Postoperative clinical outcomes and radiological healing according to deep and superficial layer detachment in first facet involving subscapularis tendon tear

Background@#Subscapularis tendon insertion at the first facet has separate layers (deep and superficial). The purpose of this study is to evaluate postoperative clinical outcomes and radiological healing according to each layer of detachment in the first facet involving subscapularis tendon tear. @*Methods@#Eighty-three patients who underwent arthroscopic repair due to First facet involving the scapularis tendon tear accompanying small to medium sized posterosuperior cuff tear were classified into three groups (group A: deep layer partial detachment, group B: deep layer complete detachment, but no superficial layer detachment, and group C: deep layer and superficial layer complete detachment). Subscapularis tendon healing was evaluated using computed tomography arthrogram and clinical result was evaluated using American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score and University of California Los Angeles (UCLA) shoulder score. @*Results@#Retear rate of the subscapularis tendon was 2.2%, 18.2%, and 33.3% in group A, group B, and group C, respectively. These rates showed statistically significant difference among the three groups, which were classified by deep and superficial layer detachment in the first facet (p=0.003). Group A showed significant difference in subscapularis tendon healing compared with group B and group C (p=0.018 and p<0.001, respectively), but there was no statistical difference between group B and group C (p=0.292). Regarding clinical outcomes, there was no significant difference among three groups in ASES and UCLA score at final follow-up (p=0.070 and p=0.106, respectively). @*Conclusions@#Complete detachment of deep layer may be related with retear occurrence regardless with detachment of superficial layer, but clinical outcome may not be related with each layer detachment in the first facet involving subscapularis tendon tear.

Comparison of the Bone Union Rates Using a Local Autobone and Bone Graft Substitute Mixed Graft in Lumbar Posterolateral Fusion / 대한정형외과학회잡지

Purpose@#To assess the effectiveness of mixed grafts in lumbar posterolateral fusion (PLF) by comparing the bone union rates of an autobone with a bone substitute mixed graft. @*Materials and Methods@#The patients were followed-up for at least two years after PLF and divided into four groups according to the mixed graft retrospectively. Group I was 48 cases using a femoral head allobone. Group II was 38 cases using b-tricalcium phosphate. Group III was 92 cases using biphasic calcium phosphate. Group IV was 38 cases using biphasic calcium phosphate and autologous bone marrow. Union was evaluated by the work up simple radiographs after two years from PLF. Union was defined if the radiographs demonstrated a bilateral continuity in the fusion mass between the cephalad and caudal transverse processes with less than 2° of angular motion and no translation between the vertebrae at the level of fusion on the lateral flexion-extension radiographs. @*Results@#According to simple radiographs after two years from PLF, the rate of union was highest in Group IV using local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft. @*Conclusion@#Biphasic calcium phosphate is an osteoconductive bone substitute that increases the bio-absorbability and mechanical strength. Autologous bone marrow has osteoinductive and osteogenic properties. These features can increase the rate of bone union. Therefore, a local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft can be considered an effective bone graft substitute for lumbar PLF instead of an autobone graft.

Effectiveness of Ultrasound-guided Single-injection Triple Nerve Block Before Cementless Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures / 대한고관절학회지

Purpose@#To compare efficacy of ultrasound (US)-guided single-injection nerve blocks (SINB) before bipolar hemiarthroplasty (BHA) of the hip in patients with femoral neck fractures. @*Materials and Methods@#Clinical outcomes of 89 patients who underwent BHA between September 2016 and February 2018 were retrospectively compared. Eight patients were excluded according to exclusion criteria and the remaining patients were divided into two groups: patients who received SINB before surgery (Group I; n=40), and patients who did not (Group II; n=41). The femoral, obturator, and lateral femoral cutaneous nerves were each blocked separately under US guidance. Pain scores determined using the visual analogue scale (VAS) were recorded 6, 12, 24, and 48 hours postoperatively, and all use of analgesics were recorded separately for 72 hours after surgery. Duration of hospitalization, general complications, and local complications due to SINB were also compared among the groups. @*Results@#Significant differences were observed between the two groups: I) VAS at 6 hours and at 12 hours after the operation, II) total amounts of analgesics used. VAS at 24 hours and at 48 hours were not significantly different between the two groups. General complications and duration of hospitalization were also not significantly different between the groups. @*Conclusion@#US-guided lower limb nerve blocks provide excellent immediate postoperative pain relief and can be used as a safe, and effective method of pain control after BHA.

