Distal Radius Fracture Treated with Two Small Fragment Plates / 대한정형외과학회잡지

PURPOSE: To analyze functional and radiological results and early motion after the stable fixation of fractures of the distal radius by using two small fragment plates. MATERIALS AND METHODS: Thirty cases were analyzed clinically and radiographically. Internal fixation was achieved using two 2.7 mm stainless steel small fragment plates on the radial and intermediate columns angled 60 degrees C apart in all cases. For functional evaluation, Green and O'Brien scores were analyzed. For radiological evaluation, volar tilting angle, radial inclination, and ulnar variance were analyzed. Arthroscopy was performed in all cases concomitantly. RESULTS: Functional results were excellent or good in 24 patients (80%) according to the modified system of Green and O' Brien. Radiological analysis showed that volar tilting angle, radial inclination or ulnar variance during the immediate postoperative to bony union period had no significant difference. Complications occurred in two wrists, namely reflex sympathetic dystrophy (1) and delayed union (1) needing an additional palmar plate and a bone graft. No case experienced implant failure or extensor tendinitis. CONCLUSION: Two 2.7 mm small fragment plates fixations provided good stability, and allowed early function. We report a series of 30 fractures treated by this method of internal fixation with satisfactory results.

Wire Fixation Technique for the Tibial Tubercle Osteotomy in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the clinical results of wire fixation technique for tibial tubercle osteotomy in total knee arthroplasty. MATERIALS AND METHODS: Twenty-three cases who underwent TKA with tibial tubercle osteotomy and wire fixation technique for the extensile exposure between January, 1982 and April, 2001, were reviewed. Seventeen cases were male and six cases female. The averageperiod of follow-up was 58 months. The average age was 62.3 years (minimal: 38, maximal: 74). Five cases underwent tibial tubercleosteotomy for primary TKA and the preoperative diagnoses were degenerative osteoarthritis in 2 cases, posttraumatic osteoarthritis in 1case and rheumatoid arthritis in 2 cases. Eighteen cases underwent tibial tubercle osteotomy for revision TKA due to the infected TKAin 10 cases and aseptic loosening in 8 cases. Osteotomized tibial tubercle in size of 2x10 cm was achieved by using oscillating saw and curved osteotome from the point of 2 cm distal to the articular surface of proximal tibia to 8 cm below the tibial tubercle. Six holes were drilled with 1 cm distance for 3 wires passage. The tubercle fragment was fixed with 3 wires and the wires were bent around the tibial stemin the medullary canal for passage through tubercle fragment. The passive range of motion was started within one week after the operation. We evaluated the preoperative and postoperative range of motion and the radiologic bony union was assessed by lateral radiograph. The clinical results were assessed by Knee Society Knee Score. RESULTS: The bony union was achieved in twenty-two cases about 13 moths after the operation, and fixation loss was observed in one case. The average range of motion were 70 degrees (5-90 degrees) preoperatively and 80.8 degrees (25-110 degrees) postoperatively. The average clinical knee scores of painand function were 51 (40-57) point, 58 (45-70) point preoperatively and 54 (50-65) point, 65 (54-78) point postoperatively. Two complications were noted with one case of infection and fixation loss due to injury in each. CONCLUSION: Wire fixation for tibial tubercle osteotomy in total knee arthroplasty results in firm fixation of tubercle fragment, therefore it seems to be an useful technique in exposure for total knee arthroplasty.

Intraoperative Measurement of Femorotibial Contact Pressure in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: A new method has been devised to determine contact pressures in prosthetic components. A real time analysis of the contact pressure distribution could help fine tuned implant positioning and ligament balancing during Total Knee Arthroplasty. MATERIALS AND METHODS: Posterior cruciate reserving type procedures were done with externally rotated femoral cut. Femorotibial contact pressure was measured in four compartments in both flexion and extension position. A LOAD CELL located beneath the tibial plate changes the contact pressure into electric signal and DP-41S transformed the electric sign into the pressure unit. Adjunctive fine-tuning operation was done to approximate the equilibrium among the four compartments of the tibial plate. RESULTS: Femorotibial contact pressure were distributed between 17.1 N (Newton) to 33.4 N (average 23.6 N). A peak contact pressure was exhibited in the anteromedial compartment in extended knee and in the posterolateral compartment in flexed knee. CONCLUSION: A LOAD CELL electronic transducer technique was introduced. This method was tried to get the balanced equilibrium of contact pressure between Femorotibial components during TKA.

