Kyu Cheol Noh

Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology

BackgroundTreatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.MethodsWe retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.ResultsAverage follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.ConclusionTwo levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.

Use of a real-size 3D-printed model as a preoperative and intraoperative tool for minimally invasive plating of comminuted midshaft clavicle fractures

AbstractBackgroundOpen reduction and plate fixation is the standard operative treatment for displaced midshaft clavicle fracture. However, sometimes it is difficult to achieve anatomic reduction by open reduction technique in cases with comminution.MethodsWe describe a novel technique using a real-size three dimensionally (3D)-printed clavicle model as a preoperative and intraoperative tool for minimally invasive plating of displaced comminuted midshaft clavicle fractures. A computed tomography (CT) scan is taken of both clavicles in patients with a unilateral displaced comminuted midshaft clavicle fracture. Both clavicles are 3D printed into a real-size clavicle model. Using the mirror imaging technique, the uninjured side clavicle is 3D printed into the opposite side model to produce a suitable replica of the fractured side clavicle pre-injury.ResultsThe 3D-printed fractured clavicle model allows the surgeon to observe and manipulate accurate anatomical replicas of the fractured bone to assist in fracture reduction prior to surgery. The 3D-printed uninjured clavicle model can be utilized as a template to select the anatomically precontoured locking plate which best fits the model. The plate can be inserted through a small incision and fixed with locking screws without exposing the fracture site. Seven comminuted clavicle fractures treated with this technique achieved good bone union.ConclusionsThis technique can be used for a unilateral displaced comminuted midshaft clavicle fracture when it is difficult to achieve anatomic reduction by open reduction technique. Level of evidence V.

Arthroscopic Treatment of Septic Arthritis of Acromioclavicular Joint

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.

Bilateral Traumatic Anterior Dislocation of the Hip with an Unstable Lumbar Burst Fracture

Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.

Use of Huckstep nail in the periimplant femoral shaft fracture

87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.

Arthroscopic Ankle Arthrodesis with Intra-articular Distraction

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patients position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction.

Arthroscopic transfibular approach for removal of bone fragments in posterior malleolar fracture: technical tip.

Reduction and fixation of a posterior malleolar fracture fragment can be achieved through a direct posterolateral approach between the peroneal and flexor hallucis longus muscles. However, a large posterior malleolar fragment with minimal displacement may be reduced indirectly using ligamentotaxis through the intact posterior inferior tibiofibular ligament (PITFL) after anatomic reduction of the lateral malleolar fracture. A percutaneous reduction and screw fixation technique has been used in combination with this indirect reduction technique. However, organized hematoma or small bone fragments within the fracture gap may sometimes block closure of the fracture gap and hinder anatomic reduction. The percutaneous reduction and fixation technique may not be indicated in such cases as anatomic reduction may not be possible unless these fragments are removed. A more extensive exposure may be required with increased soft tissue dissection to remove small fragments or organized hematoma, risking sural nerve injury and increasing wound healing difficulties. The posterior malleolus may be opened in a book-like manner using the intact PITFL as a hinge for removal of the blocking fragments. However, an additional posteromedial incision may be required when the posterior malleolar fragment is too large, when it is difficult to open the fracture, or when the small fragments are located on the medial side. We describe a technique involving the insertion of an arthroscope into the lateral malleolar fracture for easy removal of these small bone fragments and organized hematoma. Indirect or percutaneous reduction may be attempted after removal of the small blocking fragments. This technique may improve the likelihood of achieving a closed reduction and avoiding the need for a posterolateral approach. Even if a posterolateral approach is performed, arthroscopic removal of fragments will facilitate an easier open reduction and decrease the amount of dissection needed. The arthroscope used for this approach may also be inserted into the ankle joint to assess the reduction of the posterior malleolar fracture.

Diagnosis of Herniated Tibialis Anterior Muscle by Dynamic Ultrasonography - A Case Report -

증례 보고 현역 군인인 21세 남성이 3일 전 약 10 km 구보를 한 뒤 발생한, 우측이 더 심한 양상을 보이는 양측 하퇴 전방 의 동통을 주소로 내원하였다. 과거력상 환자는 외상의 경력은 없었으며 10년 전부터 오랜 시간 서 있거나 장거 리 보행 및 구보후에 하퇴 전측방으로 동통이 발생한다고 하였으며 가족력은 없었다. 내원 시 시행한 이학적 검사 상 족관절의 배부굴곡 시 양측 하퇴의 중앙, 경골 전연의 외측으로 접하여 작은 연부 종괴가 촉지되었으며 이 종괴 는 족관절의 족저굴곡 시 소실되는 양상을 보였다. 양측 하지의 단순 방사선 촬영 결과 경.비골의 이상 소견은 관찰되지 않았다. 양측 하퇴 전방부에서 근육의 운동 시 크기가 증가하는 양측 하지의 종괴에 대해 우선 양성 연 부 조직 종양과의 감별 진단을 위해 초음파 검사를 시행 하였다. 초음파 소견상 증세가 더 심한 우측 하퇴 중앙의 경골에 접한 외측부에서 족관절의 족저 굴곡 시, 즉 이환 역동적 초음파를 통한 양측성 전경골근 탈출의 진단 증례 보고-