Effectiveness of Ultrasound-guided Single-injection Triple Nerve Block Before Cementless Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures / 대한고관절학회지

Purpose@#To compare efficacy of ultrasound (US)-guided single-injection nerve blocks (SINB) before bipolar hemiarthroplasty (BHA) of the hip in patients with femoral neck fractures. @*Materials and Methods@#Clinical outcomes of 89 patients who underwent BHA between September 2016 and February 2018 were retrospectively compared. Eight patients were excluded according to exclusion criteria and the remaining patients were divided into two groups: patients who received SINB before surgery (Group I; n=40), and patients who did not (Group II; n=41). The femoral, obturator, and lateral femoral cutaneous nerves were each blocked separately under US guidance. Pain scores determined using the visual analogue scale (VAS) were recorded 6, 12, 24, and 48 hours postoperatively, and all use of analgesics were recorded separately for 72 hours after surgery. Duration of hospitalization, general complications, and local complications due to SINB were also compared among the groups. @*Results@#Significant differences were observed between the two groups: I) VAS at 6 hours and at 12 hours after the operation, II) total amounts of analgesics used. VAS at 24 hours and at 48 hours were not significantly different between the two groups. General complications and duration of hospitalization were also not significantly different between the groups. @*Conclusion@#US-guided lower limb nerve blocks provide excellent immediate postoperative pain relief and can be used as a safe, and effective method of pain control after BHA.

Comparison of the Clinical Outcomes of a Single Injection Adductor Canal Block with the Concomitant Use of Transdermal Buprenorphine and Continuous Adductor Canal Block after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared. RESULTS: The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital. CONCLUSION: The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.

Analysis of the Risk Factors for Posterior Migration of Single Cage after Transforminal Lumbar Interbody Fusion / 대한정형외과학회잡지

PURPOSE: To analyze the risk factors for posterior migration of a single cage after transforminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: This study was conducted retrospectively on 48 patients (60 discs) who were followed-up for 1 year after TLIF from January 2015 to January 2017. The patients were divided into two groups: group 1 containing 16 patients (17 discs) with cage migration and group 2 containing 32 patients (43 discs) without it. Information related to cage migration, such as the demographic factors, shape of disc, level and location of the cage inserted, and disc height change, was acquired from the medical records and radiologic images, and the possibility for generating posterior migration of cage was evaluated statistically. RESULTS: The demographic factors and cage-inserted level were similar in the two groups (16 patients in group 1, 32 patients in group 2). In the migration group, number of patients with a pear-type disc, 9 patients, was significantly larger; the disc height change, 1.8 mm, was significantly smaller; and the cage was located frequently on non-center in the anteriorposterior view and center in the lateral view in 9 and 15 out of 16 patients, respectively. CONCLUSION: A pear-type disc shape, small disc height change, cage with non-center on the anteriorposterior view and non-anterior on the lateral view are the risk factors for posterior migration. These factors are important for preventing posterior migration of the cage.

A Comparison of the Results from Femoral Nerve Block Using Different Concentration of Ropivacaine after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Peripheral nerve block is one of the many options available to reduce pain after total knee arthroplasty. Among the various kinds of peripheral nerve block procedure, femoral nerve block (FNB) using ropivacaine is a very effective method for reducing pain. However, it has been known to cause weakness in the quadriceps femoris, resulting in an increased risk of fall during ambulation after surgery. The purpose of this study was to compare the effectiveness of FNB on pain and muscle strength with different concentrations of ropivacaine. MATERIALS AND METHODS: Our study was performed on 120 patients with knee osteoarthritis who had undergone total knee arthroplasty between January 2016 and December 2016. Patients were divided to 3 groups depending on the concentration of ropivacaine: Group 1 received 0.125% ropivacaine 6 ml FNB; group 2 received 0.2% ropivacaine 6 ml FNB; group 3 received normal saline 6 ml FNB. FNB with 1% lidocaine 10 ml and 0.75% ropivacaine 10 ml was performed to all groups at 3 hours after surgery. From the day after surgery, each group of patients were injected 4 times with FNB on their own designated concentration of ropivacaine with an interval of 6 hours. The severity of pain was estimated by visual analogue scale (VAS) and the strength of quadriceps femoris was measured using medical research council (MRC) grade and knee extension angle. RESULTS: VAS score in group 3 was significantly higher compared to other groups; MRC grade in group 2 was significantly lower than in other grades, and knee extension angle in group 2 was significantly lower than in other groups at 6 pm on the day of and at 6 am on the day after surgery. VAS score, MRC grade, and extension angle of all groups showed no significantly difference at other times. CONCLUSION: FNB with 0.125% ropivacaine after total knee arthroplasty shows effective reduction of pain without inducing quadriceps femoris weakness.

Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Adjacent Lumbar Disc Herniation after Lumbar Posterolateral Fusion by Radiologic Evaluations

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) for adjacent lumbar disc herniation through radiologic evaluations. SUMMARY OF LITERATURE REVIEW: PELD minimizes posterior structural damage, allowing rapid rehabilitation. SUBJECTS AND METHODS: This study was conducted on 45 patients who were followed up for 1 year after PELD for adjacent lumbar disc herniation from March 2014 to February 2016. The modified Macnab criteria, the modified Suezawa and Schreiber score (MSS score), and visual analogue scales for the back (VAS-B) and legs (VAS-L) were evaluated. The disc height ratio and segmental angulation change were compared before posterolateral fusion and before PELD. Moreover, spinal stenosis was confirmed on magnetic resonance imaging (MRI) before PELD. RESULTS: Based on the modified Macnab criteria, 53.3% patients received an evaluation of at least “good,” and the mean MSS score improved from 4.77 to 6.99 at 1 year after the operation. The mean VAS-B score decreased from 7.02 to 4.67, and the mean VAS-L score decreased from 8.15 to 4.24 at 1 year after the operation. The mean disc height ratio was 87.1%, and the mean segmental angulation change was 6.5°, with a greater change in the “fair” or “poor” group, and the rate of spinal stenosis on MRI was also higher in the “fair” or “poor” group. CONCLUSION: The clinical outcomes of PELD, which is accompanied by degenerative changes on simple radiographic images such as disc space narrowing and increased segmental angulation or spinal stenosis on MRI, may not be satisfactory. Therefore, decisions regarding surgery should be made carefully in such cases.

Results of Minimal Incision Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus / 대한족부족관절학회지

PURPOSE: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. MATERIALS AND METHODS: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. RESULTS: The mean hallux valgus angle measured at preoperation was 37.7o and 15.9degrees at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were 15.2degrees and 8.3degrees. The mean distal metatarsal articular angle changed from 12.6degrees at preoperation to 7.8degrees at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was 37degrees and 13degrees, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. CONCLUSION: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under 37degrees and distal metatarsal articular angle under 13degrees can lead to good clinical results without recurrence.

Union Rates of Autologous Bone Marrow, Local Autobone and Biphasic Calcium Phosphate Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: We examined union rates and clinical outcomes to evaluate the efficacy of using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis. SUMMARY OF LITERATURE REVIEW: In lumbar posterolateral fusion, union rates of biphasic calcium phosphate and local autobone mixed graft are low compared to union rates of autogenous iliac bone graft. MATERIALS AND METHODS: Among the patients who had lumbar posterolateral fusion with autologous bone marrow along with local autobone and biphasic calcium phosphate mixed graft between February 2013 and January 2014, we analyzed 40 patients who were available for at least one year of follow-up. There were 22 cases with spinal stenosis and 18 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke's criteria (citation). All patients were evaluated postoperatively at one year, using 3D CT. and the clinical outcomes were assessed using Kim's method (citation). RESULTS: In spinal stenosis, bone union was observed in 19 cases out of 22 (86.4%), and in case of spondylolisthesis, bone union was observed in 16 cases out of 18 (88.9%). In spinal stenosis, the clinical outcomes were: 2 excellent, 16 good, 3 fair, and 1 poor; in other words 18 cases (81.8%) displayed good or excellent outcomes. In spondylolisthesis, 2 excellent, 12 good, 4 fair and 0 poor; in other words, 14 cases (77.8%) showed good or superior outcomes. CONCLUSIONS: Posterolateral fusion using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft showed similar bone fusion rates to using autogenous iliac bone graft. Therefore, this method could serve as an alternative to using autogenous iliac bone graft in posterior lumbar fusion.

Corrigendum: Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report / 대한족부족관절학회지

This correction is being published to correct the corresponding author's name and e-mail information.

Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report / 대한족부족관절학회지

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

Biphasic Calcium Phosphate and Local Autobone Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: Retroprospective study. OBJECTIVES: To evaluate the efficacy of biphasic calcium phosphate and local autobone mixed graft in cases of spinal stenosis and spondylolisthesis in posterolateral fusion by examining radiologic union rates and clinical outcomes. SUMMARY OF LITERATURE REVIEW: It can be a practical alternative to the use of tricalcium phosphate in hydroxyapatite as a graft aid since using hydroxyapatite mixture in lumbar spine fusion has been reported to lead to a high rate of bone union. MATERIALS AND METHODS: From July 2011 to February 2013, we followed up 107 patients who had lumbar posterolateral fusion using biphasic calcium phosphate composed of HA/TCP (60:40) and local autobone mixed graft. Of these patients, 64 had spinal stenosis and 43 had spondylolisthesis. The bone fusion rate was determined using Lenke's criteria and clinical outcomes were evaluated using Kim's method. RESULTS: In spinal stenosis, bone union was presented in 53 patients (of 64; 82.8%) and in spondylolisthesis, 35 patients (of 43; 81.4%). In spinal stenosis, the clinical outcomes resulted in 20 excellent, 34 good, 9 fair and 1 poor. (84.4%, excellent or good) In spondylolisthesis, the clinical outcomes resulted in 10 excellent, 25 good, 7 fair and 1 poor. (81.4%, excellent or good). CONCLUSION: Posterolateral fusion using biphasic calcium phosphate and local autobone mixed graft showed high rates of bone union and acceptable clinical outcomes, and is considered a satisfactory bone graft aid.

Late-Onset Infection of a Total Knee Arthroplasty Caused by Monomicrobial Klebsiella pneumoniae in a Patient with a Periprosthetic Fracture / 대한정형외과학회잡지

Septic arthritis caused by Klebsiella pneumonia in adults is rare and is rarely observed after total knee arthroplasty. Acute or early onset of septic arthritis caused by K. pneumoniae has been reported after total knee arthroplasty. However, to date the only one overseas case of late K. pneumoniae infection after total knee arthroplasty has been reported, with no such case in Korea. In addition, monomicrobial infections by K. pneumoniae are not frequently found but are found primarily in the form of polymicrobial infections. The purpose of this paper is to report on a case in which an 85-year-old female patient, who had undergone a total joint arthroplasty 11 years ago, developed the late onset of septic arthritis caused by monomicrobial K. pneumonia infection with a periprosthetic fracture through literature reviews.

Union Rates of Local Autobone and beta-Tricalcium Phosphate Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: A retroprospective study. OBJECTIVES: We used a local autobone and beta-tricalcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis and evaluated union rates to verify the efficacy. SUMMARY OF LITERATURE REVIEW: Several reports have shown high union rates of posterolateral fusion using beta-tricalcium phosphate. However, in Korea, only one study reported a low union rate. MATERIALS AND METHODS: Forty-two patients who underwent lumbar posterolateral fusion with a local autobone and beta-tricalcium phosphate mixed graft from September 2010 to July 2011 were followed up. There were 32 cases with spinal stenosis and 10 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke's criteria. Clinical outcomes were determined using Kim's method. RESULTS: In spinal stenosis, bone union was presented in 19 cases(59.4%) out of 32 cases and in spondylolisthesis, bone union was presented in 7 (70.0%) out of 10. In spinal stenosis, 12 cases showed excellent outcome, 16 good, 3 fair and 1 poor, 27 cases(87.5%) were superior to the good. In spondylolisthesis, 2 cases showed excellent outcome, 5 good, 3 fair and 0 poor, 8 cases(70.0%) were superior to the good. CONCLUSIONS: Posterolateral fusion using a local autobone and beta-tricalcium phosphate mixed graft showed lower bone fusion rates. We need further studies to enhance the fusion rate when using local autobone and beta-tricalcium phosphate mixed grafts.

Streptococcus Dysgalactiae Subspecies Dysgalactiae Infection after Total Knee Arthroplasty: A Case Report

Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), Lancefield group C streptococcus, is an animal pathogen which often causes pyogenic infection in domestic animals. Human infection by SDSD has been reported as a cellulitis on the upper arm, but a prosthetic joint infection caused by SDSD after total knee arthroplasty (TKA) has not yet been reported in the literature demonstrating that its clinical manifestation and management have not been well established. In this case report, we aimed to present a case of SDSD prosthetic joint infection after TKA, which was successfully treated by two-stage re-implantation with an application of antibiotic-impregnated cement spacer.

