Usefulness of Synthetic Osteoconductive Bone Graft Substitute with Zeta Potential Control for Intramedullary Fixation with Proximal Femur Nail Antirotation in Osteoporotic Unstable Femoral Intertrochanteric Fracture / 대한고관절학회지

Purpose@#This study was conducted in order to examine the usefulness of osteoconductive bone substitutes with zeta potential control (geneX® ds; Biocomposites, England) by comparing the complications and radiographic evaluation with or without geneX® ds augmentation for internal fixation with proximal femur nail antirotation (PFNA) for treatment of osteoporotic unstable intertrochanteric fractures. @*Materials and Methods@#A retrospective study of 101 patients who underwent fixation with PFNA in osteoporotic unstable intertrochanteric fractures was conducted from December 2015 to August 2020. The radiographic evaluation and complication rates were compared between patients with geneX® ds (Group A: 41 cases) and those without geneX® ds (Group B: 60 cases). @*Results@#In radiological valuation, the degree of blade sliding from the time immediately after surgery to one year after surgery was 1.4±1.2 mm and 5.8±2.7 mm in Group A and Group B, respectively (P<0.001). During the same time frame, a significant difference of 2.3±2.2° and 7.4±3.1° , respectively (P<0.001), in varus collapse, was observed for Group A and Group B. @*Conclusion@#Among patients fixed with PFNA for treatment of unstable intertrochanteric fractures, less blade sliding and varus collapse was observed for those with geneX® ds augmentation compared to those without it. In addition, there was no increase in the incidence of complications. The authors believe it can be regarded as a safe and effective additive for intramedullary fixation for treatment of unstable intertrochanteric fractures.

Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: retrospective study in the immediate postoperative period

Background@#The aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty. @*Methods@#Among patients who received total knee arthroplasty from June 2017 to December 2017, 50 who underwent ACB with additional IPACK and 50 who received ACB with additional PMDI were selected for this study.We compared the postoperative pain numerical rating scale (NRS), the number of times patient-controlled analgesia was administered and the amount administered, the total amount of opioids given, and complications associated with the procedure between the two groups. @*Results@#NRS measured at rest and 45° knee flexion at days 1 and 2 after surgery was significantly lower in the IPACK group than in the PMDI group. The resting NRS measured at day 3 after surgery was also significantly lower in the IPACK group than in the PMDI group, and the NRS at 45° knee flexion measured from day 3 to day 5 showed a significant reduction in the IPACK group. No complications relating to the procedure occurred. @*Conclusions@#IPACK may be a better option than PMDI for controlling acute phase pain in patients undergoing total knee arthroplasty.

Characteristics of Blood Mixed Cement in Percutaneous Vertebroplasty / 대한정형외과학회잡지

PURPOSE: This study evaluated the efficacy of blood mixed cement for osteoporotic vertebral compression fractures in reducing the complications of percutaneous vertebroplasty using conventional cement. MATERIALS AND METHODS: This study was performed retrospectively in 80 patients, from January 2016 to January 2017. Porous cement was formed by mixing 2, 4, and 6 ml of blood with 20 g of cement used previously. A tube with a diameter and length of 2.8 mm and 215 mm, respectively, was used and the polymerization temperature, setting time, and optimal passing-time were measured and compared with those using only conventional cement. Radiologically, the results were evaluated and compared. RESULTS: The polymerization temperature was 70.3℃, 55.3℃, 52.7℃, and 45.5℃ in the conventional cement (R), 2 ml (B2), 4 ml (B4), and 6 ml (B6), respectively, and the corresponding setting time decreased from 960 seconds (R) to 558 seconds (B2), 533 seconds (B4), and 500 seconds (B6). The optimal passing-time was 45 seconds (B2), 60 seconds (B4), and 78 seconds (B6) at 73 seconds (R), respectively and as the amount of blood increased, it was similar to the cement passing-time. The radiological results showed that the height restoration rates and the vertebral subsidence rates similar among the groups. Two cases of adjacent vertebral compression fractures in the R group and one in the B2 and B4 groups were encountered, and the leakage rate of the cement was approximately two times higher than that in the conventional cement group. CONCLUSION: In conventional percutaneous vertebroplasty, the procedure of using autologous blood with cement decreased the polymerization temperature, reduced the setting time, and the incidence of cement leakage was low. These properties may contribute to more favorable mechanical properties that can reduce the complications compared to conventional cements alone.

Comparison of the Effects of an Adductor Canal Block and Periarticular Multimodal Drug Local Injection on Pain after a Medial Opening High Tibial Osteotomy / 대한정형외과학회잡지

PURPOSE: The efficacy of periarticular multimodal drug injection and adductor canal block after a medial opening-wedge high tibial osteotomy was compared in terms of the postoperative pain level. MATERIALS AND METHODS: From November 2016 to March 2017, 60 patients underwent a medial opening-wedge high tibial osteotomy under spinal anesthesia. Preemptive analgesic medication, intravenous patient controlled anesthesia were used for pain control in all patients. Thirty patients received a periarticular multimodal drug injection (group I), and 30 patients received an adductor canal block (group II). These two groups were compared regarding the postoperative pain level, frequency of additional tramadol injections, total amount of patient-controlled analgesia, and number of times that the patients pushed the patient-controlled analgesia button at each time interval. RESULTS: The visual analogue scale scores over the two-week postoperative period showed no statistical significance. The frequency of additional tramadol hydrochloride injections was similar in the two groups over time. The mean number of times that patients pushed the patient-controlled analgesia button was similar in two groups over time. The total amount of patient-controlled analgesia was similar in the two groups over time. CONCLUSION: This study shows that intraoperative periarticular multimodal drug injections and adductor canal block may have a similar effect on postoperative pain control in patients who have undergone a medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis of the knee.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty

BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. RESULTS: No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. CONCLUSIONS: The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Does Combination Therapy of Popliteal Sciatic Nerve Block and Adductor Canal Block Effectively Control Early Postoperative Pain after Total Knee Arthroplasty?

