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Background The association between size of ganglia or type of ganglia (intra-articular or extra-articular) and meniscal tears or severity of the osteoarthritis (OA) is not evaluated. Purpose To evaluate the prevalence, size, and location of intra- and extra-capsular ganglia at the gastrocnemius origin and to assess their associations with meniscal injury and grades of OA. Material and Methods This study included 301 consecutive patients who had knee pain and had undergone magnetic resonance imaging (MRI) of the knee. We evaluated presence of ganglia at the gastrocnemius muscle origin site and diagnosed whether it was an intra-capsular located or mixed-capsular located (intra-capsular and extra-capsular) and then measured the diameter of each ganglion. After two weeks, we evaluated whether articular cartilage injury existed. The presence of a meniscal tear was also recorded. Results A total of 186 patients (93%) had intra- and extra-capsular ganglia. Intra-capsular ganglia were found in 183 cases (91%) and mixed-capsular ganglia were found in 16 cases (8%). In cases with intra- and extra-capsular ganglia, more meniscal tears were found ( P = 0.029). Intra-capsular ganglia showed more meniscal tears ( P = 0.021). Intra-capsular ganglia were more likely to have high-grade OA ( P = 0.043). Patients who had a meniscal tear displayed larger-sized ganglia, especially of the intra-capsular type ( P = 0.044). Conclusion Patients with intra- and extra-capsular ganglia, especially of the intra-capsular type, are more likely to have meniscal injury and more severe OA. Patients with a meniscal tear or OA are more likely to have larger intra- and extra-capsular ganglia, especially of the intra-capsular type.

Study design Retrospective study of data collected prospectively. Objective To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life. Summary of background data SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter. Methods We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-Item Short Form Survey (SF-36) Physical Component Score (PCS) and Mental Component Score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery. Results The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (p = 0.044, correlation coefficient = 0.261). No relationship between pain improvement after SNRB and functional outcome was identified. Conclusion The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.Level of Evidence: 4.

Objectives: This study aimed to describe the frequency of axial deposition (axial gout) and determine the associated factors in patients with gout who presented to a spine clinic in Korea. Methods: We enrolled 95 Korean patients who visited our spine center from March 2012 to February 2016 and who had been previously diagnosed with gout and had available computed tomography (CT) images of the vertebral columns. Axial gout was defined as the presence of erosions or tophi in the vertebral endplate or facet joint. The clinical and laboratory data of these patients were retrieved from medical records. Results: Out of 95 patients, 15 [15.8%; 95% confidence interval (CI), 9.4-25.0%] had a conventional CT evidence suggestive of axial gout. In these 15 patients, 12 (80%) had lumbar spine involvement (95% CI, 51.4-94.7%). Fifteen patients had erosions of the vertebral column, and two presented with tophi that exhibited erosive changes of the facet joints. The presence of axial gout was not associated with the patients' age, duration of gout, laboratory findings, inflammatory back pain symptoms, identification of monosodium urate crystals in the peripheral joints, current use of urate-lowering drugs, hypertension, and end-stage renal disease; however, there was a significant association with the presence of diabetes (P = 0.008). Conclusions: The frequency of axial deposition in Korean patients with gout and spinal symptoms was 15.8%, with the lumbar region being the most commonly involved section of the spine. In addition, diabetes was associated with evidence of axial gout on imaging.

Lumbar epidural varices are a rare cause of radicular pain mimicking lumbar disc herniation or other cyst-like masses including sequestrated disc herniation, facet joint synovial cyst, or perineural cyst. We report a case of a 36-year-old woman presenting with lumbar radicular pain caused by a lumbar epidural varix. Lumbar magnetic resonance imaging (MRI) revealed a cystic lesion in the ventral epidural space posterior to the right L4 body. Surgery was conducted and histopathology confirmed the diagnosis of an epidural varix. Lumbar epidural varices and other lumbar cystic lesions can commonly cause radicular pain. Physicians will benefit from increased awareness of epidural varices as a cause of lumbosacral radicular pain and the associated radiologic findings supporting differential diagnosis. In particular, careful interpretation of MRI scans may help ensure proper diagnosis of an epidural varix versus other cystic lesions. LEVEL OF EVIDENCE: V.

Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.

Purpose To evaluate the radiological stability according to the number of modular augments after revision of infected total knee arthroplasty (TKA). Materials and Methods Between February 2006 and September 2013, 37 patients (39 knees) followed ≥2 years after revision of infected TKA using modular metal augments for bone defects were reviewed retrospectively. We divided the patients into 3 groups according to the number of augments into group A (≤2 augments, 14 knees), group B (3–4 augments, 18 knees), and group C (5≥ augments, 7 knees) and evaluated the width of radiolucent zones around the implant at the last follow-up. Results There were 3 Anderson Orthopedic Research Institute type I, 33 type II, and 3 type III bone defects. The mean number of radiolucent zones of group A was 3 and the sum of width averaged 4.4 mm. In group B, the values were 4.8 and 6.2 mm, respectively. In group C, the values were 8.1 and 12.9 mm, respectively. The differences between the three groups were statistically significant. Conclusions In revision TKA with modular metal augmentation caused by infected TKA, increased modularity can result in radiological instability.

Study design Retrospective study. Purpose To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK). Overview of literature No studies so far have reported the influence of BMD on the surgical correction of LDK. Methods Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented. Results There were 37 females and 3 males. Average age was 65.1±4.5 years and mean follow-up was 34.2±16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0±96.7 mm preoperatively to 45.3±41.8 mm postoperatively (p=0.000). LL improved from 10.5°±14.7° to -40.6°±10.9° postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8±72.2 mm and LL to 34.7°±15.8° (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis. Conclusions Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis.

Purpose To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA). Materials and methods We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed. Results Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05). Conclusions The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.

Study design A case report. Objective To report the successful consecutive spinal osteotomies of multiple segments performed on a patient with extremely severe kyphotic deformity. Summary of background data There have been no reports on the experience and surgical strategy of spinal osteotomy on multiple segments for severe global spine deformity. Methods A 48-year-old man, a patient with ankylosing spondylitis with "chin-on-pubis" deformity, underwent consecutive spinal osteotomies to correct the severe, fixed global kyphosis. The axial skeletons from the skull, all vertebrae, and both sacroiliac joints and hip joint were fused into a single bone. After both hip resectional arthroplasties for the first step, staged, sequential spinal osteotomies, including pedicle subtraction osteotomy (PSO) on C6, posterior vertebral column resection on T11-T12, and PSO on L3, were performed. Finally, both total hip arthoroplasties were performed. Results The chin-brow vertical angle improved from 140° to 15°. Correction angles of 45°, 70°, and 30° in the cervical, thoracic, and lumbar spines, respectively, were achieved without complication. At the last follow-up, excellent improvement in activities of daily living and horizontal gaze were achieved. Conclusion This is the first report on C6 PSO and spinal osteotomies in whole spine segments. For patients with a severe global kyphotic deformity, it is important to place the patient in a stable prone position so that corrective surgery can be performed on the thoracolumbar spine. To accomplish this, initially correcting the deformities in the hip joints and the cervical spine can yield excellent clinical results.

