consistency in mechanical axis deviation, coronal femoral component angle, and sagittal tibial component angle. The coronal tibial component position was acceptable in both groups. The navigation TKA markedly improved the restoration of mechanical axis, but not so much in sagittal femoral component position. The fluoroscopy-assisted conventional TKA had a tendency that femoral component was inserted in flexed position than in navigation TKA. Unlike the fluoroscopy-assisted conventional TKA, the femoral component was inserted in slightly extended position in the navigation TKA than expected. In conclusion, even though the use of navigation in TKAs help the surgeon to achieve good results, the surgeon should know the tendency of extension of the femoral component in sagittal plane to avoid anterior notching.

Early Postoperative Analgesic Effects of a Single Epidural Injection of Ropivacaine Administered Preoperatively in Posterior Lumbar Interbody Spinal Arthrodesis A Pilot Randomized Controlled Trial

BACKGROUND Despite the suitable characteristics of ropivacaine as an epidural analgesic agent, such as better preservation of motor function and less neurotoxicity, we are aware of no data on its clinical application in pain management following lumbar spine surgery. The purpose of the present study was to evaluate the preemptive analgesic effects and safety of a single epidural injection of ropivacaine during lumbar arthrodesis. METHODS We performed a randomized, double-blinded, intention-to-treat study. Patients with planned one-level posterior lumbar interbody arthrodesis were randomly assigned to either the injection group (n = 32) or the control group (n = 34). The injection group received a 10-mL epidural injection of 0.1% ropivacaine twenty minutes before the skin incision at the planned vertebral level, and the control group received an epidural injection of 10 mL of 0.9% saline solution. A numeric rating scale (from 0 to 10) was measured at seven time points after surgery (at two, four, eight, twelve, twenty-four, and forty-eight hours and at the time of discharge), and the frequency of pushed-button patient-controlled analgesia and total fentanyl consumption were assessed at similar time points (up to two, up to four, up to eight, up to twelve, up to twenty-four, and up to forty-eight hours after surgery). Postoperative nausea and vomiting, the duration of the hospital stay, and the Likert satisfaction score at the time of discharge were evaluated. RESULTS There were no significant differences between the two groups preoperatively. The numeric rating scale score was higher until twelve hours (p < 0.05) and the frequency of button pushes was higher at every time point except eight to twelve hours (p < 0.05) in the control group as compared with the injection group. Fentanyl consumption until eight to twelve hours (p < 0.05) and total consumption (p < 0.001) at discharge were higher in the control group. There were no differences between the two groups in terms of postoperative nausea and vomiting, the duration of hospital stay, or the mean satisfaction score, and no transient motor weakness was seen in relation to epidural injection of ropivacaine. CONCLUSIONS A single-dose epidural injection of 0.1% ropivacaine before lumbar spine surgery is effective for reducing early postoperative pain without related complications such as transient motor weakness.

Acutely Progressing Paraplegia Caused by Traumatic Disc Herniation Through Posterior Schmorlʼs Node Opening Into the Spinal Canal in Lumbar Scheuermannʼs Disease

Study Design. A case report. Objective. To report an unusual neurologic complication caused by traumatic disc herniation through atypical posterior Schmorls node (SN) opening into the spinal canal in lumbar Scheuermanns disease. Summary of Background Data. Neurologic complications in Scheuermanns disease are rare and disc hernia has been reported as one of the causes of neural compression. However, there has been no report on acutely progressing paraplegia caused by traumatic disc herniation through an atypical posterior SN opening into the spinal canal in lumbar Scheuermanns disease. Methods. A clinical and radiologic review of such a case of traumatic disc herniation through an atypical posterior SN that resulted in acutely progressing paraplegia in Scheuermanns disease was performed. Results. The patient presented with severe back pain after a fall, without any neurologic abnormalities. Computed tomographic scan revealed lumbar Scheuermanns disease, acute compression fracture of T12, and a large posterior SN with “trough-like” indentation of the lower endplate of T12 opening into the spinal canal. Abruptly progressing paraplegia occurred in less than 24 hours after the first visit and the magnetic resonance imaging revealed severe spinal cord compression by large disc extrusion with superior migration at T12-L1 through the atypical posterior SN at the lower endplate of T12. The patient underwent posterior decompression and discectomy at T12-L1 through transfacet pedicle-sparing approach. Postoperatively, the patient showed immediate improvement in the sensory deficit on L1 dermatome and the perianal area and motor function of the hip flexors to grade 2 without further neurologic improvement, at 2-year follow-up. Conclusion. The case report highlights the clinical significance of the atypical posterior SN that could be a channel for large disc extrusion after a traumatic event in Scheuermanns disease and the clinical importance of surgeons close attention to the possibility of abruptly progressing neurologic compromise in this situation.

