Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine results of treatment according to the guidelines of the Vancouver classification in periprosthetic femoral fractures after total hip arthroplasty. MATERIALS AND METHODS: Among 44 cases of periproshtetic femoral fractures after hip arthroplasty treated between Aug. 1991 and Feb. 2008, thirty-two cases with minimum follow-up greater than one year were included. Outcomes were evaluated using the Beals and Tower's critieria. RESULTS: Outcomes were excellent in 27 cases, and poor in 5 cases. Four of 5 cases with poor result were due to non-union. Three cases were treated with internal fixation and 1 case was treated with a conservative method. One case with a poor result was due to loosening of the cemented stem of a Vancouver type B1 fracture. Loosening of the stem after mid to long term follow up occurred in an additional 4 cases (3 cases with a cemented stem in a type B1 fracture, 1 case with a cemented stem of a type C fracture). Loosened stems were revised with a long revision stem. CONCLUSION: For type B1 periprosthetic fractures around a cementless stem, and for type B2, type B3 periprosthetic fractures, treatment according to the guidelines of the Vancouver classification showed excellent results. However, type B1 periprosthetic fractures around a cemented stem showed poor results with non-union or stem loosening. Hence, more rigid fixation using a bone graft or revision of the stem is needed. In type C periprosthetic fractures in osteoporotic patients, closer attentions is needed to avoid complications.

Long Level (T4-L1) Spinal Epidural Abscess in a Diabetic Patient: A Case Report

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.

The Value and Limitation of the Modified Mau Osteotomy(30 Cases Follow Up Report) / 대한족부족관절학회지

PURPOSE: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. MATERIALS AND METHODS: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. RESULTS: The mean preoperative HVA and IMA were 40.4degrees, 17.4degrees and the mean amounts of correction were 31.2degrees and 11.5degrees. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. CONCLUSION: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

Arthroscopically assisted Anterior Cruciate Ligament Reconstruction using Bone-Patellar tendon-Bone Autograft: 13 to 26-month Follow-up Evaluation / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate arthroscopic anterior cruciate ligament reconstruction (ACLR) using Bone-Patellar tendon-Bone (BPTB) autograft by analyzing its follow up data with subjective, physical and quantitative tests and radiological measurement. MATERIALS AND METHODS: From march 1997 to march 1998, 71 patients who received arthroscopic ACLR using BPTB autograft were followed up for minimum 1 year. RESULTS: A negative pivot shift was noted in 68 patients (95.9%) and there was significant improvement in manual maximum side-to-side differences at a last follow up. Postoperative Tegner scales were similar to preinjury scores and the mean Lysholm score was 55.8 points preoperatively and 94.1 points at the last follow up. Repair of meniscal tears showed significant improvement in Tegner scale compared with menisectomy of meniscal tears group at a last follow up. CONCLUSION: The short-term results of arthroscopic ACLR using BPTB autograft was very satisfactory. Above all, this procedure needs more accurate and skillful surgical technique. Repair of combined meniscal tears improved functional ability of the patients and proved good meniscal healing process.

Correlation between Clinical Features and MRI Findings in One Level Lumbar Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical features and assess the MRI measurements of the stenosis quantitatively in patients undergoing surgery for level one lumbar stenosis. The goal of this study was to correlate MRI measurements with clinical features and define whether the measurements have prognostic value. MATERIALS AND METHODS: From October 1994 to October 1996, 31 patients with level one lumbar spinal stenosis underwent posterior decompression and posterolateral fusion with instrumentation. Average age of the patients at the time of surgery was 56 years (range, 34-77 years). There were 11 men and 20 women. Most commonly involved level was L4-L5 (29 patients). All patients were evaluated before surgery and at defined intervals of 6 weeks, 3 months, 6 months, 1 year after surgery and at last follow up. The average follow up period was 29 months (range, 19-43 months). Clinical features of the patients were back pain, radiating pain, intermittent neurogenic claudication and gross pain score. MRI measurements of the patients were measured by anteroposterior diameter of spinal canal, canal area, foraminal area and depth of lateral recess. A statistical analysis was performed with the Chi-square test and Mann Whitney test. RESULTS: Patients with smaller spinal canal area (area 80 mm2) (P0.05). Other MRI measurements did not correlate with the preoperative and postoperative clinical features. CONCLUSIONS: In conclusion, spinal canal area measured on the MR image seems to have some prognostic value in patients undergoing surgery for level one lumbar stenosis.

Synovial Chondromatosis of the Hip Joint / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of MRI in diagnostic studies and management of synovial chondromatosis involving the hip joint. MATERIALS AND METHODS: From November 1995 to September 1998, 6 patients from 6 cases of synovial chondromatosis involving the hip joint, underwent complete removal of loose bodies and subtotal excision of the synovial membrane. RESULTS: Preoperatively, all cases had hip pain and 5 cases had limited hip motion. Preoperative MRI revealed target-like lesion in T2 images and synovial hypertrophy. MRI findings revealed lesions in the inferomedial capsular portion in all cases and invading the intrapelvic portion in 2 cases. Pathologic findings revealed Milgram stage II in 5 cases and Milgram stage III in 1 case. It also showed 15 to 350 loose bodies in the diameter of 1 mm to 40 mm. Two cases received reoperations due to recurred lesions with pain 3 to 4 months after the operation. Average Harris Hip Score was 37.8 points preoperatively and 90.8 points in the last follow-up. CONCLUSION: For synovial chondromatosis involving the hip joint, MRI contributed to a faster and more accurate diagnosis and aided in surgical planning for complete removal. There was also a need for a radical synovectomy and loose body removal for prevention of recurrence.