Navigation Guided Open Wedge High Tibial Osteotomy / 대한정형외과학회잡지

Navigation systems are currently being widely used in orthopedic surgery. The mechanical axis alignment can be judged accurately via a navigation system. High tibial osteotomy (HTO) is a procedure that aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success. And, by using a navigation system, accurate multiplane measurements of the lower limb alignment can be performed intraoperatively in real time, and alignment adjustments can be made as the surgeon desires. Compared with the conventional cable-method, computer navigation significantly improves the accuracy of postoperative leg axis, reduces correction variability with fewer outliers, and reduces radiation time. This paper reviews the advantages, clinical results, complications, pitfalls, and posterior tibial slope control in navigation guided open wedge HTO.

Current Trends in Anterior Cruciate Ligament Reconstruction

The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience.

Failure of a Metal Femoral Head after Revision Total Hip Arthroplasty for a Ceramic Liner Fracture / 대한고관절학회지

Popularity of ceramic materials has increased among joint reconstruction surgeons for treatment of young patients who wish to maintain their active lifestyle. However, ceramic fracture is one of the most serious complications, and there are many concerns regarding the acceleration of third body wear and refracture of ceramic articulation after revision total hip arthroplasty for a ceramic fracture. To date, a few authors have reported on complications due to residual ceramic particles after revision surgery. We report on a case of metallosis due to metal head wear caused by residue of fractured ceramic particles lodged in the polyethylene liner after revision total hip arthroplasty for a ceramic liner fracture.

Treatment of Periprosthetic Tuberculous Infection of Total Hip Arthroplasty with Long Term Medication without Implant Removal / 대한고관절학회지

Periprosthetic joint infection is one of the most dreaded complications of replacement arthroplasty and the incidence of periprosthetic tuberculous infections is increasing. This report presents a case of extensive periprosthetic tuberculous infections of primary total hip arthroplasty which was treated with debridement and long periods of antituberculous medication without implant removal. The patient completed 18 months of 4 drug antituberculous chemotherapy and the plain radiograph on the last review showed new bony consolidation around the prosthesis without loosening or signs of reactivation.

Extensor Pollicis Longus Rupture after Distal Radius Fracture

PURPOSE: To evaluate the cause and surgical outcome of extensor pollicis longus rupture after distal radius fractures. MATERIALS AND METHODS: Nineteen cases in which the patients underwent surgical treatment for rupture of the extensor pollicis longus after distal radius fractures were followed for more than one year. Among the nineteen cases, fourteen extensor pollicis longus ruptures occurred after conservative treatment, four occurred after closed reduction with K-wire fixation, and one occurred after open reduction and internal fixation with a plate. All cases were treated by extensor indicis proprius transfer. RESULTS: Extensor pollicis longus ruptures were caused by K-wire irritation in two, by a protruding screw tip in one, and by a callus in one. In the conservative treatment group, tendon ruptures were diagnosed at an average of 3.1 months (0.7~17). Tendon ruptures were detected in the surgical treatment group at an average of 12.8 months (1~48). All the patients showed favorable recovery of the extension capability of the thumb at the final follow-up. CONCLUSION: The main cause of extensor pollicis longus rupture after distal radius fracture was ischemic damage. Therefore, during the surgery, the length and direction of screws and K-wires should be fixed carefully to avoid such damage. Distal radius fracture also requires careful observation of the extensor pollicis longus during follow-up. Furthermore, extensor indicis proprius transfer is considered to be an effective method for extensor pollicis longus rupture.

Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the prevalence and associated factors of the concurrent lower thoracic lesions in patients who have a lumbar spine disease, using the extended lumbar MRI. SUMMARY OF LITERATURE REVIEW: There are no studies regarding the concurrent thoracic lesions with lumbar disease. MATERIALS AND METHODS: All the patients, who had visited the out-patient department (OPD) of orthopaedic surgery in our hospital and underwent lumbar spine MRI, were studied during 1 year. Totally, 750 patients were included. The extended lumbar spine MRI contained additional extended T2-weighted sagittal images that cover the lower thoracic vertebrae with 35 centimeters long. We analyzed the highest observable level, characteristics of detected thoracic lesions. Those lesions were classified according to the severity of compression of the spinal cord and investigation for associated factors of patients. Also, the times for additional tests were measured. RESULTS: Additional tests were able to observe up to the 7th thoracic vertebrae. In 257 cases (34.3%), the lower thoracic lesions were detected and increased with aging (p<0.001). A total of 48 patients (6%) had the lesion compressing the spinal cord and 28 patients needed further evaluation for the lower thoracic lesion. Further, 2 cases were treated surgically for lower thoracic lesions. Scanning extra time for additional test were 3 minutes. CONCLUSIONS: The prevalence of lower thoracic lesions accompanied with the lumbar disease was 34% in this study. Therefore, additional extended lumbar spine MRI is needed to check possible concurrent lesions in the lower thoracic spine.