Interference of Union after the Use of Beta-Tricalcium Phosphate Block in High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy (HTO) is a commonly used treatment for genu varum and medial compartment osteoarthritis. Recently open wedge HTO has been the preferred method due to its facilitated technique, fewer neurovascular and joint injuries, etc. In open wedge HTO materials such as autogenous, allogenous bone graft and tricalcium phosphate (TCP) are used to help with bone union and have a role in filling in the empty space. However the authors of this study report on two cases of nonunion 1 year after HTO using TCP block.

Relation Between Adjacent Superior Segmental Disease and Facet Joint Violations After Posterolateral Lumbar Fusion

STUDY DESIGN: To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. OBJECTIVES: We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion. MATERIALS AND METHODS: We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement. RESULTS: The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically. CONCLUSIONS: Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.

Treatment of Enchondromas of the Hand with Curettage, Autoiliac Bone Graft and Contact Cryotherapy

PURPOSE: The purpose of this study was to evaluate the effectiveness of contact cryotherapy as an adjuvant therapy after intralesional curettage and autoiliac bone graft of enchondromas of the hand. MATERIALS AND METHODS: Thirty seven cases in 30 patients (17 males, 13 females) with enchondromas of the hand who underwent curettage, contact cryotherapy and autoiliac bone graft between July 2004 and March 2010 were reviewed with a minimum follow-up of 1 year. Radiologic evaluations were done periodically. Mean follow-up period was 26 months (range: 12-54 months). The radiologic results were evaluated according to the degree of new bone formation based on the Tordai's criteria. RESULTS: According to the Tordai's criteria, 33 cases (89%) were group I, and 4 cases (11%) were group II. There was no case of group III, which meant recurrence. Bone healing was achieved at average 4.8 months (range: 4-5.3 months) after the operation. There was no cryotherapy-related complication such as pathologic fracture, bone necrosis and skin necrosis during the follow-up periods. CONCLUSION: We suggest that the contact cryotherapy can be used as an effective adjuvant therapy for treatment of enchondroma of the hand without complications.

Radiologic Changes after Shelf Acetabuloplasty on Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To evaluate the radiologic changes in the acetabulum after shelf acetabuloplasty in Legg-Calve-Perthes (LCP) disease. MATERIALS AND METHODS: From January 2003 to March 2006, 13 patients with unilateral LCP disease were treated by shelf acetabuloplasty. The mean follow-up period was 51 months. Pre-operative, post-operative, and annual follow-up radiographs were obtained to assess the changes in lateral subluxation ratio (LSR), acetabular head quotient (AHQ), acetabular depth index (ADI), acetabular height index (AHI), total depth index (TDI) and width of bone graft. RESULTS: The mean LSR decreased from 1.78+/-0.32 pre-operatively to 1.48+/-0.15 post-operatively, and remained 1.33+/-0.21 at last follow-up (p=0.011). The mean AHQ increased from 81.0+/-7.5% pre-operatively to 120.0+/-15.1% post-operatively, and remained 109.7+/-13.8% at final follow-up (p=0.001); the post-operative TDI that included the width of bone graft, decreased at follow-up. Furthermore, the mean ADI and AHI changed from 0.97+/-0.12, 1.13+/-0.07 pre-operatively to 1.04+/-0.02, 1.15+/-0.09 post-operatively; last follow-up results were 1.03+/-0.05 and 1.16+/-0.07, respectively. Between the 2 indices, post-operative ADI for 2 years was statistically significant (p<0.05). Also, the width of bone graft decreased from 24.4+/-3.6 mm post-operatively to 15.0+/-4.1 mm at final follow up (p<0.05). CONCLUSION: The indices LSR and AHQ confirmed that the shelf acetabuloplasty could preserve the femoral head containment. The growth of the acetabulum after shelf acetabuloplasty was stimulated by increasing the depth of acetabulum in comparison with height for postoperative 2 years. Further follow-up is needed until skeletal maturity.

