Corrigendum: Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report / 대한족부족관절학회지

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Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report / 대한족부족관절학회지

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique / 대한정형외과학회잡지

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.

Outcome of Arthroscopic Suture Bridge Technique for Rotator Cuff Tear: Short Term Clinical Outcome In Full-thickness Tear With Fatty Degeneration Less Than Moderate Degree

PURPOSE: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. MATERIALS AND METHODS: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. RESULTS: Postoperative UCLA scores improved from16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. CONCLUSION: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.

Surgical Treatment and Prognostic Factor for Metastatic Bone Tumor / 대한정형외과학회잡지

PURPOSE: In this retrospective study, we tried to find out potential prognostic factors that can be used to determine the optimal treatment for some conditions that are indicated for surgery like pathological fractures or epidural compression. MATERIALS AND METHODS: Between 1985 and 2003 we treated 78 patients with skeletal metastases. A multivariable analysis was conducted using the Cox proportional hazard model. The rates of survival were calculated by the Kaplan-Meier method. RESULTS: We identified four significant prognostic factors for survival: the site of the primary lesion, the presence of visceral or cerebral metastases, any previous chemotherapy and multiple skeletal metastases. With these factors, we could divide the patients into two prognostic groups: the good prognostic group satisfies more than two of the four significant factors and the poor prognostic group doesn't. For the good prognostic group, the average rates of survival at 6 months and a year were 95% and 28%, respectively, and those for the poor prognostic group were 28% (6 mo) and 13% (1 yr), respectively. CONCLUSION: Each patient's life expectancy should be considered when we decide the surgical method for treating metastatic bone tumor. Patients with a very short life expectancy should probably be treated with a less invasive method but patients with a long life expectancy require aggressive surgery. If the life expectancy is estimated to be at least more than 2 month and 3-6 months for bony metastases to the extremity and spine respectively, then an aggressive surgical method should be chosen. With these practical prognostic factors, the life expectancy may be predicted more accurately and so the optimal surgical treatment can be selected more appropriately.

The Early Results of Linear Distal Metatarsal Osteotomy with Minimal Incision for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: Good results using minimal invasive hallux valgus surgery has been reported recently. We evaluate the usefulness of linear distal metatarsal osteotomy with minimal skin incision in mild and moderate hallux valgus deformity. MATERIALS AND METHODS: Twenty-eight patients (thirty-one cases) who had mild to moderate hallux valgus deformity and underwent linear distal metatarsal osteotomy using minimal skin incision were evaluated between February 2005 and February 2006. Hallux-metatarsophalangeal-interphalangeal scale of AOFAS (American Orthopaedic Foot and Ankle Society) score was used as clinical evaluation. Preoperative, postoperative, after pin removal, and final follow up plain radiographs were used as radiologic evaluation. RESULTS: Twenty-six cases (83%) among thirty-one cases showed more than average satisfaction, Average AOFAS score were improved from 63.2 points (range 45-74 points) to 86.4 points (range 67-93 points). Preoperative radiologic index of IMA 14.0 degrees (range 10-18 degrees), HVA 30.2 degrees (range 19-39 degrees), DMAA 13.8 degrees (range 5-23 degrees) were improved postoperatively as IMA 8.3 degrees (range 5-10 degrees), HVA 10.5 degrees (range 2-20 degrees), DMAA 7.2 degrees (range 0-14 degrees) correctively. Mean operative time was 15.5 minutes (range 11-18 minutes) and mean operative time was 5.6 days (range 2-8 days). CONCLUSION: Despite small skin incision and short operative time and admission period, linear distal metatarsal osteotomy with minimal skin incision showed similar results with conventional distal metatarsal osteotomy. Thus, it was thought to be useful operation in mild and moderate hallux valgus deformity.