A New Slip Knot with Locking Loop / 대한정형외과학회잡지

PURPOSE: To introduce a new arthroscopically tied knot with self-locking mechanism (SMC knot) and compare the knot security between the SMC knot and other arthroscopically tied knots used commonly in arthroscopic repair. MATERIALS AND METHODS: We performed tensile testing on SMC knot and four arthroscopically tied knots with No.2 Ethibond suture material. The four types of knot configurations were Tennessee knot, Duncan knot, Overhand throw knot and Revo knot. After knot creation, we measured displacement in cyclic loading, load at clinical failure, ultimate failure strength and mode of failure, using MTS Bionix test system and analyzed the data by One-way ANOVA. RESULTS: In cyclic loading, displacement of overhand throw knot was significantly higher than those of others. In clinical failure, load of SMC knot was significantly higher than those of Overhand knot and Duncan knot , but lower than that of Revo knot. In ultimate failure strength, load of SMC knot was higher than those of Overhand and Tennessee knot, but showed no difference with those of Duncan and Revo knots. As for failures, knot slippage occurred in the Overhand throw knot, Duncan knot and Tennessee knot, whereas knot breakage occurred in SMC knot and Revo knot. CONCLUSION: The results show that SMC knot is a safe arthroscopic knot that provides great knot security without slippage.

The MR Signal Intensity Changes in the Muscles and Tendons of the Limbs of the Mongrel Dogs, and Rotator Cuffs of Adult Humans after Local Steroid Injection / 대한정형외과학회잡지

OBJECTIVE: The changes of magnetic resonance signal intensity after the local steroid injection in to the muscle and tendon in mongrel dogs and the subacromial spaces of patients were studied. MATERIALS AND METHODS: Local injection of the methylprednosolone acetate was performed in muscles and tendons of the limbs of ten mongrel dogs and rotator cuffs of patients. Normal saline was injected in to six muscles and tendons as a control. MR imaging was obtained before and after the local injection of methylprednisolone and the normal saline. RESULTS: After one week and two weeks after the injection, increased signal intensity on T2-weighted fast spin echo MR image was found in four and five of ten muscles and tendons respectively, to which methylpredisolone was injected. None of the muscles or tendons, to which normal saline was injected, showed increased signal intensity on follow-up MR imaging. The cases with increased signal intensity were interpreted as having a inflammation or injury. Moreover, in the clinical study, two of five patients who underwent local steroid injection showed an area of increased signal intensity on T2-weighted fast spin echo MR imaging. CONCLUSION: MR images after local steroid injection should be interpreted carefully with regard to the previous steroid injection.

Tram Track Lesion of the Talar Dome / 대한정형외과학회잡지

PURPOSE: We report a distinctive lesion in the articular cartilage of the talar dome in anterior bony impingement syndrome of the joint. MATERIALS AND METHODS: Arthroscopic debridement was done in 68 ankles under the diagnosis of anterior impingement syndrome of the ankle joint between October 1994 and June 1996. There were 6 tram track lesions of talar dome of the 68 ankles. We evaluated arthroscopic findings of tramtrack lesion, injury mechanism, and treatment results according to the criteria of Ogilvie-Harris DJ et al. RESULTS: All six male patients were professional or collegiate soccer players. Average age was 29 years (26 to 34). All 6 cases were dorminant ankles. Trauma history was not definite in all 6 cases. All 6 patients were anterior impingement syndrome of the ankle and treated by arthroscopic removal of osteophytes. The cartilage lesions were full thickness defects, located in the anterior half of the medial aspect of the talar dome and were longitudinal with variable widths resembling a tram track, thus named ""tram track lesion"". Tram track lesion and osteophytes were contacted by ankle dorsiflexion. Overall, good and excellent results were achieved in five patients at a mean follow up of twenty-seven months. Two cases had recurrences of osteophytes. CONCLUSIONS: Tram track lesion of talar dome occurred by repeated scratching of the osteophyte of distal tibia and treated effectively by arthroscopic removal of osteophyte and debridement.

