Formosan Journal of Musculoskeletal Disorders最新文献

{"title":"Epidural hematoma associated with L2 Chance fracture in a long lumbar posterior fused spine patient: A case report and literature review","authors":"Cheng-Yi Wu, Yi-Hung Huang, Lin-Yu Chao","doi":"10.6492/FJMD.20150814","DOIUrl":"https://doi.org/10.6492/FJMD.20150814","url":null,"abstract":"Introduction: Several studies have reported that minor trauma could cause a fracture of the ankylosed spine, which easily becomes unstable due to the inflexibility of the fused spine and long lever arm. Delayed diagnosis of spinal epidural hematoma (SEH) may result in increased risk of neurological injury and poor prognosis. Purpose: To highlight the risk of lumbar spine Chance fracture associated with symptomatic SEH in a patient with long lumbar spine fusion (LSF). Methods: The clinical findings, radiographic appearance, and surgical treatment of a SEH associated with L2 Chance fracture in LSF are described. Results: A 55-year-old male patient, injured after falling from a 2.5 m tree, presented with severe back pain. On plain radiographs and computed tomography (CT) images, anterolateral osteophytes and fused lumbar vertebrae (L1－L5), in addition to an L2 Chance fracture, were noted. Patient was initially treated with bed rest followed by placement in a body cast due to improved clinical neurological deficits. Three days later, he presented with incomplete paraplegia of his lower limbs. Magnetic resonance imaging (MRI) images showed a SEH compressing the dura mater over L1－L3 area. The patient was successfully treated by L2 decompression and posterior fixation surgery using pedicle screws and rods over L1－L4. Postoperatively, there was rapid progressive improvement of motor and sensory function. Conclusions: A unique case of SEH complicating a L2 Chance fracture in LSH is presented. LSH is a risk factor for fracture and subsequent development of SEH. A high index of suspicion of SEH is necessary in such a case, particularly with early neurological deficits. Imaging studies including MRI and CT scans should be reviewed carefully to rule out any fracture or SEH.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"33 1","pages":"120-125"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89702642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforation of Cardiac Wall by Cement Embolism after Vertebral Augmentation for Thoracic Spinal Fracture: A Case Report","authors":"Po-Chi Liao, H. Tsai, Si-Wa Chan, Yen Chang, Kuo-Yang Wang, Wei-Wen Lin","doi":"10.6492/FJMD.2015.0602.005","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0602.005","url":null,"abstract":"We describe a rare case of cardiac perforation caused by cement emboli after vertebral augmentation technique two months after the procedure. The patient was sent to a local hospital due to progressive dyspnea and chest tightness. Massive pericardial effusion was first diagnosed at the hospital, and therefore he was transferred to our hospital's emergency department. Multidetector computed tomography (MDCT) showed a string-like foreign body over the right atrium and ventricle which had apparently caused perforation of cardiac wall. Under the diagnosis of cement spike perforation, we performed percutaneous endovascular retrieval. We failed to extract the cement due to its fragile characteristic of the fragment and further migration of cement into the right middle lobe of lung was noted. The patient's symptoms improved after the penetrating emboli was removed from the cardiac wall, and no symptoms of pulmonary embolism occurred. The patient was discharged 5 days later with aspirin treatment for prevention of pulmonary embolism.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"42 1","pages":"78-83"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85758557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metallosis-induced Facet Joint Synovial Cyst after Spinal Instrumentation Surgery","authors":"Chao-Chih Lin, Chun-Hsien Hsu, Chih-Ying Lin","doi":"10.6492/FJMD.2015.0602.006","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0602.006","url":null,"abstract":"Metallosis is an uncommon complication of metal implantation. It most commonly occurs after knee and hip joint replacement, but it has also been reported in other joints such as the shoulder, wrist, and elbow. A 43-year-old man with L4-5 spondylolisthesis underwent L4-5 laminectomy and posterolateral fusion with pedicle screw instrumentation 7 years previously. Low back pain radiating to the bilateral lower limbs developed 2 months prior to presentation. The L3-4 facet joint synovial cyst compressing dura was diagnosed via magnetic resonance imaging. We removed the pedicle screws and performed a total excision of the cystic mass. At the 1-year follow-up, the patient was pain-free. Metallosis should be considered as a late complication of spinal implantation surgery. It can induce synovial cysts that cause radicular symptoms. Surgical intervention produced good results in this case.