The Treatement of the Unstable Proximal Humerus Fracture Using Bifurcate Angled Blade Plate with Tension Band Wiring

PURPOSE: To evaluate the results of internal fixation with bifurcate angled blade plate and tension band wiring of greater tuberosity or rotator cuff for the unstable proximal humerus fracture. MATERIALS AND METHODS: Nineteen cases of unstable proximal humerus fracture who were followed up for more than 1 year were treated using bifurcate angled blade plate and tension band wiring between March 2003 and March 2005. Average age of the patients was 46.5 years (range, 24 to 69), and there were 9 male and 10 female patients. The radiological results were evaluated by bony union and neck shaft angle. In addition, the clinical results were evaluated by Neer's evaluation criteria. RESULTS: In 18 out of 19 cases, bony union was obtained in average 12.5 weeks after operation. The neck shaft angles of sixteen cases were between 120 and 140 degrees by Paavolainen method. According to Neer's evaluation criteria, 17 cases showed excellent or good results. CONCLUSION: The patients treated using bifurcate angled blade plate and tension band wiring could exercise earlier because of good initial stability. Also, the radiological and clinical results were relatively good. The treatment of unstable proximal humerus fracture with bifurcate angled blade plate and tension band wiring was considered as a good method.

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.

Endoscopic Carpal Tunnel Release and Radiological Measures of Carpal Tunnel to Predict the Ease of Access / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the correlation between the preoperative radiological measures of the carpal tunnel and the ease of access of the instruments into the carpal tunnel during an endoscopic carpal tunnel release (ECTR) and to estimate changes in the radiological measures after ECTR. MATERIALS AND METHODS: Carpal tunnel views were possible in 45 patients, 78 wrists taken before the ECTR and the distances between scaphoid and pisiform (S-P) and between trapezium and hamate (T-H) were measured. The correlation between the measured distances and the ease of access of instrument was analyzed. In addition, the radiographic carpal tunnel views were taken three months after surgery and the distance changes after ECTR were measured. RESULTS: In "easy" rated access, the average S-P and T-H distances were 34.5 mm and 24.8 mm in females and 37.0 mm and 26.1 mm in males, respectively. In the "difficult" rated access, the average distances were 29.5 mm and 20.0 mm in females and 32.4 mm and 22.7 mm in males, respectively. Therefore, as the distances became shorter, the insertion of the endoscopic instrument became more difficult (p<0.001). However, after ECTR, the average distances were significantly increased in all cases by 2.5 mm (7.6%) and 2.4 mm (9.6%) in females and 2.8 mm (7.9%) and 2.8 mm (11.2%) in males, respectively (p<0.001). CONCLUSION: The ease of access of an endoscopic device into the carpal tunnel on ECTR had a significant correlation with the radiological measures of the S-P and T-H distances on the preoperative carpal tunnel view. In view of such radiological measures, it is believed that the carpal tunnel is widened after ECTR.

Reference Line Closer to the True Femoral Anteversion During Primary Cementless Total Hip Arthroplasty / 대한정형외과연구학회지

PURPOSE: We investigated the reference line closer to the true femoral anteversion on only the cutting surface of the proximal femoral neck during the femoral stem insertion in cementless total hip arthroplasty. MATERIALS AND METHODS: A postoperative CT of both hips was taken to observe the positioning of the stem and its correlation with the true anteversion of the contralateral side of 33 consecutive patients after unilateral primary cementless total hip arthroplasty with avascular necrosis of the femoral head. We defined several parameters and measured the true anteversion on the contralateral side and the stem anteversion on the lesion side. RESULTS: The average of the midcortical angle was 13.9 degrees +/-6.8 degrees on the lesion side and 0.1 degrees +/-1.3 degrees less than the true anteversion on the contralateral side. CONCLUSION: The study has shown that anteversion using a midline between the anterior cortical line and the posterior cortical line is compatible with the true femoral anteversion.

Postmortem Retrieval of Bipolar Cemented Femoral Stem: A Case Report / 대한정형외과학회잡지

The purpose of this postmortem retrieval study of the femoral stem was to measure, analyse and compare the femoral stem taken from the patient who died after hip arthroplasty morphologically and radiologically. In this case we analysed the femoral stem from a patient who underwent bipolar endoprosthesis 4 months previously, which had never been reported previously in Korea. From radiologic and stereomicroscopic studies, we found that the cement around the femoral stem was inserted uniformly, and the cement thickness was shown the same uniform pattern. A cross sectional study showed small voids and defects that was not seen on the radiographs. Postmortem retrieval of hip arthroplasties can help in studies of operation methods, voids, cement, stemcement interfaces, and cement-bone interfaces.