Breakage of Reamer during Tibia Intramedullary Nailing: A Case Report

The reamer crack, followed by breakage at its distal part occurred during intramedullary nailing of tibial shaft fracture. The broken reamer was trapped in the intramedullary canal, making it very difficult to pull out. We successfully extracted the broken reamer by retrograde impaction through the fracture site and completed intramedullary nailing procedure. Thus, we present this case with a review of the literature.

Epidermal Cyst in the Foot and Ankle / 대한정형외과학회잡지

PURPOSE: To document post-excision recurrence rates for epidermal cysts of the foot and ankle by location. MATERIALS AND METHODS: The authors retrospectively reviewed epidermal cysts confirmed histologically by excisional biopsy in 37 patients (male 20, female 17) from 2004 to 2011. Cyst locations and sizes were analyzed and preoperative and postoperative pain levels were compared using a visual analogue scale (VAS). Rates of recurrence and patient satisfaction levels were also measured. RESULTS: Epidermal cysts occurred most commonly on the 1st toe (15 cases, 40.6%), followed by the ankle (7 cases, 18.9%), 2nd toe (6 cases, 16.2%), 3rd toe (4 cases, 10.8%), 4th toe (1 case, 2.7%), 5th toe (2 cases, 5.4%), and heel (2 cases, 5.4%). Average cyst size in 35 cases was 15.5x15.0x7.9 mm. VAS reduced from 6.5 preoperatively to 1.0 postoperatively. Cysts recurred in 7 cases (18.9%); on the 1st toe in 5 and on the 2nd toe in 2. Thirty patients (81.0%) were very satisfied with treatment results, 2 patients (5.4%) were satisfied, and 5 (13.5%) were not satisfied. Recurrence occurred in 4 cases, and in one of these cases the cyst recurred after second excision. CONCLUSION: The excision of epidermal cysts in the foot and ankle area was found to have an 18.9% recurrence rate. To achieve good results, the precise location of cysts should be determined by imaging study before excision, and cysts must be excised completely.

Structural Analysis of the Coracoclavicular Ligaments in Koreans: A Cadaveric Study / 대한정형외과학회잡지

PURPOSE: Recently, the methods for reconstructing the acromion joint focused on an anatomical reconstruction. However, the reports of the anatomical method of the coraco-clavicle ligament have given different descriptions. This paper reports an anatomical study of the coraco-clavicle ligament in Koreans. MATERIALS AND METHODS: One hundred and two coraco-clavicle ligaments distracted from 6 fresh cadavers and 96 drug-administered cadavers were analyzed and calibrated. A quantitative analysis of the shape and location of the attachment site of the coracoid process and clavicle was performed, and the clinical and radiological applications were examined considering the calibrating variables. RESULTS: The conoid and trapezoid ligaments were thick and wide when measured in the middle part, and the average length up to the attachment site of the coracoid process was 11.3+/-3.6mm in men and 9.5+/-2.2mm in women. The average length of the clavicle was 158.5+/-55.7mm in men and 146.6+/-50.9mm in women. The length between the middle of the trapezoid tubercle or conoid tubercle and the lateral edge of the clavicle was 21.7+/-3.2mm and 42.8+/-3.4mm respectfully in men and 20.9+/-1.8mm and 39.9+/-3.3 respectfully in women, respectively. The angles of the conoid ligament and trapezoid ligament from the anteroposterior and lateral aspects were measured to be 25+/-8degrees and 19+/-3degrees respectfully in men and 28+/-5degrees and 17+/-3degrees degree respectfully in women. CONCLUSION: A more delicate reconstruction of the coraco-clavicle ligament is believed to be possible with regard to the mean distance from the clavicle to the conoid and trapezoid ligaments and the anticipation of a relationship between these ligaments.