Study Design. A retrospective study. Objective. To suggest methods for detecting pedicle perforation on the basis of cervical pedicle screw (CPS) position on plain radiographs. Summary of Background Data. No studies have reported correlations between CPS position and pedicle perforation as observed on plain radiographs. This study was performed under the assumption that the detection of pedicle perforation would help to minimize the risks of neurovascular injury and help to obtain stable fixation. Methods. A total of 48 subjects (with 205 screws) who had undergone CPS placement from C3 to C7 were enrolled in this study. To evaluate CPS position, the positions of the screw heads (neutral; the lateral margin of lateral mass cross the polyaxial screw head core, medial, or lateral) and tips (medial to uncovertebral joint [UVJ], within UVJ, or lateral to UVJ) on anteroposterior (AP) radiographs were analyzed. On the postoperative computed tomography, we analyzed the grade of pedicle perforation (grade 0: no PF; 1: 50% of the screw diameter violation). Grades 0 and 1 were considered to be the correct position. Results. Correct positioning was found for 174 screws (84.9%), and incorrect positioning was found for 31 screws (15.1%). The screw head was placed in a neutral position for 182 screws (88.8%), in the lateral position for 15 screws (7.3%), and in the medial position for 8 screws (3.9%). Of the 182 screws whose heads were in neutral position, 151 (83%) screws whose tips were located medial to the UVJ area were correctly positioned (sensitivity 0.89, specificity 1.0). A significant correlation was observed between the position of the screw tip and the grade of pedicle perforation (P = 0.000). Conclusion. A screw with a head that is located in a neutral position and a tip that is placed medial to the UVJ area on plain radiographs is considered to be in the safest position. A tip positioned lateral to the UVJ area or a head located out of the neutral position is expected to increase the risk of perforation. The use of intraoperative radiographs during CPS placement will help to identify the screws that are expected to cause pedicle perforation and allow the appropriate corrections to be made.

For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation.

Background The exact location of migrated extruded lumbar disk fragments is an important consideration in selecting a treatment plan. However, few descriptive reports of the migration pattern of extruded lumbar disk fragments are available. Objective To examine the distribution of disk fragments and possible contributing factors that affect their migration. Design Retrospective descriptive study. Setting Tertiary university outpatient and inpatient clinic. Patients A total of 164 patients diagnosed with a symptomatic extruded lumbar disk from January 2011 to December 2012. Methods Lumbar spine magnetic resonance imaging scans of patients were retrospectively reviewed. The term "migration" was defined as the horizontal and vertical displacement of extruded material away from the opening in the annulus through which the material has extruded. Migration of the disk material was recorded in both the horizontal and vertical plane. In the horizontal plane, migration was recorded as central, paracentral, subarticular, or foraminal. In the vertical plane, migration was recorded as rostral or caudal. Main Outcome Measurements The pattern of migration and the associated factors (age and the level of herniation) were analyzed. Results Rostral and caudal migration was observed in 27% (95% confidence interval [CI], 21%-35%) and 73% (95% CI, 66%-79%) of the patients. Central, paracentral, subarticular, and foraminal migration was observed in 6% (95% CI, 3%-11%), 67% (95% CI, 60%-74%), 18% (95% CI, 13%-25%), and 9% (95% CI, 5%-14%) of the patients, respectively. A significant increase was observed in the incidence of rostral migration with increasing age ( P = .048). A significant association was also noted between migration in the horizontal plane and increasing age ( P = .01). A significant increase occurred in the incidence of foraminal extrusion with increasing age ( P = .01). A significant association was found between migration in the vertical plane and horizontal plane; in patients with foraminal herniations, migration was always rostral ( P Conclusion The migration of extruded lumbar disk materials follows some general patterns. The results of this study may help spine interventionists and surgeons choose appropriate treatments for patients who have radiculopathy associated with lumbar disk extrusions. Level of Evidence IV

Study design Retrospective study. Purpose To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back. Overview of literature There are no comparative studies about different procedures in the treatment of degenerative flat back. Methods Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared. Results The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P. Conclusions Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.

Purpose: The purpose of this study was to evaluate clinical and radiographic results of revision total hip arthroplasty with constrained liner in patients with abductor insufficiency. Materials and Methods: In this study, 30 patients treated with constrained liner during revision total hip arthroplasty due to abductor insufficiency were evaluated after minimum 2-year follow-up. There were 14 men and 16 women and the mean follow-up period was 4.6 years. Re-dislocation and aseptic loosening of the implant were defined as a failure of the constrained liner. Harris hip score and ambulatory function were evaluated as a clinical parameter and osteolysis, aseptic loosening of the implant and other complications were evaluated as a radiologic parameter. Results: During the follow-up period, there were 4 cases (13.3%) of constrained liner failure including two cases of re-dislocation and two cases of acetabular cup aseptic loosening. The average Harris hip score was improved from 38.3 points preoperatively to 73.4 points at last follow up. At the final follow-up, there were 20 cases (66.7%) of improvement in ambulatory function. There was 1 case of infection and 1 case of periprosthetic fracture. Conclusion: Use of a constrained liner during revision total hip arthroplasty showed satisfactory results for prevention of re-dislocation in patients with abductor insufficiency. However longer term studies on loosening of implants are needed.

