Treatment of Subtrochanteric Nonunion with a Blade Plate / 대한정형외과학회잡지

PURPOSE: Although nonunion is a relatively common complication in the management of subtrochanteric fractures, there are few studies regarding the treatment of nonunion. The purpose of this study was to evaluate clinical and radiological results for the treatment of subtrochanteric nonunions with a blade plate. MATERIALS AND METHODS: We retrospectively analyzed 16 cases of subtrochanteric nonunions that were treated with a blade plate between April 1997 and June 2008 and were followed for at least one year after the index operation. There were 8 males and 8 females with an average age of 58 years (range, 42-77 years). Outcome variables included the time to union, postoperative complications, Harris hip score, and the functional rating scale of Sanders. The average follow-up period was 26 months (range, 12-63 months). RESULTS: Union was achieved in 15 (94%) of 16 subtrochanteric nonunions after an average of 7 months (range, 4-11 months). One patient who did not reach union after the index operation underwent repeated surgery with a longer blade plate and bone graft, but this patient was eventually treated with total hip arthroplasty because of persistent nonunion and breakage of the blade plate. Two patients developed complications. One patient had bursitis around the greater trochanter and the other developed avascular necrosis of the femoral head. Of these, the patient with avascular necrosis of the femoral head was treated with total hip arthroplasty because of persistent hip pain 2 years after the index operation. At latest follow-up, the mean Harris hip score was 88 points (range, 36-100 points) and the functional rating scale of Sanders was good or excellent in 14 (88%) of 16 patients. CONCLUSION: The treatment of subtrochanteric nonunions with a blade plate is associated with a very high union rate and good clinical results.

An Extramedullary Femoral Alignment System in Total Knee Arthroplasty Using the Inter-Femoral Head Center Distance / 대한정형외과학회잡지

PURPOSE: Total knee arthroplasty using the extramedullary technique for alignment has some difficulty for detecting the center of the femoral head intra-operatively. In this study we tried to evaluate the usefulness and accuracy of a newly developed Mechanical Axis Marker that synchronizes the center of the knee joint and femoral head with the mechanical axis for the distal femoral cutting and femoral prosthesis alignment. MATERIALS AND METHODS: Between October 2008 and January 2009, 255 knees in 156 patients underwent total knee arthroplasty. We measured the distance between each centers of the femoral head using the PACS system and we applied the distance to the newly developed Mechanical Axis Marker. Subsequently, we applied the new marker to patients to align the centers of knee, the femoral head and the marker in line with the mechanical axis intra-operatively. The accuracy of the marker was validated with C-arm fluoroscopy pre-operatively in 20 patients. Post-operatively we measured and analyzed the frontal femoral component angle to evaluate the coronal alignment of the femoral implant. The accuracy was rated as excellent when the alignment was 5degrees. RESULTS: The pre-operative validation study with the C-arm fluoroscopy showed that the distance between the femoral head center and the metal peg of the marker was within 5 mm in 95% of the patients, which implied acceptable accuracy. The average frontal femoral component angle against the mechanical axis was 89.0degrees+/-1.1 (range 86degrees-96.6degrees). The proportion of excellent, good, and poor alignments was 90.6% (231 cases), 8.6% (22 cases), and 0.8% (2 cases), respectively. The intraclass correlation coefficient between the two observers for the frontal femoral component angle was 0.972 which showed high concordance. CONCLUSION: Our results indicate that the extramedullary technique assisted by our new Mechanical Axis Marker can easily identify the center of femoral head and improve the accuracy of frontal femoral component alignment with the proper mechanical axis.

Clinical Result of Arthroscopic Partial Repairs in Massive Rotator Cuff Tears

PURPOSE: With the better understanding of cuff function, partial repair or "force couple repair" for treating massive irreparable rotator cuff tear has gained some popularity. However, there were few reports on the results of partial repair. The purpose of this study was to report the clinical outcome of massive irreparable rotator cuff tears who received arthroscopic force-couple repair or partial repair. MATERIALS AND METHODS: From June 2005 to Feb 2008, arthroscopic partial repairs were performed for 16 irreparable rotator cuff tears among the 101 large to massive rotator cuff tears that were operated on. Clinical and radiographic evaluation were done at the final follow-up RESULTS: There were 7 men and 9 women with a mean age of 66.6 years. The mean follow-up period was 27.3 month (range: 15-46). The pain VAS improved from 4.4 (+/-2.50) to 2.1 (+/-2.26) and the functional VAS improved from 46.9 (+/-16.64) to 70.0 (+/-22.80). The ASES score improved from 39.0 (+/-10.80) to 80.3 (+/-16.78) and the KSS score was 81.9 (+/-16.74) at the final follow-up. The acromio-humeral distance was 6.6 cm (+/-1.74) preoperatively and 6.2 cm (+/-1.69) postoperatively without significant change (p=0.3874). The degenerative changes had no statistically progressed (p=0.2663). CONCLUSION: Partial repair for massive rotator cuff injury patients showed improvement in the clinical score without progression of arthritic change at a mean of 2.3 years follow-up.