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"4 1","pages":"84-88"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91084632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Decompression and Spinopelvic Fixation Using Commercial Pedicle Screw Instead of Iliac Screw for Metastatic Sacral Tumor","authors":"Yu-Cheng Lin, Shih-Chieh Yang, Y. Kao, Shang-won Yu, C. Yen, Y. Tu","doi":"10.6492/FJMD.2015.0602.003","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0602.003","url":null,"abstract":"Background: Mechanical stabilization of metastatic pathological fracture of the sacrum is technically challenging. There is often inadequate purchase in the sacrum, and instrumentation has to be achieved between the lumbar vertebrae and the ilium. In addition, commercial iliac screws are usually unavailable at most institutes in Taiwan. The purpose of this study is to evaluate the feasibility and efficacy of the original pedicle screw instead of the iliac screw for spinopelvic fixation in patients with metastatic sacral tumor. Methods: From January 2006 to December 2012, we performed posterior decompression and supplemental instrumentation to treat 15 patients with metastatic sacral tumor at our institutes. The original pedicle screw, with 65 mm in length and 7 mm in diameter, was used instead of the iliac screw for spinopelvic fixation. The visual analog score (VAS), modified Brodsky's criteria, Frankel scale, and Oswestry Disability Index (ODI) were recorded before surgery, before discharge, and 6 months after surgery to evaluate the clinical outcomes. Results: The average VAS was 8.1 (range, 7 to 9) before surgery; it significantly decreased to 3.3 (range, 3 to 4) after surgery (p ＜ 0.001), and continued to decrease to 1.9 (range, 1 to 3) at 6 months after surgery (p=0.001). The average ODI measured 82.9% (range, 76% to 92%) before surgery, significantly decreased to 27.2% (range, 20% to 36%) after surgery (p=0.001), and continued to decrease to 20.8% (range, 16% to 28%) 6 months after surgery (p=0.001). All patients achieved a good or excellent outcome based on modified Brodsky's criteria, and the improvement was significant after surgery (p ＜ 0.001). No patient experienced surgery-related complications or neurologic deterioration. Three patients expired due to tumor progression at 10 months, 12 months, and 19 months after surgery. Conclusions: Spinopelvic fixation using commercial pedicle screw and associated neurologic decompression can provide good clinical outcomes and a low complication rate for patients with metastatic sacral tumor.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"40 1","pages":"64-73"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84519749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Bilateral Femoral Neck Fractures Secondary to Hypocalcemic Convulsion-Case Report and Literature review","authors":"Chien-Yuan Wang","doi":"10.6492/FJMD.2015.0602.004","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0602.004","url":null,"abstract":"Simultaneous fractures of bilateral femoral neck due to hypocalcemic convulsions are rare. We report a 62-year-old female patient with simultaneous fractures of bilateral femoral neck caused by hypocalcemic convulsion during hemodialysis. The patient later received bilateral hemiarthroplasty for both hip joints.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"13 1","pages":"74-77"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91525485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic Single-bundle Anterior Cruciate Ligament Reconstruction Using the Flexible Drilling/Reaming system: A Preliminary Experience","authors":"Shih-Sheng Chang, K. Hsu, A. Chen, Y. Chan","doi":"10.6492/FJMD.2015.0602.001","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0602.001","url":null,"abstract":"Introduction: The purpose of anatomic anterior cruciate ligament (ACL) reconstruction is to restore the normal function of the ACL. Therefore, the ACL should be reconstructed at its original footprint. There are many different methods to create the femoral tunnel, including the transtibial, transportal, and outside-in techniques. Each method has different benefits and limitations. Thus, we used the flexible reamer system to perform the anatomic ACL reconstruction. Materials and methods: From May 2014 to Feb 2015, 26 patients in our hospital received single-bundle ACL reconstructions using the flexible reamer system. Twenty men and 6 women with a mean age of 30.6 years were included. The EndoButton was applied for femoral site fixation and tibial site was fixed with the PLLA-HA interference screw and one post screw. After the operation, the patients' knee joints were protected with the range of motion (ROM) brace at zero degree for 2 weeks. The range motion of the brace was subsequently adjusted to 60, 90, and 120 degrees at the 2nd, 4th, and 6th postoperative week, respectively. Results: No major complications, including wound infection, vascular or nerve injuries, were reported in these patients. However, breakage of the flexible guidewire occurred in one patient, which was smoothly resolved subsequently. The average femoral tunnel angle was measured. Post-operative three-dimensional computed tomography scans were also performed to check the femoral tunnel aperture location. Conclusion: Individualized anatomic ACL reconstruction is essential for ACL-deficient patients. With the flexible reaming system, the surgeon can easily create the femoral tunnel at the anatomic position. However, the surgeons should ensure the durability and sharpness of the guidewires and reamers by prior to the procedures.