Analysis of Ankle Bony Abnormality in the Patients with Chronic Ankle Sprain and Marked Ankle Instability / 대한족부족관절학회지

PURPOSE: We analyzed the ankle bony abnormality of patients with marked ankle instability who had chronic ankle sprain more than 3 years. MATERIALS AND METHODS: We evaluated the chronic ankle sprain (more than 3 years) patients with marked ankle instability tested by varus stress test and anterior draw test from March 2000 to December 2005. Eighty-nine patients (104 ankle) were evaluated and there were 38 males and 51 females. The mean age of patient at the time of diagnosis was 34.5 (range, 18 to 56 years). The average duration of morbidity was 7 years and 3 months (range, 3 years and 3 months to 21 years). The patients who had history of dislocation, fracture, malalignment, operated patients, and rheumatoid ones were excluded. Plain radiographs of AP, lateral, oblique and mortise view were checked. RESULTS: Radilologic abnormalities were found at 74 ankles (71%) among 104 ankles. Frequent sequences of location were anterior talotibial osteophyte, medial malleolar osteophyte, Os subfibulare, lateral malleolar osteophyte. Posteior osteophyte, ankle arthritis, talar articular defect were rarely found. CONCLUSION: Seventy-one percent among patients with chronic ankle sprain and marked ankle instability showed more than one radiologic abnormalities. Thus, more exclusive and accurate ankle examination should be performed in these patients.

Acetabular Development after Operative Treatment of Developmental Dislocation of the Hip / 대한정형외과학회잡지

PURPOSE: To examine the acetabular development after the surgical treatment of a developmental dislocation of the hip (DDH). MATERIALS AND METHODS: The serial radiographs of 27 hips were evaluated. The measurement included: acetabular index, CE angle, Smith's h/b, c/b ratio, medial joint space, and center-head distance discrepancy (CHDD). All the patients were followed up until they were at least 10 years old. The overall results were evaluated using the modified Severins classification (group I & II, satisfactory; group III & IV, unsatisfactory). RESULTS: In the satisfactory group, the average acetabular index at 1 and 3 years after the pelvic osteotomy was 6% were in the unsatisfactory group. CONCLUSION: The most reliable factors for predicting normal acetabular development after surgery were an acetabular index <25 degrees and a CHDD <6%. If the hips do not meet the criterion of a CHDD <6% after the osteotomy of one component (either the pelvic or femur) then the other component must be osteotomized.

Pathologic Rupture of Flexor Pollicis Longus Tendon Secondaryto Kienbock's Disease: A Case Report / 대한정형외과학회잡지

A pathologic rupture of the flexor pollicis longus tendon secondary to Kienbock disease is extremely rare with only three cases being reported in the literature. We encountered a case of a pathological rupture of the flexor pollicis longus tendon secondary to longstanding Kienbock disease. The treatment included tendon ball insertion after excising the collapsed lunate and a flexor pollicis longus tendon reconstruction with autogenous palmaris longus tendons. Satisfactory results with a restoration of the active motion of the interphalangeal joint of the thumb, maintenance of the preoperative active range of motion of the wrist and markedly reduced pain was achieved after a one year follow up. We describe this case with a review of the relevant literature.

Periosteum-Derived Mesenchymal Stem Cells and Scaffolds Transplanted into Long-Bone Defects of Rabbit / 대한정형외과연구학회지

PURPOSE: To observe the changes in periosteum-derived mesenchymal stem cells and different scaffold materials transplanted into rabbit long-bone defects. MATERIALS AND METHODS: Thirty-five white rabbits were grouped according to the material transplanted into their tibial bone defects: Group 1 (control group); Group 2-A (agar plus mesenchymal stem cells); Group 2-B (agar only); Group 3-A (Biocompatible Osteoconductive Polymer plus mesenchymal stem cells); Group 3-B (BOP(R) only); Group 4-A (xenograft plus mesenchymal stem cells); Group 4-B (xenograft only). After surgery, radiologic and microscopic observation were performed weekly for 8 weeks. RESULTS: Rabbits transplanted with mesenchymal stem cells showed better bone formation than those without. Mesenchymal stem cells transplanted with agar had better results than mesenchymal stem cells plus BOP(R). Rabbits receiving xenografts showed severe inflammatory reactions. CONCLUSION: Further research is needed on rigid scaffold materials which minimize immune reaction, and on how to ensure uniform distribution of mesenchymal stem cells within such materials.

