The development of Genu Valgum of the Affected Limb in Legg-Calve-Perthes Disease

Purpose: Genu valgum in Legg-Calve-Perthes disease (LCPD) is not a known complication. We investigated whether this valgus tendency is a complication of femoral varus osteotomy (FVO) or the sequela of the disease process itself, and what are the related factors. Materials and Methods: 35 patients treated by FVO and 38 by abduction orthosis (AO) were selected for this study. Only those patients with unilateral involvement, fragmentation stage, Catterall Group III or IV, and who were followed-up to full skeletal maturity were included in the study. We measured mechanical axis deviation percentage and hip-knee-ankle angle for femorotibial alignment, and mechanical lateral distal femoral angle and medial proximal tibial angle (mMPTA) for knee orientation on teleoroentgenograms and compared the affected and normal limbs. Results: All measurements, excluding the mMPTA, demonstrated a tendency of relative genu valgum versus the opposite normal limbs. This tendency was observed in both groups. There was no statistically significant difference between the two groups. Conclusion: Genu valgum occurred in 66% to 70% of the LCPD patients. Four factors were found to be significantly correlated with valgus shift: increased medial bowing of the femoral neck, decreased acetabulum head index, coxa magna, and limb shortening. Multivariate regression analysis identified limb shortening as the factor most responsible for valgus shift.

Comparative Study of Acute and Chronic Reconstruction of Anterior Cruciate Ligament?

PURPOSE: To compare the clinical? results and stability of acute and chronic reconstruction of anterior cruciate ligament (ACL). MATERIALS AND METHODS: Patients who had ACL reconstruction with a quadruple hamstring tendon and ligament anchor (LA) screw with a minimum 2-year follow-up were included in this study. Acute (within 4 weeks) reconstruction group was composed of 27 knees and chronic (over 3 months) group was 44 knees. We compared the two groups with regard to Lysholm knee score, range of motion, thigh circumference, Lachman test, Tegner activity scale, associated meniscal injuries, and anterior laxity difference by Telos stress arthrometer. RESULTS: At last follow-up, no significant differences were found between the acute and chronic groups for Lysholm score, range of motion, Lachman test, Tegner activity scale, and instrumental laxity. 16 cases (59%) of acute and 33 cases (75%) of chronic patients had a meniscal injuries of which were reparable in 5 cases (28%) and 7 cases (17%). CONCLUSIONS: Acute reconstruction of ACL had excellent clinical and radiologic results as good as the chronic group without motion problem.

The Radiographic Comparative Study of the Unicompartmental Knee Arthroplasty: Manual versus Navigation System / 대한정형외과학회잡지

PURPOSE: To compare the radiographic results of unicompartmental knee arthroplasty using a navigation system with those using a manual alignment system. MATERIALS AND METHODS: The results of 50 cases (46 patients) of unicompartmental knee arthroplasty using a navigation system (24 patients, 25 cases) and using a manual alignment system (22 patients, 25 cases) were evaluated. Knee anteroposterior, lateral, and weight-bearing full-length lower extremity radiographs before and after the arthroplasty were used for the measurements. RESULTS: The mean postoperative femorotibial alignment was 3.6 degrees of valgus in the manual alignment group and 5.4 degrees of valgus in the navigation group. The postoperative mechanical axis measured using Kennedy and White's method was located at zone 1 in 4 cases (16%), at zone 2 or C in 21 cases (84%) in the manual group, and at zone C for all cases in the navigation group (p=0.001). In the coronal axis of the femoral component, 11 cases (44%) were excellent, 7 cases (28%) were good and, 7 cases (28%) were poor in the manual alignment group. In the navigation group, 15 cases (60%) were excellent and 10 cases (40%) were good and there were no poor results (p0.05). In the sagittal axis of the tibial component, 9 cases (36%) showed poor results in manual group and there were no poor results in the navigation group (p<0.05). CONCLUSION: Unicompartmental knee arthroplasty using navigation produced better results in restoring the alignment of the prosthesis and the mechanical axis of the lower extremity than that using manual alignment.

Modified Chiari Pelvic Osteotomy for Dysplastic Hip / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical, radiographic results of a modified Chiari osteotomy for dysplastic hips associated with early osteoarthritis. MATERIALS AND METHODS: 17 dysplastic hip patients were examined, and treated with modified Chiari osteotomy, which is dome-shaped pelvic osteotomy. Their mean age at surgery was 33.5 years old (range: 14-53 years), and the mean follow-up period was 28.2 months (range: 12-73 months). In the clinical evaluation, limping, range of motion and Harris Hip Score (HHS) were used and in the radiographic evaluation, center edge angle, acetabular angle, head coverage, weight bearing joint space and minimal joint space were evaluated. RESULTS: Six out of 13 patients who had an antalgic gait improved, and the level of abduction, internal rotation and external rotation showed significant improvement at the final follow-up. The radiographic results showed that the acetabular angle improved significantly from 47.5degrees preoperatively to 40.0degrees at the last follow-up. The center edge angle showed significant improvement from 9.9degrees preoperatively to 38.5degrees at the last follow-up and the head coverage also showed significant improvement from 57.9% preoperatively to 82.4% at the last follow-up. CONCLUSION: A modified Chiari osteotomy is an effective method for a dysplastic hip with a mild and moderate grade of osteoarthritis, and shows improved clinical and radiographic results.