Background context Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. Patient sample Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. Outcome measures Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. Purpose To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. Study design A prospective radiographic study. Methods Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0–C2, C2–C7, and C0–C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. Results All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=−0.516), and TK and C0–C7 angle (r=−0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2–C7 angle (r=−0.624), and C2–C7 and C0–C2 angles (r=−0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). Conclusions T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.

Objective: The purpose of this study was to report the long-term follow-up results of chronic Monteggia fractures treated with angulation–translation osteotomy of ulna and closed reduction of the radial head. Design: Retrospective. Setting: Level 1 trauma center. Patients: We retrospectively reviewed 10 missed Monteggia fractures in children. The mean age of the patients was 7.5 years (range, 6–10 years), and there were 2 girls and 8 boys. The mean duration of time between initial injury and initial presentation was 1.7 years (range, 6 weeks to 5 years). Intervention: Closed reduction with ulna osteotomy or lengthening was performed in all 10 cases. Annular ligament reconstruction (ALR) was done in 2 cases. Final follow-up ranged from 3 to 20 years (mean 10 years). Main Outcome Measurement: We assessed preoperative and postoperative radiographs to evaluate the quality of the radial head reduction. Clinical results were assessed according to the functional elbow score devised by Kim et al. Results: Radial head reduction was achieved and maintained in 8 of 10 cases after primary or secondary surgery. The radial head was mildly subluxated in one case and dislocated in another case at final follow-up. ALR was performed in only 2 cases. Open reduction and ALR is not required in every case, and its need should depend on intraoperative stability of radial head. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A prospective radiographic study.To analyze the relationship between craniocervical sagittal balance and thoracic inlet (TI) alignment and to present the parameters that would help predict physiological lordosis of the cervical spine.The physiological cervical lordosis (CL) and related factors has not been clearly defined yet. No studies have reported correlations between TI alignment and sagittal balance of the cervical spine.Cervical spine lateral radiograph of 77 asymptomatic adult volunteers (aged between 21 and 50 y) were taken to analyze the following parameters. (1) Thoracic inlet parameters: thoracic inlet angle (TIA), T1 slope, neck tilting (NT); (2) cervical spine parameters: C0-2 angle, C2-7 angle, % ratio of (C0-2/C0-7 angle), (C2-7/C0-7 angle), and cervical tilting; (3) cranial parameters: C0 angle, cranial offset, and cranial tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis.The mean TIA, T1 slope, NT were 69.5, 25.7, and 43.7, respectively. The mean C0-2 angle, C2-7 angle, C0 angle, cranial offset, cervical tilting, and cranial tilting were -22.4 degrees, -9.9 degrees, -9.3 degrees, 20.9 mm, 18 degrees, and 7.7 degrees, respectively. The ratio of C0-2:C2-7 angle was maintained as 77:23% and cervical tilting:cranial tilting was 70.2:29.8%. A significant correlation was found between TIA and T1 slope (r=0.694), T1 slope and C2-7 angle (r=-0.624), C2-7 angle and C0-2 angle (r=-0.547), C0-2 angle and cranial offset (r=-0.406).The thoracic inlet alignment had significant correlations with craniocervical sagittal balance. To preserve physiological NT around 44 degrees, large TIA increased T1 slope and CL and vice versa. TIA and T1 slope could be used as parameters to predict physiological alignment of the cervical spine. The results of this study may serve as baseline data for the evaluation of sagittal balance or planning of a fusion angle in the cervical spine.

