Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients

PURPOSE: To evaluate the clinical and radiological outcome of the greater trochanter reattachment device (GTRD) as firm fixation method for displaced greater trochanter fragment in bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture in elderly patients. MATERIALS AND METHODS: From January 2006 to January 2008, 32 patients above 70 years old treated with bipolar hemiarthroplasty using the GTRD as fixation method for comminuted intertrochanteric femur fracture with greater trochanter bone fragment displaced above 1 cm. They were followed up for more than one year. Clinically, the postoperative Harris hip score (HHS) and daily activities of life of Johnston et al were evaluated, and radiological, any displacement of greater trocharter bone fragments and/or GTRD. RESULTS: The mean postoperative HHS was 71.6 (range, 53~82) points. In rating the daily activity of life, twenty seven (84.4%) patients` postoperative results were above fair. Two patients (6.3%) had displacement of the greater trochanter bone fragment above 1 cm. One patient had a deep infection, so we removed the bipolar head and inserted antibiotics-loaded cement block instead, and after the infection was controlled, conversion to total hip arthroplasty was done. CONCLUSION: In bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture with displaced greater trochanter bone fragment, GTRD produced satisfactory results and early rehabilitation.

Natural History of the Calcaneal Avulsion Fracture in Neuropathic Arthropathy in a Young Diabetic Patient (A Case Report) / 대한족부족관절학회지

The avulsion fracture of the calcaneal tuberosity is rare injury. Usually, it occurs from indirect trauma in old patients with osteoporosis or in patients with diabetic neuropathy. Especially, the bone and joint damage occurred in active patient with severe sensory loss or arthropathy related to nerve damage regardless of the cause is referred to neuropathic arthropathy. Generally, a patient with nondisplacement or minimally displacement is treated by conservative therapy and a patient with severe displacement is treated by open reduction and internal fixation. We experienced a 33 years-old woman with diabetes mellitus who had the displaced avulsion fracture of the calcaneal tuberosity without significant trauma and did not treat. We report upon this case at the 2 years follow-up.

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.

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.