Diagnosis of Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

The purposes of this study were to evaluate the diagnostic modalities of the acute rupture of anterior cruciate ligament(ACL) and to know the differences hetween complete and partial ACL rupture preoperatively, analyzing the methods of physical examimation and the clinical features in acutely injured patient. We analyzed the anterior drawer test, Lachman test, KT-2000 arthrometer, MRI findings and associated injuries in the 35 patients who were confirmed to have ACL rupture by arthroscopy of the knee joint, performed within a month after trauma. We divided the patients by arthroscopy into 2 groups: complete rupture group and the partial rupture group. Among the 35 cases of ACL rupture, there were 10 cases of partial rupture and 25 cases of complete rupture. The Lachman s test was the most sensitive method of the physical examinations in detecting acute ACL injuries, with 90% and 92% positive rate in each group retrospectively. KT-2000 arthrometer with more than 3mm side-to-side difference showed all positive findings except one. The findings of ACL rupture in MRI were discontinuity, increased signal intensity, ahnormal course of ACL fibers and so on. The sensitivity of MRI in diagnosing the acute injuries of ACL was 97.2% hut had difficulties in differentiating the complete from partial rupture. Associated injuries of the ACL injured knee were medial and lateral meniscus tear and medial collateral ligament injury. The diagnosis of acute ACL rupture was made possihle hy physical examinations and with use of the KT-2000 arthrometer and MRI was useful in detecting the ACL rupture or associated injuries but not in differentiating complete from partial rupture of the ACL.

Arthroscopic Ankle Arthrodesis / 대한정형외과학회잡지

Eleven cases of arthroscopic ankle arthrodesis were reviewed. Average age of patients was 59 years, 4 male and 7 female. Underlying diseases were osteoarthritis in 7 cases, rheumatoid arthritis in 3 cases and one post-traumatic arthritis. At the mean follow up of 15 months, fusion rate was 100%, mean time to complete union was 9.5 weeks. There were no complications such as nonunion, infection and skin problems. All patients stayed at the hospital just overnight after the surgery. Patients satisfaction was high and the functional clinical grade was excellent in 9 patients, good in 1 patient and fair in 1 patient. We concluded that arthroscopic technique was a simple and effective method for ankle arthrodesis in the selected patients and had significant advantages over the open technique.

Comparisons of Early MRI Patterns with Arthroscopic Findings of Possible Acute ACL Tears / 대한정형외과학회잡지

Early MRI and arthroscopic findings were compared to evaluate the efficacy of the former for patients, who upon physical examination, were diagnosed with possihle acute ACL tears. MRI, taken between 1-21 days after injury, had to reveal complete ACL tears and arthroscopic surgery should have taken place 3-12 weeks after the injury for patients of this prospective study. Fifty such cases were initially catagorized according to five MRI patterns. Types I to V were separated by the following ACL tear characteristics: Enlarged and diffusely increased in signal, horizontally oriented, non-visualized, discontinuous and vertically oriented. The cases were then divided into two groups of arthroscopic findings; Group A included cases of complete ACL tearing and group B included those with intact or minimally torn ACLs. Of MRI types I through V, there were 31, 9, 5, 4, and I cases of each respectively. 37 cases resulted in complete ACL tears (21 type I, 6 type II, 5 type III, 4 type IV and 1 type V) and 13 cases were catagorized into group B, 10 of which had pattern type I and 3 of which had pattern type II. As result, types III, IV and V had a 100% Positive Predictive Value (PPV) whereas types I and II together had a 67% PPV vaiue. Division of the cases into the five pattern types in early MRI proved valuble for possible cases of acute ACL tears. MRI pattern types III, IV and V were correlated with definite complete ACL tears. However, caution must be taken for types I and II, the majority of the cases, for which there exists a significant possibility for misdiagnosis and consequently unnecessary arthroscopic surgery.