Sacral Perineural Cyst: A Case Report / 대한정형외과학회잡지

A sacral perineural cyst is composed of an arachnoid membrane of the nerve root at the sacral region. We performed a wide posterior decompression and cystectomy in a patient who suffered from back pain with pain radiating in both lower extremities, and whose MRI findings coincided with those of a sacral perineural cyst. Clinical improvement was observed during the follow-up review. We report the surgical treatment with a review of the relevant literature.

Treatment of Comminuted Femoral Shaft Fracture by Interlocking Intramedullary Nailing: Comparision of results between open reduction with cerclage wiring and closed reduction

PURPOSE: To compare of results between open interlocking intramedullary nailing combined with cerclage wiring and closed interlocking intramedullary nailing in treatment of femoral shaft comminuted fracture, we reviewed retrospectively 62 femoral shaft fractures. MATERIALS AND METHODS: We reviewed retrospectively 62 femoral shaft comminuted fractures, who had been followed up for a minimum one year including Winquist-Hansen classification II, III, IV from January 1996 to December 2002. The group I include the patients who treated with closed interlocking intramedullary nailing. The group II include the patients who treated with open interlocking intramedullary nailing combined with cerclage wiring. RESULTS: The average bone union time was 18.6 weeks in group I, 27.6 weeks in group II. The complication included 3 delayed unions, 1 nonunion and shortening of more than two centimeters in 1 patents in group I. In group II, The complication included 2 infections, 7 delayed unions and 3 nonunions. CONCLUSION: We can use open interlocking intramedullary nailing with cerclage wiring in some femur shaft comminuted fractures, but there are many problems and complications. So we must consider it carefully before using this method.

Operative Treatment of Adult Flexible Flatfoot with Young's Tenosuspension: Case Report / 대한족부족관절학회지

We present the case of an adult flexible flatfoot that was managed with dynamic and multiplarnar approaches which consist of Young's tenosuspension, Evans osteotomy, posterior tibialis tendon advancement with flexor digitorum longus tendon transfer and Lapidus procedure.

Result of Transplantation of Chondrocytes and Periosteum-Derived Cells for Long-Bone Growth Plate Injuries of the Rabbits / 대한정형외과연구학회지

PURPOSE: To study the effectiveness of chondrocyte and periosteum-derived cell transplantation in preventing bar formation in growth plate injuries. MATERIALS AND METHODS: Thirty immature rabbits were grouped according to site of growth plate damaged (distal femur or proximal tibia on the medial side) and type of cell and material inserted (chondrocytes plus agar, periosteum-derived cells plus agar, periosteum-derived cells plus Gelfoam, agar alone, or Gelfoam alone). Radiograms were taken for 16 weeks to measure the changes in varus angle of the distal femur and proximal tibia. Transformation of inserted cells was observed histologically. RESULTS: Rabbits inserted with agar alone showed more severe genu varum compared to those inserted with chondrocytes plus agar. Rabbits inserted with periosteum-derived cells plus agar or Gelfoam showed similar deformities compared to those inserted with agar or Gelfoam alone. Some inserted periosteum-derived cells began transformation into chondrocytes. All rabbits showed gradual bar formation and ultimate fusion of the growth plate. CONCLUSION: Cell-based therapy of growth plate injury still has obstacles to overcome. Further study will be required on how to maintain the inserted chondrocytes, or chondrocytes differentiated from the inserted periosteum-derived cells, and to prevent them from changing into osteoid formation cells.

Long Term Follow-up of Avascular Necrosis after Talar Fracture and Dislocation: 5 Cases / 대한족부족관절학회지

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.

Long Term Follow-up of Avascular Necrosis after Talar Fracture and Dislocation: 5 Cases / 대한족부족관절학회지

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.