Effect of Amniotic Membrane Transplantation and Heparin on Tissue Adhesion in Flexor Tenorrhaphy of Chicken / 대한정형외과연구학회지

PURPOSE: The role of the amniotic membrane with or without heparin was investigated with regard to the prevention of adhesion formation following flexor tenorrhaphy of chicken. MATERIALS AND METHODS: We classified twelve chickens into four groups of three chickens. In group A, the flexor tendon was partially cut and the tendon was repaired. In group B, The repaired tendon was covered with heparin. In group C, the repaired tendon was covered with amniotic membrane. In group D, the repaired tendon was covered with amniotic membrane and heparin. Histologic and gross findings of the repaired tendon were evaluated at postoperative 3, 6 and 9 weeks. RESULTS: In group D, there were less inflammatory cell infiltration and fibroblasts proliferation in all stages. At postoperative 9 weeks of all groups, there were less inflammation and fibroblasts proliferation than those in postoperative 3 and 6 weeks. CONCLUSION: The use of amniotic membrane transplantation and heparin is effective in the prevention of inflammation and adhesion formation following flexor tenorrhaphy of chicken.

Effect of Amniotic Membrane Transplantation and Heparin on Tissue Adhesion in Flexor Tenorrhaphy of Chicken / 대한정형외과연구학회지

PURPOSE: The role of the amniotic membrane with or without heparin was investigated with regard to the prevention of adhesion formation following flexor tenorrhaphy of chicken. MATERIALS AND METHODS: We classified twelve chickens into four groups of three chickens. In group A, the flexor tendon was partially cut and the tendon was repaired. In group B, The repaired tendon was covered with heparin. In group C, the repaired tendon was covered with amniotic membrane. In group D, the repaired tendon was covered with amniotic membrane and heparin. Histologic and gross findings of the repaired tendon were evaluated at postoperative 3, 6 and 9 weeks. RESULTS: In group D, there were less inflammatory cell infiltration and fibroblasts proliferation in all stages. At postoperative 9 weeks of all groups, there were less inflammation and fibroblasts proliferation than those in postoperative 3 and 6 weeks. CONCLUSION: The use of amniotic membrane transplantation and heparin is effective in the prevention of inflammation and adhesion formation following flexor tenorrhaphy of chicken.

Treatment of Idiopathic Genu Varum Using Tibiofibular Osteotomy and External Fixation / 대한정형외과학회잡지

PURPOSE: This paper examined the results of a tibiofibular osteotomy and external fixation in idiopathic genu varum. MATERIALS AND METHODS: Ten patients (20 cases) with idiopathic genu varum were treated with a tibiofibular osteotomy and external fixation. The average follow-up period was 13 months (range, 6-27). The average age of the patients was 23.1 (range, 16-39). A tibial osteotomy was performed an average 9.1 cm (range, 5-13.5) distal to the tibial spine, which was 2 cm distal to the center of the rotation axis (CORA). RESULTS: The preoperative anatomical tibio-femoral angle of varus, 7.0o (range, 4-10), was corrected to valgus 0.8o (range, varus 5-valgus 6). After surgery, the femur intercondylar distance of 5.3 cm (range, 4-7) was improved to 0.4 cm (range, 0.5-4), and the preoperative average maximal intercalf distance of 11.2 cm (range, 8.5-13) was improved to 6.5 cm (range, 4-9). A preoperative mechanical axis deviation of 2.0 cm (range, 0-3.5) improved to 0.3 cm (range, 0-2.3). The complications encountered were 4 cases of a pin site infection, 1 case of a superficial peroneal sensory nerve injury, 1 case of a deep peroneal nerve partial injury and 2 cases of a popliteal artery partial occlusion. CONCLUSION: The tibiofibular osteotomy and external fixation is considered to be an effective method for treating an idiopathic genu varum with early ROM and weight bearing. However, surgeons need to pay careful attention in order to prevent a neurovascular complications.