Radiologic and Serologic Factors Associated with Bone Union at Femoral Atypical Fracture

PURPOSE: The purpose of this study was to investigate the radiologic and serologic factors related to postoperative union using intramedullary (IM) internal fixation in atypical femoral fractures (AFF), which are closely related to bisphosphonates (BPs) for osteoporosis. MATERIALS AND METHODS: From February 2008 to December 2016, 65 patients (71 cases) who had undergone IM nail fixation after diagnosis of AFF were enrolled in this study. Patients were divided into group A, who experienced union within 6 months and group B, who did not experience union within 6 months. They were evaluated for duration of BPs use, radiologic factors and serological factors. RESULTS: The mean duration of BPs use was 6.17 years in group A and 8.24 years in group B (p=0.039). In the subtrochanteric area, there were 14 cases (27.5%) in group A and 14 cases (70.0%) in group B. In the femoral shaft, there were 37 cases (72.5%) in group A and 6 cases (30.0%) in group B (p=0.001). On the preoperative, the flexion in the coronal plane was 5.9° (2.1°–9.2°) in group A and 8.0° (3.1°–12.1°) in group B (p=0.041). On the postoperative, conversion to valgus was 15 cases (29.4%), 8 cases (40.0%); conversion to neutral was 34 cases (66.7%) and 8 cases (40.0%); conversion to varus was 2 cases (3.9%) and 4 cases (20.0%), each (p=0.037). The fracture site gap was 1.5 mm (0–2.9 mm) on the front side and 1.2 mm (0–2.2 mm) on lateral side and 2.2 mm (0.9–4.7 mm) and 1.9 mm (0.5–3.5 mm), each (p=0.042, p=0.049). Among serological factors, there was no significant difference between the two groups. CONCLUSION: Factors adversely affecting the union should be recognized before surgery, such as longterm BPs use or a severe degree of bending of the femur in the coronal plane. During surgery, proper reduction and spacing of the fracture site on the coronal plane should allow adequate reduction of the anterior and posterior surfaces. Obtaining anatomic reduction would be most beneficial for union, but if that is not possible, obtaining congenital valgus rather than varus on the coronal plane may be helpful for union.

Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

Comparison of Ultrasonography and Magnetic Resonance Imaging in Measurement of Lumbar Muscles / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare magnetic resonance imaging (MRI) and ultrasonography measurement of peri-lumbar muscle atrophy which is thought to be a cause of low back pain. MATERIALS AND METHODS: Eighty-two patients (44 males, 38 females) who visited Wonkang University Hospital from March, 2015 to August, 2015 complaining of lumbar back pain and underwent lumbar MRI were enrolled in this study. Cross section area (CSAMRI) and muscle thickness (MTMRI) of psoas major (PS) and lumbar extensor (LM) located on both sides of L4/5 and L3/4 was measured by MRI, and sono measurement of thickness of the same muscle (MTUS) at the same level of that MRI measurement were analyzed. RESULTS: In correlation analysis of PS CSAMRI and PS MTUS is the correlation coefficient of L4/5 was 0.136 (p=0.64), L3/4 right (Rt) was 0.070 (p=0.81), and L3/4 left (Lt) was 0.288 (p=0.32). PS CSAMRI at L4/5 Rt showed that correlation coefficient of PS MTUS showed a positive correlation to 0.559 (p=0.04). In analysis of the PS MTMRI and PS MTUS, the correlation coefficient of L4/5 Rt was measured by a 0.316 (p=0.27), L4/5 Lt was 0.022 (p=0.94), L3/4 Rt was 0.236 (p=0.41), and L3/4 Lt did not show a significant result with 0.287 (p=0.31). In the results of correlation analysis of the LM MTMRI and LM MTUS, the correlation coefficient of L4/5 Rt was 0.207 (p=0.49), L4/5 Lt was 0.051 (p=0.86), and L3/4 was Rt 0.048 (p=0.87), L3/4 Lt did not show a significant value with 0.154 (p=0.61). CONCLUSION: This study proved that muscle volume obtained from ultrasono is effective for evaluation of cross-sectional area of lumbar muscle.

Complete Rupture of the Proximal Hamstring / 대한스포츠의학회지

While a sprain of the hamstring muscle is relatively common in athletes or those who participate in physically active sports, a complete rupture of the proximal hamstring is relatively rare. A rupture of the long head of the biceps femoris without rupture of the semimembranosus and semitendinosus muscles has rarely been reported. In this study, we saw relatively favorable outcomes after reattachment with a suture anchor at the ischial tuberosity in two patients who had a rupture of the long head of the biceps femoris.

Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph

PURPOSE: The purpose of this study was to compare the sliding distance of lag screw in patients with unstable femoral intertrochanteric fractures treated with intramedullary fixation using a cephalomedullary nail with a fixed angle between the neck and shaft of the femur in relation to reduction type by lateral radiographs. MATERIALS AND METHODS: Between January 2009 to October 2013, 86 cases (86 patients) with unstable femoral intertrochanteric fractures were treated with intramedullary fixation using a metal nail with a fixed neck-shaft angle and followed for at least 6 months. We used AO/OTA classification, and all cases were unstable fractures. Twenty cases were 31-A22, 54 cases were 31-A23, and 12 cases were 31-A3. There were 30 men and 56 women. Average patient age was 73.7 years (range, 47-97 years). We classified reduction types into three groups as postoperative lateral radiologic findings. Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displacement of the femur neck. The radiological assessment compared the sliding distance of the lag screw between postoperative X-ray and last follow-up X-ray. RESULTS: Forty-two cases were in group 1, 22 cases were in group 2, and the other 22 cases were in group 3. There was no significant difference in the patient characteristics of each group. The sliding distances of the lag screw were 4.9±3.2 mm, 4.6±3.6 mm, and 8.5±4.9 mm, respectively, and group 3 showed a significant result (p<0.0001, p=0.024). CONCLUSION: In cases treated with intramedullary fixation using a cephalomedullary nail with a fixed neck-shaft angle, appropriate reduction with a lateral radiograph before screw fixation is needed to prevent excessive lag screw sliding.