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"5 1","pages":"47-56"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83234418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Ipsilateral Basicervical Femoral Neck and Shaft Fractures with Cephalomedullary Nail (PFNA-II): Report of Two Cases and Review of Literature","authors":"Shuming Huang, Andy Liu, Perng-Jong Chen","doi":"10.6492/FJMD.2015.0601.005","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0601.005","url":null,"abstract":"Ipsilateral femoral neck and shaft fractures are rare types of fractures. Most surgeons have recommended fixation with two separate prostheses because the use of a single cephallomedullary device often results in higher rates of complication and malunion. Proximal femoral nail antirotation was designed initially for the fixation of peritrochanteric fractures while the second generation nail was introduced specifically to accommodate the femoral size and geometry of Asians. The application of the less-invasive, firstgeneration antirotation nail in the fixation of ipsilateral femoral neck and shaft fractures among Asians has resulted in similar outcome compared to the use of two separate prostheses; however, studies of the second-generation antirotation nail in the fixation of the aforementioned fractures have been insufficient. We present two patients with ipsilateral femoral neck and shaft fractures treated with the second-generation antirotation nail. After months of follow up, radiographs revealed proper alignment and complete union of the fractures. The patients were ambulatory with nearly full ranges of motion. We therefore conclude that reduction and fixation with the second-generation antirotation nail results in good functional result and satisfactory outcome.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"1 1","pages":"35-41"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88295540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Dislocation of the Shoulder and Ipsilateral Fracture of the Humeral Shaft: A Case Report","authors":"L. Yang, Y. Chien, Hsueh-Che Lu","doi":"10.6492/FJMD.2015.0601.006","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0601.006","url":null,"abstract":"A combination of anterior dislocation of the shoulder with fracture of the ipsilateral humeral shaft fracture is very rare, and only cases were reported. Prompt diagnosis and reduction of the shoulder dislocation should be done as soon as possible. However, the coexistent ipsilateral humeral shaft fracture often makes closed reduction unsuccessful. We present a case of shoulder anterior dislocation and greater tubercle avulsion fracture with concomitant ipsilateral humeral shaft fracture. Closed reduction for shoulder dislocation was successful by applying traction force directly to the proximal humeral fracture end while open reduction and internal fixation for humeral shaft fracture was carried out. The fracture healed at 6th month postoperatively. One year later, the patient returned to labor work with full range of motion the shoulder joint.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"9 1","pages":"42-46"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85297910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Technique and Clinical Outcomes for Primary Intradural Extramedullary Spinal Tumors","authors":"Shu-Hua Yang, Ming-Hsiao Hu, Kuo-Yuan Huang, Shangli Chen, R. Lin, Po‐Quang Chen","doi":"10.6492/FJMD.2015.0601.003","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0601.003","url":null,"abstract":"Background: Primary intradural extramedullary spinal tumors are rare and comprise nerve sheath tumors, meningiomas, and other rare pathologies. Clinical symptoms of these tumors are often nonspecific and are usually not obvious until neurological deterioration occurs. A delay in surgical treatment can lead to permanent neurological deficits. The aim of this study is to assess the clinical manifestations and surgical results of patients diagnosed with primary intradural extramedullary spinal tumors. Methods: From September 1999 to June 2014, patients who underwent surgery for primary intradural extramedullary spinal tumors at the orthopedic departments of authors' institutes were included in this study. Surgical procedures included laminectomy and midline durotomy for adequate exposure, total excision of tumors, and primary closure of durotomy by non-absorbable sutures. Spinal instrumentation and fusion was performed to prevent postlaminectomy kyphosis in only one patient whose tumor located in upper