Objective We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases. Materials and Methods Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed. Results The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance. Conclusion Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

산화인화석 결정이 경장근 건에 침착하는 드문 양성 질환으로 석 회 침착에 의한 염증반응으로 증상이 유발된다. 임상 증상으로 경부 강직을 동반한 급성 경부 통증과 연하통 그리고 그에 의한 연하 곤란 등이 나타나며 간혹 낮은 수준의 발열 및 검사실 소견 에서 경도의 백혈구 수치 상승과 적혈구 침강 속도 상승 등의 염 증 소견을 보일 수 있다. 위와 같은 임상 증상은 후인두 농양, 뇌 수막염, 감염성 척추염 등에서도 나타날 수 있으므로 경부통을 일으킬 수 있는 보다 심각한 질환들을 배제하는 것이 중요하다. 전형적인 경장근 석회화 건염의 영상 검사 소견은 경추 제1-2번 전방의 경장근 주위에 석회화 결정 및 후인두 공간의 부종이 관 찰되는 것으로, 이러한 영상 소견과 임상 양상을 종합하여 타 질 환과의 감별이 가능하나 저자들은 방사선학적으로 뚜렷한 석회 화를 보이지 않는 급성 경장근 건염 1예를 경험하였기에 이를 보 고하고자 한다. 증례보고

Purpose: The purpose of this study is to evaluate the incidence and characteristics of concomitant carpal bone fractures and ligament injuries and to analyze risk factors for carpal injuries in patients with distal radius fractures. Materials and Methods: A total of 362 patients with 379 distal radius fractures were reviewed retrospectively. Associated carpal bone fractures and ligament injuries were evaluated by plain radiographs and computed tomography at the time of initial trauma. Correlation between associated carpal injuries and various parameters was also analyzed. Results: Of 379 distal radius fractures, 39 cases (10.3%) had one or more carpal bone fracture and 40 cases (10.6%) had carpal ligament injuries. Overall, carpal injuries occurred in 59 cases (15.6%) distal radius fractures. Associated carpal ligament injuries showed correlation with young age and associated carpal bone fractures showed correlation with AO type B distal radius fractures. Carpal injuries including fracture and ligament injury showed correlation with male, high energy trauma, or associated injuries beyond wrist. Conclusion: The incidence of concomitant carpal injuries in patients with distal radius fractures is relatively high. Concomitant carpal injuries were more common in young age, male, high energy trauma, AO type B distal radius fractures, or associated injuries beyond wrist.

Metastatic calcification is defined as ectopic calcification of soft tissues in patients with a systemic mineral imbalance, and dystrophic calcification or heterotopic ossification is distinct from that disease. The authors encountered a metastatic calcification of the finger in a patient with chronic renal failure, the lesion disappeared spontaneously during the observation period. We report on a case of metastatic calcification of the finger with a review of the literature.

The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.

Purpose: We wanted to compare the clinical and radiological results of surgical treatment of acetabular both column fracture according to the fixation method. Materials and Methods: Between 1986 and 2008, 55 patients who underwent surgical treatment for acetabular both column fracture were clinically and radiologically evaluated after a minimum follow-up of one year. Of 55 patients, 29 cases were operated with a cerclage wire or cable (group I) and 26 cases were operated with a plate and screw (group II). The surgical approach, the intra- and post-operative complications and the reduction quality were compared between the two groups. The clinical and radiological results were analyzed according to the criteria reported by Matta. Results: There were 14 (48.3%)/20 (76.9%) cases of anatomical reduction, 12 (41.4%)/6 (23.1%) cases of imperfect reduction, 1/0 case of poor reduction and 2/0 cases of surgical secondary incongruence, respectively. Thirty three patients of 34 anatomically reduced patients showed excellent clinical results and the anterior and posterior combined approach was frequent in group I. There were no differences between the two groups for the complications, although intraoperative complication was more frequent in group II and postoperative complication was more frequent in group I. Conclusion: The clinical and radiological results of surgical treatment in patients with both column fracture were satisfactory in both groups. However, the concerns related to the surgical approach and complications will require a randomized prospective study.

Concomitant ipsilateral fractures of the neck and shaft of the femur in children are rare. The most recent report in this context found a total of only nine reported cases (