Rising Incidence of Hip Fracture in Gwangju City and Chonnam Province, Korea

The purpose of study was to determine the incidence of hip fracture in 2001, to compare this with that of 1991, and to identify possible causes of change. Patients aged 50 yr or more living in Gwangju City and Chonnam Province, Korea, and who sustained a fracture of the hip during 2001 were investigated. Only patients who were admitted to hospitals for primary treatment of the first hip fracture were selected. There were 1,152 patients. A comparison of fracture incidences for 1991 and 2001 showed considerable increase during the 10-yr period. The total annual number of hip fractures rose from 247 in 1991 to 1,152 in 2001 and the fracture incidence also increased remarkably from 3.3 persons per 10,000 population in 1991 to 13.3 in 2001, representing a 4-fold increase over 10-yr. The reasons for this rising trend of hip fracture were not fully explained. However, an increase in the elderly population, an increase in osteoporosis, and an increase in injurious falls could partly account for the observed increase.

Sesamoids and Accessory Bones of the Forefoot in Normal Korean Adults / 대한족부족관절학회지

PURPOSE: To determine the locations and incidences of sesamoids and accessory bones of the forefoot in normal Korean adults. MATERIALS AND METHODS: The plain radiographs of the forefoot of 400 volunteers, 200 males and 200 females, were taken. The three orthopedic surgeons participated in the radiographic evaluation independently. Persons who had history of foot problem or injury were excluded. RESULTS: Sesamoids of first metatarsophalangeal joint were nearly always present; medial 99% and lateral 100%. The bipartite sesamoid was more common in medial (9.8%) and in female (17.0%) than in lateral (0.3%) and in male (2.5%). Sesamoids of the interphalangeal joint of the first toe were seen in 35.8%. Sesamoids of metatarsophalangeal joints in other four toes were rarely observed. Their incidences were 5% in second toe, 0.8% in third, 0% in fourth, and 2.8% (lateral) and 7.5% (medial) in fifth. Sesamoids of interphalangeal joint in four lesser toes were not observed except two cases (0.5%) in the fifth toe. Accessory bone was very rarely observed. Os vesalianum was observed in five feet (1.3%), Os intermetatarseum in 14 feet (3.5%), and Os cuneo-metatarsal I tibiale in none. CONCLUSION: We determined the location and incidences of sesamoids and accessory bones of the forefoot, and we expected this to help to diagnose the forefoot problem.

Sesamoids and Accessory Bones of the Forefoot in Normal Korean Adults / 대한족부족관절학회지

PURPOSE: To determine the locations and incidences of sesamoids and accessory bones of the forefoot in normal Korean adults. MATERIALS AND METHODS: The plain radiographs of the forefoot of 400 volunteers, 200 males and 200 females, were taken. The three orthopedic surgeons participated in the radiographic evaluation independently. Persons who had history of foot problem or injury were excluded. RESULTS: Sesamoids of first metatarsophalangeal joint were nearly always present; medial 99% and lateral 100%. The bipartite sesamoid was more common in medial (9.8%) and in female (17.0%) than in lateral (0.3%) and in male (2.5%). Sesamoids of the interphalangeal joint of the first toe were seen in 35.8%. Sesamoids of metatarsophalangeal joints in other four toes were rarely observed. Their incidences were 5% in second toe, 0.8% in third, 0% in fourth, and 2.8% (lateral) and 7.5% (medial) in fifth. Sesamoids of interphalangeal joint in four lesser toes were not observed except two cases (0.5%) in the fifth toe. Accessory bone was very rarely observed. Os vesalianum was observed in five feet (1.3%), Os intermetatarseum in 14 feet (3.5%), and Os cuneo-metatarsal I tibiale in none. CONCLUSION: We determined the location and incidences of sesamoids and accessory bones of the forefoot, and we expected this to help to diagnose the forefoot problem.

Primary Total Hip Arthroplasty with Mini-Incision Technique: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of total hip arthroplasty with the mini-incision technique (mini-incision THA) by comparing it with conventional THA. MATERIALS AND METHODS: Two groups were compared; one group received conventional THA, the other group mini-incision THA. All these patients were treated using same prosthesis. We compared the postoperative clinical and radiological results. RESULTS: Skin incisions ranging from 13 cm to 28 cm were needed for conventional THA and 5.5-9 cm for mini-incision THA. The mean operative time was 53 minutes for the conventional method and 52 minutes for the mini-incision method. Mean blood loss in mini-incisionTHA was less than in conventional THA by about 240 cc, mean length of hospital stay was shortened by 5 days. Using a 5-point scale, pain was reduced in mini-incision THA. No differences were found between the two groups in terms of the opening angle of the acetabularcomponent and the intramedullary status of the femoral stem insertion. CONCLUSION: Mini-incision THA produced better clinical results and no differences were observed in the radiological findings versus conventional THA. Mini-incision THA is believed to be a useful method of reducing the skin incision and soft tissue dissection, and permits earlyrehabilitation and increases patient satisfaction.