Short-term Results of the Agility Total Ankle Arthroplasty / 대한정형외과학회잡지

PURPOSE: Recently, there has been increasing interest in total ankle arthroplasty as an alternative to ankle arthrodesis. This study examined the short-term results of total ankle arthroplasty using an Agility prosthesis. MATERIALS AND METHODS: This study reviewed the results of 11 patients who underwent total ankle arthroplasty using the Agility prosthesis between May, 2003 and May, 2004. With a postoperative follow-up period of 2 years, 10 patients (10 ankles) were available for review at the time of the follow-up. The clinical evaluation included the ankle range of motion, the personal type of preferred shoe, walking pain (VAS score) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. In addition, the patients were asked whether they were satisfied with the outcome and if they would choose to undergo the same procedure again. The radiologic evaluation included the loosening of the prosthesis, osteolysis and syndesmosis union. The anterior surgical approach was used. The syndesmosis area was fixed using 2 cannulated screws inserted percutaneously in 9 cases and a plate in 1 case. RESULTS: The patients consisted of two men and eight women. The average age was 51.8 years (range 41 to 67) with an average follow-up of 30.3 (range 24 to 36) months. The mean preoperative and postoperative AOFAS ankle scores were 38.2 and 73.8, respectively, demonstrating significant improvement. The mean preoperative and final follow-up walking pain was 8.9 and 2.8, respectively. The ankle range of motion was decreased slightly at the final follow-up. Five patients required a cane to walk. Radiographic analysis showed no prosthesis failure, even though osteolysis occurred around the prosthesis in all cases. Only one case showed further progression. Union in the syndesmosis area occurred within 6 months in 5 cases and delayed union was observed in 3 cases, and nonunion was observed in 2 cases. Sensory loss in the area innervated by the deep peroneal nerve and a fracture in the lateral malleolus was encountered in one case, but this recovered with conservative treatment. Subtalar joint arthritis was noted in one case. CONCLUSION: Agility total ankle arthroplasty results in a favorable outcome at the short-term follow-up. However, total ankle arthroplasty is associated with radiographic complications including syndesmosis nonunion and osteolysis. Only syndesmosis nonunion was associated with the clinical results. Therefore, long-term follow-up is considered to be necessary to demonstrate osteolysis and loosening with their clinical association.

Triple Osteotomy for Hallux Valgus in Patient with Osteopetrosis: A Case Report / 대한정형외과학회잡지

Osteopetrosis is a very rare hereditary musculoskeletal disorder with an unknown cause. There are few reports on this condition with most focusing on long bone fractures. Most patients with osteopetrosis require non-surgical treatment and surgery is technically difficult. Hallux valgus deformities in patients with osteopetrosis are always severe and there are no reports on its treatment. We treated a hallux valgus deformity using triple osteotomy method and experienced nonunion, subluxation of the first metatarsophalangeal joint and screw breakage. This is the first report of the surgical treatment of such a case in Korea. We report this case with a review of the relevant literature.

The Results of Triple Osteotomy in Adult Hallux Valgus Patients with Highly Increased Distal Metatarsal Articular Angle / 대한족부족관절학회지

PURPOSE: To evaluate the clinical and radiographical results of triple osteotomy as a treatment for adult hallux valgus with highly increased distal metatarsal articular ankle (DMAA). MATERIALS AND METHODS: From October 2003 to April 2005, we retrospectively reviewed 7 hallux valgus patients (3 cases: moderate, 4 cases: severe) treated with triple osteotomy and followed-up for more than 1 year after operation. The mean follow up was 15.1 months. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the length of 1:2 metatarsal bone were measured. Proximal chevron osteotomy and distal biplanar chevron osteotomy were done in 1st metatarsal bone. Akin osteotomy was added to the base of the proximal phalanx. The clinical result was assessed using the AOFAS Hallux score, tenderness on the medial eminence, ROM of 1st metatarsophalangeal joint, calluses and patient satisfaction. RESULTS: The mean HVA and IMA was improved from 37.5 degrees and 13.4 degrees to 10.5 degrees and 6.2 degrees respectively. The mean DMAA was corrected from 34.2 degrees to 11.2 degrees and mean shortening of 1st metatarsal was 2.4 mm (0.9-5.8 mm). The mean AOFAS hallux score was improved from 66.4 to 92.5 and VAS score (pain on the medial eminence) from 4.3 points to 0.4 points. Metatarsalgia disappeared in all cases and there was no complications such as necrosis of the metatarsal head. CONCLUSION: Triple osteotomy for adult hallux valgus with a highly increased DMAA is effective and should be considered as a part of the treatment armamentarium.

Methods to Increase the Effectiveness of Trochanteric Stabilizing Plate for Unstable Femoral Intertrochanteric Fractures with Gtreater Trochanteric Fracture: Fixation of Greater Trochanter with Wire and Screw

PURPOSE: The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. MATERIALS AND METHODS: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. RESULTS: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96+/-5.98mm and 4.80+/-3.68, respectively, showing a statistical difference (P value0.05). CONCLUSION: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.