thoracic spine. The data were gathered retrospectively from medical records and included clinical presentation, tumor location, histopathology, postoperative complications and outcomes. Results: There were 11 patients, 5 males and 6 females, included in this study. The mean age of the patients was 52.8 (between 25 and 75) years. Preoperative symptoms included back pain in all cases, Brown-Sequard syndrome in the 3 cases of thoracic lesions, and sciatica-type of symptoms in 8 cases of lumbar lesions. The histopathologic results were meningiomas for 2 cases, schwannomas for 6 cases, paraganglioma for 1 case, ependymoma for 1 case, and mesenchymal chondrosarcoma for 1 case. Meningiomas and mesenchymal chondrosarcoma were located in the thoracic spine. Three schwannomas located at the level of conus medullaris. Paraganglioma, ependymoma, and the other three schwannomas located at the level of cauda equina. The case of mesenchymal chondrosarcoma received radiotherapy after surgery for the malignant nature of the tumor. All patients recovered well from preoperative symptoms after surgery. Persistent CSF leakage needed revision of dural repair was noted in one case. Iatrogenic spondylolisthesis at the operated levels was noted in one case but the patient declined the suggestion of additional spinal fusion because the clinical symptoms were minimal. No recurrence of tumor was found in the follow-up period. Conclusion: Although malignant lesions have been reported sporadically in the literature, intradural extramedullary tumors are usually benign. There is no typical presentation of clinical symptoms, therefore early-stage intradural extramedullary tumors are difficult to detect. Complete excision of these tumors is usually achievable and the neurologic prognosis after surgical excision is often better than the other spinal neoplasia.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"18 1","pages":"16-22"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75464231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Floating Elbow Injury","authors":"Jr-Yi Wang, Ying-Chao Chou, Po-Cheng Lee, Yi-Hsun Yu, W. Yeh, Chi-Chuan Wu","doi":"10.6492/FJMD.2015.0601.001","DOIUrl":"https://doi.org/10.6492/FJMD.2015.0601.001","url":null,"abstract":"Background: A floating elbow injury (FEI, concomitant ipsilateral fractures of the humerus, ulna, and radius shafts) is rare and difficult to treat. The optimal methods for treating this complex injury have not been well defined. Materials and methods: Twenty-six adult patients with a FEI were treated between 2004 and 2010. Twenty patients were followed for at least one year and were included in this study. Each forearm fracture was treated with open reduction and plate fixation. Humeral fractures were treated with internal fixation using a plate or intramedullary nail. 6 patients received one stage operation and 14 patients were staged operation. The Mayo Elbow Performance Score was used to evaluate elbow function. Prognostic factors were studied according to injury severity and treatment methods. Results: Twenty patients (77%, 20/26) were followed for at least one year (average, 25.8 ± 10.2 month) and were included in this study. The rate of open forearm fractures (45%, 9/20) was higher than that of humeral fractures (30%, 6/20); moreover, 66.7% (10/15) of these open fractures were Gustilo type III open fractures. The union rates of the humerus, radius, and ulna were 95%, 90% and 85%, respectively. The average union times of the humerus, radius, and ulna were 17.7 ± 8.6, 25.9 ± 10, and 25.1 ± 10.8 weeks, respectively. The union time of the humerus was significantly shorter than that of the radius (p=0.008) and ulna (p=0.01). Satisfactory elbow function was observed in 13 patients (65%, 13/20). Eleven patients (55%, 11/20) had isolated or multiple nerve injuries. Radial nerve injury was most common (40%, 8/20). Recovery may be spontaneous in 62.5% of all radial nerve injury cases and 100% in patient with isolated radial nerve injury. In univariate analysis (Mann-Whitney U test), open fractures, vascular injury, nonunion, and deep infection were found to significantly associated with unsatisfactory elbow functions. Based on a Kruskal Wallis test, BPI or multiple nerve injuries was associated with significantly poorer surgical outcomes than no nerve injury and transient nerve palsy (p=0.01). Conclusions: A FEI is difficult to treat and only 65% of patients may achieve satisfactory elbow function. An unsatisfactory prognosis may be related to open fractures, BPI or multiple nerve injuries, vascular injury, nonunion, and deep infection. Radial nerve injury was most common (40%, 8/20). Recovery may be spontaneous in 62.5% of all radial nerve injury cases and 100% in patient with isolated radial nerve injury. Humeral fractures may heal faster than radial or ulnar fractures.","PeriodicalId":100551,"journal":{"name":"Formosan Journal of Musculoskeletal Disorders","volume":"65 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86511808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}