Chronological Changes of the Human Allograft Meniscal Transplants: MRI, Arthroscopic and Histologic Study

Vascular ingrowth is essential for the survial of the graft tissue. The purposes of this study were to evaluate any changes in signal intensity of cqropreserved meniscal allograft with time in the magnetic resonance images(MRI) and to demonstrate the viability of the grafts. Eight patients underwent meniscal transplantation with cryopreserved allcgrafts using the bone block technique. MRIs of the knee were taken at 3 days, 3 weeks, 6 weeks, 3 month, 6 months. And I year after the implantation. A second-look arthroscopy and a small meniscal biopsy(sized 2mm x 2mm1 at the peripheral and central part of the meniscus were conducted at 3 months and 1 year. Three days after the operation, the signal intensity of the implanted meniscus revealed a homogenrous low signaJ intensity that could not be differentiated from that of' a contralateral normal meniscus. At 3 weeks, a high signal intensity appeared at the periphery of the meniscus. This signal, which did not communicate into the joint space, fuither intensified at 6 weeks. The high signal intensity of the meniscus, though still higher than that of the normal meniscus, decrexsed slightly at 3 months and continued to decrease progressively even a year after the implantation. The second-look arthroscopy revealed that the grafts were viable and that there was no tearing or shrinking of the meniscus. Cellular proliferation was also found at the central edge oi' the meniscus at 3 months. This cellular pattern differentiated from that of a nonmal meniscus in that the d stribution of cells was not in an even, but in a clonal pattem. The cellularity after a year, however, was sirnilar to that of normal meniscus except some area with deficiency of cells. It can be concluded that increased signal intensity of' the implanted meniscus with time indicates hypervascularity caused by vascular ingrowth, similar to the high signal intensity ot>tained from normal meniscus in young children. Increasecl signal intensity in the chronological postoperative MRls demonstrates the viability of the implanted cryopreserved meniscal allograft.

Two Posteromedial Portal Technique of All-Inside Meniscus Repair for Posterior Horn Tear of Medial Meniscus

No abstract available.

Atypical High Attachment of Wrisberg Ligaments in Discoid Menisci

No abstract available.

Arthroscopic Notchplasty in the Treatment of Flexion Contracuture of Early Osteoarthritic Knee ( a preliminary study ) / 대한정형외과학회잡지

Although causes of restriction of knee extension in osteoarthritis are thought to be contractures involving the posterior capsule and the hamstring muscles, intercondylar notch stenosis, osteophyte, loose body, and displacement of ruptured meniscus, few studies have investigated incidence and treatment. The purpose of this study is to consider intercondylar notch stenosis and anterior impingement as major causes of flexion contracture in osteoarthritic knee and to assess their relationship through arthroscopic notchplasty. We performed arthroscopic notchplasty and debridement in sixty patients (sixty-eight cases) with more than Sflexion contracture for early osteoarthritic knee and compared flexion contracture before and after operation. The average flexion contracture was 13degrees (5degrees-35degrees) before operation and 4degrees (0degrees- 25degrees) immediately after. An average of 9degrees improvement was shown, with 29 cases ( 48% ) showing improvement of over 5degrees. Our study indicates that flexion contracture in the 29 cases (48%) improved by arthroscopic notchplasty was caused by intercondylar notch stenosis and anterior impingement. Arthroscopic notchplasty may beneficially affect those with flexion contracture in early osteoarthritic knee when conservative management of this disease has failed. This is a preliminary study on the immediate postoperative outcome, therefore, long-term follow-up and recurrence rate should be investigated in future studies.

Percutaneous Release of the Trigger Finger using Newly Designed Scalpel / 대한정형외과학회잡지