Bernese Periacetabular Osteotomy for Treatment of Acetabular Dysplasia / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiologic results of Bernese periacetabular osteotomy in treating acetabular dysplasia. MATERIALS AND METHODS: We evaluated the results of 24 Bernese periacetabular osteotomies performed in 21 patients (18 female, 3 male). The osteotomies were performed through an ilioinguinal approach in 20 cases, and dual (anterior and posterior) approaches in 4 cases. The mean age of the patients at the time of surgery was 23.4 years (range, 13.1-36 years). The average follow-up period was 26 months (range, 12-48 months). The Harris hip score was used for clinical evaluation. Radiological changes of acetabular angle, CE angle, acetabular depth, and femoral head coverage were measured. RESULTS: Clinically, the mean Harris hip score improved from 59.3 preoperatively to 88.3 postoperatively. All four radiological measurements improved significantly after surgery (Wilcoxon Rank Sum test, p<0.05). The following complications were noted: superficial skin infection (1 case), posterior column fracture (3 cases), temporary sciatic nerve symptoms (2 cases), and conversion to total hip arthroplasty (2 cases). CONCLUSION: Bernese periacetabular osteotomy is an effective surgical treatment for acetabular dysplasia in adults.

The Outcomes of Surgical Treatment for Idiopathic Clubfoot / 대한정형외과학회잡지

PURPOSE: We evaluated the efficacy of the different operative procedures for idiopathic congenital clubfoot. MATERIALS AND METHODS: Ninety-six feet in sixty-seven patients underwent surgical treatment. The average age of the patients at the time of surgery was 9 months (range, 2 to 18 months) and the mean followup period was 5 years (range, 2 to 9.7 years). Clinical evaluation both preoperatively (by the classification of Dimeglio et al.) and postoperatively (by the classification of Ezra et al.), and radiological assessment (AP and lateral weight-bearing views) of the feet were performed. RESULTS: Eighty-seven feet (83.1%) demonstrated excellent or good clinical results. The position of the heels with standing and subtalar motion were the assessment categories that demonstrated the least amount of improvement. All radiological indices were improved after surgery. CONCLUSION: The results suggest that the outcome of treatment for clubfoot is dependent largely on the degree of the initial deformity. Three-dimensional correction is important to achieve a satisfactory result.

Dislocation of the Carpometacarpal Joint of the Thumb in Ehlers-Danlos Syndrome: A Case Report / 대한정형외과학회잡지

A subluxation or dislocation of the carpometacarpal joint of the thumb is a rare injury, which usually occurs from trauma. There is a relative dearth of literature about the results of hand surgery for the treatment of Ehlers-Danlos syndrome. To the best of our knowledge, there has been no report on capsular ligament reconstruction in the hand using an autogenous tendon graft for the treatment of Ehlers-Danlos syndrome. We describe a case of atraumatic dislocation of the carpometacarpal joint of the thumb that had gradually progressed in a patient with Ehlers-Danlos syndrome; and which was treated with capsular ligament reconstruction by use of a portion of the flexor carpi radialis tendon. Six months after surgery, a trapeziometacarpal arthrodesis was performed secondarily, because of subluxation and pain in the carpometacarpal joint of the thumb, with a pinching motion.

An Experimental Model of Chronic Nerve Compression in the Rat / 대한정형외과학회잡지

PURPOSE: The aim of this study was to develop a model for chronic nerve compression in a rat and a model reproducing a normal anatomical narrow portion that lies in the course of the peripheral nerve. MATERIALS AND METHODS: Male Sprague-Dawley rats were used. A 5 mm tendinous band was made from the patellar tendon harvested from each rat and placed around the sciatic nerve. In order to determine the degree of compression, a series of internal diameters of the band (0.2 mm smaller than (group I), same as (group II), and 0.2 mm (group III), 0.4 mm (group IV) and 0.6 mm greater (group V) than the diameter of sciatic nerve) were used. The rats were evaluated at 1, 2, 3, 4, and 6 months after banding using an electroneurophysiologic study, a pathohistologic study, and the morphometric nerve fiber analysis. RESULTS: In groups III and IV the morphometric findings showed statistically significant compressive changes in the periphery after 3 and 4 months, respectively and revealed significant changes in both the periphery and central portion at 6 months (p<0.05). In group V, the measurements and histologic findings were almost identical to the control group at 6 and 10 months. The nerve electrophysiologic study showed significant compressive changes at 6 months in groups III and IV (p<0.05). In the group V, the measurements were similar to those of the normal control. CONCLUSION: Groups III and IV appear to be a reliably reproducible chronic nerve compression model while excluding the possibility of foreign body reactions. In addition, group V appears to be a reliable model of a normal anatomical narrow portion that lies in the course of the peripheral nerve.