Hybrid External Fixation in the Treatment of Periarticular Fractures of Tibia / 대한정형외과학회잡지

The authors constructed a simple hybrid frame by combining AO tubular and llizarov ring external fixator, using a modified AO single adjustable clamp. From 1997 Jan. to 1998 Apr. 19, periarticular fractures of the tibia were treated with hybrid external fixator. The clinical results using this frame were then analyzed. Of the 19 cases, there were 11 proximal and 8 distal periarticular fractures of the tibia. Open fractures were 5 cases in proximal and 2 cases in distal tibial fractures. All fractures were classified according to the AO classification. There were 1 A2, 4 A3, 1 C1, 5 C2 proximal and 1 A2, 4 A3, 1 C1, 2 C2 distal periarticular fractures. The mean bony union time was 13 wks (range 8-36 wks) and the mean length of time in the external fixator was 12 wks (range 8-36 wks). At last follow up, the MPTA of the proximal tibia was 87.2+/-0.8 and the LDTA of the distal tibia was 88.6+/-1.1. The mean articular depression of the intra-articular fractures was 1 mm. Complications were intermittent pin drainage in 7 patients (26.3%), deep infection in 1 patient (5.3%), delayed union in 3 patients (15.8%) and nonunion in 1 patient (5.3%). In conclusion, hybrid external fixation is a good treatment option for periarticular fractures of the tibia because of its simplicity, versatility, sufficient stability to allow early joint motion, little further soft tissue damage, and so on.

Usefulness of MRI in Dexision for Operation in Shoulder Diseases of Athletes / 대한정형외과학회잡지

PURPOSE: MRI has been widely used in the evaluation of shoulder diseases in many athletic patients. The purpose of this study was to evaluate the usefulness of MRI in treatment of shoulder diseases in athletes. MATERIALS AND METHODS: Fifty-seven athletes were evaluated for shoulder diseases from March 1995 through July 1997. MRI was performed in thirty cases (53%). We analyzed the findings of MRI and checked if operation was determined by MRI findings. RESULTS: MRI findings revealed rotator cuff tear in 6 cases (20.0%), including one full thickness tear and five partial thickness tear. Among 57 cases, four cases (7.0%) were operated. Only in one case (3.3%) was open acromioplasty and rotator cuff repair in accordance with the finding of full thickness tear of rotator cuff on MRI decided upon. One case, which was initially treated conservatively, was treated by arthroscopic acromioplasty later. The two other cases were treated with arthroscopic acromioplasty and Bankart repair with capsular shift without MRI. CONCLUSIONS: MRI is not so useful for determining surgery in initial examination of shoulder diseases of athletes. MRI should be better reserved for cases with rotator cuff disease developed after trauma, cases without improvement by conservative measures or the unusual cases with difficulty in clinical diagnosis.

Clinical Value of Supraspinatus Outlet View and Thirty-Degree Caudal Tilt View in Rotator Cuff Disease / 대한정형외과학회잡지

Supraspinatus outlet view and thirty-degree caudal tilt view have been used for the diagnosis of rotator cuff disease. Because scapula is moving on the thoracic cage, these two views are not always easy to take. The purposes of this study were to investigate the detectability of these views, to compare both views and to observe the interobserver reliability of these views. Supraspinatus outlet views and thirty-degree caudal tilt views were taken from 66 shoulders with clinically diagnosed rotator cuff disease. The shape of the acromions was examined on the supraspinatus outlet views and the size and shape of the acromions were analyzed on the thirty-degree caudal tilt views. An orthopaedic resident, an orthopaedic staff and a radiologic staff reviewed the all films without knowing the opinions of others. Suprapinatus outlet views were not-acceptable in average 43.9% and thirty-degree caudal tilt view were not-acceptable in average 12.6%. All of the three observes had same opinions in 43.9% for the supraspinatus outlet views, and in 45.5% for in thirty-degree caudal tilt views. Disagreement among all three observes was noticed in 13.6% for the supraspinatus outlet views and in 3.0% for in thirty-degree caudal tilt views. In the supraspinatus outlet views, the hooked acromions appeared in average 12.1%. In the thirty-degree caudal tilt view, acromial spurs appeared in average 27.3%. Only 2.5% in average showed hooked acromion on supraspinatus outlet view and acromial spur on thirty-degree caudal tilt view. Thirty-degree caudal tilt view is easier to take and more reliable than supraspinatus outlet view. In is better to take both supraspinatus outlet view and thirty-degree caudal tilt view for each patients with rotator cuff diseases. Radiologic findings should be judged on the base of clinical feature.