Percutaneous method of Al pulley release for the trigger fingers using hypodermic needle or small sharp scalpel has been described by some authors. In our experience, however, these methods had some difficulties in handling the instruments and not easy to utilize proper technique. Therefore we designed a special scalpel for easy and safe percutaneous release of the Al pulley. The scalpel has a hook shaped end with a blade on the inner side. Insertion site through the skin should be 0.5cm distal to the Al pulley, and the hooked end is located at the proximal margin of the Al pulley followed by longitudinal cut of the pulley distally. We performed this procedure in 44 trigger fingers of 41 patients in our out-patient clinic. There were 9 males and 32 females with a mean age of 54.4 years (range, 24 to 83 years). Affected digits were 23 thumbs, 1 index, 13 middle, 5 ring and 2 little fingers. 9 of them were locked in flexion or extension. The duration of symptom was an average of 7.9 months. After a mean follow up of 11.3 months, 42 fingers (95.4%) were completely free of symptoms including triggering. One had mild residual triggering due to incomplete release of the pulley and another had re-release of the pulley for remaining flexion limitation. One finger showed mild bowstringing after release, which subsided in 3 months. One patient complained of persistent pain and tenderness over the release site. There were no injuries of nerves or vessels and no infections. The duration of discomfort after release ranged from 3 to 70 days (av. 18.5 days). All patients, except one, were satisfied with the treatment method and their results. We think that percutaneous release of trigger fingers using our special scalpel is a very effective and convenient procedure both to surgeons and patients. It can be easily and safely performed in out-patient clinic with successful results.

The Use of Holmium: Yag laser in Partial Menisectomy / 대한정형외과학회잡지

Previous applications of laser bone and cartilage ablation have focused largely on the CO2 and the Nd:Yag lasers, using both the continuous wave and rapid superpulsed mode, which revealed severe thermal damage such as tissue necrosis and carbonization of the remaining tissue. In contrast, Excimer lases have provided better histologic results with minimal or no thermal damage, but the ablation rate and cutting efficiency have remained unsatisfactory. Though arthroscopic partial menisectomy has become the accepted technique for dealing with tears in menisci, division of the meniscus is sometimes difficult in the confined joint space of the knee and is associated with iatrogenic injury to the articular cartilage. The ability to quickly and safely divide or remove meniscal tissue would be a distinct advantage. The Holmium:Yag laser has many potential advantages over the CO2 laster, the Nd:Yag laser and the Excimer laser. Its principal advantages include minimal mechanical trauma to the articular cartilage, greater access to tight or restricted area of the knee joint, and its ability to function in a saline medium and to resect meniscus with minimal tissue necrosis. We have evaluated the effectiveness of the Holmium:Yag laser 74 partial menisectomies of 57 patients. Among 74 meniscal tears, there were 35 medial and 39 lateral meniscal tears. The average operation time was 33 minutes in the menisectomy and hospital stay was average 3 days. There was no significant carbonization on the surrounding tissue. Menisectomy of the posterior horn was safe and easy and there was minimal iatrogenic articular cartilage damage.

Osteochondritis Dissecans of the Capitellum Humeri: Analysis of C. T. Findings / 대한정형외과학회잡지

We have compared the computed tomographic(C. T.) findings with those of conventional roentgenogram(simple AP and lateral radiograms) in 18 cases of osteochondritis dissecans of the capitellum humeri available for review. Among the 18 cases, 2 cases of them had a lesion of osteochondritis dissecans on C. T. which, however, had not been found on conventional rentgenograms. Fro the 5 cases, which had not clearly found on conventional rentgenograms, 2 loose body on conventional view, 3 cases had different numbers and locations of loose body on C. T. films. On the bases of our findings, we recommend that C. T. is necessary in early detection and the determination of anatomical location and status of osteochondritis dissecans of capitellum.

C. T. arthrography on Bankart lesion / 대한정형외과학회잡지

Accompanying to the development of the knowledgment of mechanism and pathology of recurrent dislocation of the shoulder, accurate diagnostic tools to detect that pathology have been developed. During the period from May 1990 to May 1992, we treated 28 cases of recurrent anterior dislocation of the shoulder. Twenty-eight cases were examined with C.T. arthrography before the operation. Among the 28 cases, we identified the Bankart lesion in 20 cases by C.T. arthrography, and in 21 cases intraoperatively. We concluded that the C.T. arthrography is an accurate method for confirming the clinical diagnosis of recurrent dislocation of the shoulder and to be helpful in detecting the Bankart lesion and its severity or pathologic findings.

Surgical treatment of impingement syndrome of the shoulder / 대한정형외과학회잡지

No abstract available.

Reconstruction of old posterior cruciate ligament injuries with the medial gastrocnemius tendon / 대한정형외과학회잡지

No abstract available.

Arthroscopic debridement in the management of degenerative arthritis of the knee

No abstract available.