Anatomical Assessment of the Proper Insertion Site for a Tibial Nailing

PURPOSE: To investigate the proper insertion site for a tibial intramedullary nail in the Korean. MATERIALS AND METHODS: Forty volunteers without trauma below knee joint were studied to determine relationship between central axis of medullary canal and lateral tibial spine, patellar tendon and the proper insertion site, and to evaluation changes of proper insertion site during rotation of knee and effective diameter. RESULTS: The proper insertion site located average 4.3+/-0.9 mm medial to the lateral tibial spine. The proper insertion site was in the medial 1/3 of patellar tendon in 6 knees, middle 1/3 of patellar tendon in 20 knees, and lateral 1/3 of patellar tendon in 14 knees. The proper insertion site might be changed two times in internal rotation more than in external rotation. The effective diameter was more narrow in medial slope than in lateral slope at proximal tibia. CONCLUSION: The study indicates the ideal insertion site of tibial nail is the medial aspect of the lateral tibial spine in Korean. To reduce the mal-reduction from a improper insertion site, lateral insertion site might be safer than medial one. However, individual variations in the relationship between the patellar tendon and tibial medullary canal should be considered.

Analysis of the Orientation of Lumbar Isthmic Defect / 대한정형외과학회잡지

PURPOSE: We analyzed angles of defect planes of spondylolysis from coronal plane using axial computed tomography to identify the problem of 45degrees oblique plain radiograph by which we routinely has used and to suggest an appropriate radiological diagnostic tool for spondylolysis. MATERIALS AND METHODS: From January 2001 to July 2002, 84 cases of spondylolysis from 44 patients were studied. The diagnosis of spondylolysis was confirmed with axial computed tomography in all cases and angles of isthmic defect from coronal plane were measured. We intended to assess the distribution of angles of isthmic defect and analyzed the result of plain radiographs which were obtained in the direction parallel to the angle of the mean value. RESULTS: Although angles of lumbar isthmic defects have a wide distribution, the mean value was 20.9+/- 9.5degrees which was nearer to coronal plane than 45degrees oblique plane. Fifty eight cases were distributed within 23degrees from coronal plane. A diagnostic sensitivities were 88.1% in lateral view, 78.6% in 45degrees oblique view and 100% in 20degrees oblique view, so a 20degrees oblique view seemed to be more sensitive in diagnosis of lumbar isthmic defect. CONCLUSION: Because the mean angle of lumbar isthmic defects from coronal plane was about 21degrees, obliqueview with 20degrees was more appropriate and sensitive diagnostic tool for spondylolysis than oblique view with 45degrees which have been used routinely.

Scaphocapitate Fracture Syndrome: Case Report / 대한정형외과학회잡지

Scaphocapitate fracture syndrome is a relatively uncommon variant of trans-scaphoid perilunte dislocation in which the head of the capitate is fractured and rotated 180 degrees. The incidence of the injury has not been documented, and no report has been issued in Korea since the lesion was originally described in 1937. Termed degrees naviculocapitate fracture syndrome " by Fenton in 1956, scaphocapitate fractures continue to pose problems at diagnosis and treatment. The author experienced one case of scaphocapitate fracture syndrome in the left wrist joint which was treated by open reduction and K-wire fixation.

Conservative Treatment of Acute Isolated Injuries to the Posterior Cruciate Ligament: Prospective Study

PURPOSE: We assessed prospectively the results of acute, isolated, posterior cruciate ligament injuries treated conservatively. MATERIALS AND METHODS: Between August 1999 and December 2001, the study population consited of 11 patients. The patients were treated conservatively and were prescribed full extension long leg splint with posterior tibial support for 6 weeks and then posterior tibial support brace for another 6 weeks. Patients completed a subjective and objective evaluation at 6 weeks, 3 month, 6 month and each year for an average of 17.5 months. RESULTS: Two patients underwent reconstructive surgery because of combined posterolateral rotatory instability. The nine patients were treated conservatively, the mean Orthopadishe Arbeitsguppe Knie score was 93.2 points, International Knee Documentation Committee score in 5 patients was A and 4 patients was B. CONCLUSION: Our study suggests that patients with acute, isolated posterior cruciate ligament injuries treated conservatively may get good clinical results, but we are planning a long term follow-up evaluation to reveal change in laxity, incidence of arthrosis and their correlation.