Effects of Leptin on Proliferation, Anabolic and Catabolic Metabolism in Chondrocytes / 대한정형외과연구학회지

PURPOSE: Leptin may play an important role in the pathophysiology of osteoarthritis. However, the effect of letpin on the anabolic and catabolic metabolisms in chondrocytes remains unclearly elucidated. Therefore, the purpose of this study was to investigate the effect of leptin on proliferation, anabolic and catabolic metabolism of chondrocyte using ATDC5 chondrogenic cell line. MATERIALS AND METHODS: The effects of leptin on chodnrocyte proliferation, anabolic and catabolic meatabolism were examined in ATDC5 cells treated with leptin at varying concentrations(10, 100, 300, 600 ng/ml) for 24, 48, and 72 hours. The cell proliferation was evaluated by MTT assay. The anabolic and catabolic activities were assayed by RT-PCR for transforming growth factor-beta(TNF-alpha), proteoglycan-4 (PRG4), type- I collagen (type- I Col) and tumor necrosis factor-beta(TNF-alpha), matrix metalloproteinase -2 (MMP-2), respectively. RESULTS: Leptin treatment did not influence cell proliferation of chondrocyte regardless of concentration. TGF-beta expression was increased until 48 hours of leptin treatment compared to controls. Especially, it was significantly increased in leptin of 10 ng/ml and 100 ng/ml (P<0.05). PRG4 expression was not different between letpin treatment and controls. Type-I Col expression was decreased in dose- and time-dependent manner. Leptin of 10ng/ml significantly inhibited MMP-2 and TNF-alpha expressions compared to controls (P<0.05). CONCLUSION: This study shows that leptin at low concentration increases TGF-beta expression, but inhibits the expression of TNF-alpha and MMP-2. Also this study shows that leptin do not affect the cell proliferation of chondrocytes. These results suggest that leptin at low or physiological level contributes to the prevention of cartilage damage by stimulating anabolic activity and inhibiting catabolic activity of chondrocyte rather than chondrocyte regeneration by increasing cell proliferation.

Percutaneous Transphyseal Intramedullary K-wire Fixation for the Diaphyseal Forearm Fractures in Children

PURPOSE: Although the standard treatment of diaphyseal forearm fractures in children is conservative treatment with closed reduction and cast immobilization, unstable or irreducible fractures are usually needed by surgical intervention. The aim of this article is to determine the efficacy of the percutaneous transphyseal intramedullary K-wires fixation for the forearm diaphyseal fractures in children. MATERIALS AND METHODS: In this retrospective study, we reviewed 18 cases of forearm diaphyseal fractures in children, which were treated with percutaneous transphyseal intramedullary nailing using K-wires from January 2001 to December 2004. We analyzed the period for radiologic bone union and the complications until the last follow-up. RESULTS: The average period of follow-up was 15 months with mean age of 7.8 years. The average time to bone union was 6.2 weeks and nonunion, malunion, radio-ulnar synostosis and refracture were not found, just 2 local pin site infections were seen but healed by conservative treatment. Postoperative scar was small and the complications until the last follow-up were not found. CONCLUSION: In the operative treatment of the forearm diaphyseal fractures in children, we think percutaneous transphyseal intramedullary K-wire fixation is one of the effective methods because of the minimal invasiveness, simplicity and easiness in removal.

Modified Ender Nailing For Intertrochanteric Fracture of the Femur

PURPOSE: To evaluate the modified Ender nailing technique for the treatment of femoral intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: 31 cases of femoral intertrochanteric fractures treated by modified Ender nailing from May 1997 to December 2004 were included in this study. We analyzed the method of the anesthesia, amount of intraoperative blood loss, operation time, number of used nail, postoperative ability of ambulation, postoperative complication, and the time for radiological union. RESULTS: 22 cases were operated under epidural anesthesia and 9 cases under general anesthesia. The average amount of intraoperative blood loss was 55 ml and average time for operation was 37 minutes. The average number of used nails were 3.1. The postoperative ambulatory ability was clinically recovered to the preoperative ambulatory ability in 23 cases, and decreased than before in 8 cases. Postoperative complications included knee joint pain or limitation of motion of the knee joint and distal migration of the nails. The average time for radiological bone union was 17.1 weeks postoperatively. CONCLUSION: The modified Ender nailing technique is the one of the proper method in elderly femoral intertrochanteric fractures with associated medical problems. This method reduce the operation time and the amount of intraoperative blood loss.