PURPOSE: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. MATERIALS AND METHODS: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. RESULTS: The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. CONCLUSIONS: SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.

Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee

PURPOSE: The purpose of this study was to investigate complications and radiologic and clinical outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate. MATERIALS AND METHODS: This study reviewed 167 patients who were treated with MOWHTO using a locking plate from May 2012 to June 2014. Patients without complications were classified into group 1 and those with complications into group 2. Medical records, operative notes, and radiographs were retrospectively reviewed to identify complications. Clinically, Oxford Knee score and Knee Injury and Osteoarthritis Outcome score (KOOS) were evaluated. RESULTS: Overall, complications were observed in 49 patients (29.3%). Minor complications included lateral cortex fracture (15.6%), neuropathy (3.6%), correction loss (2.4%), hematoma (2.4%), delayed union (2.4%), delayed wound healing (2.4%), postoperative stiffness (1.2%), hardware irritation (1.2%), tendinitis (1.2%), and hardware failure without associated symptoms (0.6%). Major complications included hardware failure with associated symptoms (0.6%), deep infection (0.6%), and nonunion (0.6%). At the first-year follow-up, there were no significant differences in radiologic measurements between groups 1 and 2. There were no significant differences in knee scores except for the KOOS pain score. CONCLUSIONS: Our data showed that almost all complications of the treatment were minor and the patients recovered without any problems. Most complications did not have a significant impact on radiologic and clinical outcomes.

Analysis of the Factors Affecting Bone Union after Open-Wedge High Tibial Osteotomy and Graft Material for Lateral Cortex Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze patient factors including smoking, body mass index, correction angle, graft material, presence of lateral cortex fracture, and age for the effect on bone union after open-wedge high tibial osteotomy and the effect of graft material used for lateral cortex fractures. MATERIALS AND METHODS: This retrospective study was conducted on 54 patients and 58 cases with osteoarthritic change Kallgren-Lawrence grade 2 or less from May 2012 to June 2014. Average follow-up period was 22 months (14–38 months). The patients were divided into two groups according to patient related factors and graft materials (allograft, n=6; beta-tricalcium phosphate [β-TCP], n=6) used for lateral cortex fractures and were analyzed for the relationship with bone union after open-wedge high tibial osteotomy. Radiographic and clinic analyses were performed, and van Hemert grading was used for grading bone union at 6 weeks, 3 months, 6 months, and 1 year postoperatively. RESULTS: The non-smoking group and the group without lateral cortex fracture showed significantly higher bone union rates than the control group. No significant clinical or radiological difference was observed between the two groups in 12 cases and the allograft group showed significantly higher rates of union at 6 months and 1 year postoperatively according to the van Hemert grading. CONCLUSION: Smoking and the presence of a lateral cortex fracture is a risk factor for nonunion in medial open-wedge high tibial osteotomy. The use of allograft material rather than β-TCP for lateral cortex fractures is thought to result in better bone union.

Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients

PURPOSE: To evaluate the clinical and radiological outcome of the greater trochanter reattachment device (GTRD) as firm fixation method for displaced greater trochanter fragment in bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture in elderly patients. MATERIALS AND METHODS: From January 2006 to January 2008, 32 patients above 70 years old treated with bipolar hemiarthroplasty using the GTRD as fixation method for comminuted intertrochanteric femur fracture with greater trochanter bone fragment displaced above 1 cm. They were followed up for more than one year. Clinically, the postoperative Harris hip score (HHS) and daily activities of life of Johnston et al were evaluated, and radiological, any displacement of greater trocharter bone fragments and/or GTRD. RESULTS: The mean postoperative HHS was 71.6 (range, 53~82) points. In rating the daily activity of life, twenty seven (84.4%) patients` postoperative results were above fair. Two patients (6.3%) had displacement of the greater trochanter bone fragment above 1 cm. One patient had a deep infection, so we removed the bipolar head and inserted antibiotics-loaded cement block instead, and after the infection was controlled, conversion to total hip arthroplasty was done. CONCLUSION: In bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture with displaced greater trochanter bone fragment, GTRD produced satisfactory results and early rehabilitation.

Natural History of the Calcaneal Avulsion Fracture in Neuropathic Arthropathy in a Young Diabetic Patient (A Case Report) / 대한족부족관절학회지

The avulsion fracture of the calcaneal tuberosity is rare injury. Usually, it occurs from indirect trauma in old patients with osteoporosis or in patients with diabetic neuropathy. Especially, the bone and joint damage occurred in active patient with severe sensory loss or arthropathy related to nerve damage regardless of the cause is referred to neuropathic arthropathy. Generally, a patient with nondisplacement or minimally displacement is treated by conservative therapy and a patient with severe displacement is treated by open reduction and internal fixation. We experienced a 33 years-old woman with diabetes mellitus who had the displaced avulsion fracture of the calcaneal tuberosity without significant trauma and did not treat. We report upon this case at the 2 years follow-up.