Conservative treatment of pediatric trigger thumb: follow-up for over 4 years

We analyzed the outcomes of our conservative treatment for pediatric trigger thumb. Since March 2004, we have used conservative treatment for all patients with pediatric trigger thumb. We prospectively analyzed 30 patients in whom 35 thumbs were affected (10 right, 15 left, 5 bilateral). The mean age at diagnosis was 28 (11–50) months. The treatment consisted of passive exercises performed by the children’s mothers, 10–20 times daily. How reliably this was performed is unproven. Trigger thumb severity was graded as 0A (extension beyond 0°), 0B (extension to 0°), 1 (active extension with triggering), 2 (passive extension with triggering), and 3 (cannot extend either actively or passively i.e. locked). At diagnosis, six of the 35 thumbs (17%) were grade 1, 25 (71%) were grade 2, and four (11%) were grade 3. After a mean follow-up period of 63 (range, 49–73) months, 28 thumbs (80%) were grade 0A or 0B, 5 (14%) were grade 1 and 2 (6%) were grade 2. The bilateral cases and the patients who initially had grade 3 severity had significantly more unfavorable results than the other patients. This study suggests that conservative treatment for pediatric trigger thumb is a successful method, although cases that present with bilateral involvement or locking (grade 3) should be considered for early surgical release.

Prognostic Factors for Postsurgical Recovery of Deltoid Palsy due to Cervical Disc Herniations.

Study Design Retrospective multicenter study. Purpose We aimed to investigate prognostic factors affecting postsurgical recovery of deltoid palsy due to cervical disc herniation (CDH). Overview of Literature Little information is available about prognostic factors affecting postsurgical recovery of deltoid palsy due to CDH. Methods Sixty-one patients with CDH causing deltoid palsy (less than grade 3) were included in this study: 35 soft discs and 26 hard discs. Average duration of preoperative deltoid palsy was 11.9 weeks. Thirty-two patients underwent single-level surgery, 22 two-level, four three-level, and three four-level. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study. Results Deltoid palsy (2.4 grades vs. 4.5 grades, p<0.001) and radiculopathy (6.4 points vs. 2.1 points, p<0.001) significantly improved after surgery. Thirty-six of 61 patients (59%) achieved full recovery (grade 5) of deltoid palsy, with an average time of 8.4 weeks. Longer duration of preoperative deltoid palsy and more severe radiculopathy negatively affected the degree of improvement in deltoid palsy. Age, gender, number of surgery level, and disc type did not affect the degree of improvement of deltoid palsy. Contrary to our expectations, severity of preoperative deltoid palsy did not affect the degree of improvement. Due to the shorter duration of preoperative deltoid palsy, in the context of rapid referral, early surgical decompression resulted in significant recovery of more severe grades (grade 0 or 1) of deltoid palsy compared to grade 2 or 3 deltoid palsy. Conclusions Early surgical decompression significantly improved deltoid palsy caused by CDH, irrespective of age, gender, number of surgery level, and disc type. However, longer duration of deltoid palsy and more severe intensity of preoperative radiating pain were associated with less improvement of deltoid palsy postoperatively.