Result of Interlocking Intramedullary Nailing for Humeral Shaft Fracture Evaluation of Post-operative Shoulder Function

PURPOSE: To evaluate the post-operative functional reduction of the shoulder joint and the impacting factors to post-operative shoulder joint function in interlocking IM nailing treatment of humeral shaft fracture. MATERIALS AND METHODS: From April 1999 to August 2004, 35 patients (35 cases) whom admitted to hospital for humeral shaft fracture and treated using interlocking intramedullary nail were followed up for more than 1 year. 1 year post-operative shoulder joint function were evaluated using American Shoulder Elbow Surgery Scale (ASES). Pre-operative shoulder joint pain, radiologically degenerative change and extent of nail protrusion were evaluated, and each factor was correlated with function of the shoulder joint. RESULTS: 33 cases out of 35 cases showed union and average union period was 12 weeks. Complications consisted of 2 cases of nonunion, 1 case of infection, 1 case of loosening of distal fixing screw, 1 case of radial nerve palsy and 1 case of axillary nerve palsy. Shoulder joint function 3 months after operation : mean ASES score 78.2, 12 months after operation : mean ASES score 89.6. Pre-operative shoulder joint pain and nail protrusion showed to be statistically related to shoulder joint function. CONCLUSION: If the operation leaves no protrusion of intramedullary nail, it can be concluded to be relatively safe and effective.

Clinical Diagnosis of Meniscus Injury of Knee Joint / 대한정형외과학회잡지

PURPOSE: To report the differences between previous articles in Korea on the common occurence of lateral meniscus tears and our cases, and also which clinical symptoms and signs are the most reliable for diagnosis of meniscal tear. MATERIALS AND METHODS: We analysed 118 patients who were confirmed to have a meniscal tear by arthroscopy from May 1996 to May 1998. The Chi-Square test was used for statistical analysis. RESULTS: There is no statistical difference of frequency between tears of the medial meniscus and those of the lateral meniscus. The most frequent clinical symptom is feeling of subluxation and sign is McMurray test. A combination of McMurray and squatting test is the most frequent positive sign of meniscal tear in our cases. CONCLUSIONS: In our cases, the frequency of medial meniscus tears is more common than those of the previous articles in Korea. To increase the accuracy of clinical diagnosis of meniscal tear, repeated and accurate history taking and physical examination, including above symptoms and signs are very important.

Different Patterns of Meniscal Tears in Recent Anterior Cruciate Ligament ( ACL ) Ruptures and Chronic ACL-deficient Knees / 대한정형외과학회잡지

PURPOSE: We tried to outline the incidence and characteristics of meniscal tears in recent lesions and chronic insufficiency of the ACL. MATERIALS AND METHODS: Through this retrospective study of 103 reconstructions of the anterior cruciate ligament (ACL) performed between Jun 1996 to Sep 1998, according to a more accurate evaluation, ACL-deficient knees can be classified into two different stages (recent, chronic injuries). RESULTS: Overall, there was a significantly increasing incidence of meniscal tears in chronic injuries (P<0.05). A predominance of lateral meniscal tears were demonstrated with recent injuries, whereas the incidence of medial meniscal tears increased significantly with chronic injuries (P<0.05). CONCLUSIONS: This study highlights the increase of lateral meniscal lesion in recent ACL rupture and increase of severe meniscal lesion, especially medial meniscus, with progressive worsening of knee instability after an ACL injury. Although not significant, meniscal tears in the recent injuries were more amenable to repair. The results suggest that maximal meniscal preservation is best achieved with ACL reconstruction shortly after injury.

Change of Segmental Motion After Lumbar Posterolateral Fusion / 대한정형외과학회잡지

PURPOSE: To verify the changes of segmental motion after posterolateral lumbar fusion. MATERIALS AND METHODS: Thirty-eight cases of lumbar posterolateral fusion with good postoperative results and full range of motion, followed up for at least one year were reviewed. We measured the translation and angulation by the Dupuis method on flexion extension radiographs. RESULTS: 1) The motion at adjacent segments was 0.75 mm translation and 6.5 degree angulation at L1-2, 0.75 mm and 8.62 degree at L2-3, 0.95 mm and 9.67 degree at L3-4, 1.17 mm and 10.67 degree at L4-5 and 0.41 mm and 7.41 degree at L5-S1. The motion at L5-S1 was less than that in the control group, but at other levels it was not different. 2) The total range of motion of lumbar spine in the control group was 47.8 degree. In one-segment fusion the range of motion was 31.1 degree(64.9%), in two-segment fusion was 26.8 degree(56.1%) and in three-segment fusion was 14.3 degree(29.8%). The longer the fusion level was, the smaller the total range of motion of lumbar spine was. 3) The percentage of motion at adjacent mobile segments in the fusion group increased more significantly than that in the control group. CONCLUSIONS: Segmental motion at adjacent segment in the fusion group was similar to the motion in the control group. The compensatory increased motion at adjacent mobile segment was not definite, however, the percentage of motion at adjacent segment increased after spinal fusion.

The Value of the Tip - Apex Distance in Predicting Failure of Fixation of Intertrochanteric Fractures of the Hip / 대한정형외과학회잡지

Failure of fixation of intertrochanteric fractures that have been treated with a fixed-angle sliding hip-screw device is frequently related to the position of the lag screw in the femoral head. The purpose of this study is to introduce the concept of the tip-apex distance and to demonstrate its clinical usefulness as a predictor of cutout of the screw used for fixation of the intertrochanteric fractures of the hip. The tip-apex distance is the sum of the distance from the tip of the lag screw to the apex of femoral head on an anteroposterior radiograph and this distance on a lateral radiograph after controlling for magnification. To determine the value of tip-apex distance in the prediction of cutout of the lag screw, 67 intertrochanteric fractures that have been treated with a fixed-angle sliding hip screw device were studied. The minimum duration of follow-up was three months during which period all of the fractures either healed or had failure of the fixation. The average tip-apex distance was 21mm (range,22.8-65.8mm) for the successfully treated fractures compared with 35mm (range,8.4-65.8mm) for those in which the screw cutout. There was strong statistical relationship between an increasing tip-apex distance and the rate of cutout. An unstable fracture, a poor reduction were also associated with a significantly increased risk of failure due to cutout.

Measurement of the Morphologic Changes of Intercondylar Notch by Magnetic Resonance Imaging / 대한정형외과학회잡지

The purpose of this retrospective study was to evaluate the morphology of the intercondylar notch of the knee in 72 anterior cruciate ligament (ACL) intact group and 30 acute and chronic ACL tear group by plain radiographs and MRI, and to find the predisposing factors of ACL tear. The ACL tear group was divided into acute and chronic ACL tear group. In plain lateral radio-graphs, beta angle, angle between extension line from anterior cortical line of distal femur and from Blumensaat s line, was measured. In magnetic resonance imaging, the width of intercondylar notch (NB), the widest width of both femoral condyle (NW), intercondylar notch width from lower one third point of notch basal line (NB1), intercondylar notch width from upper one third point of notch basal line (NB2), depth of intercondylar notch from notch basal line (ND), and intercondylar angle which made from both end point of notch basal line and apex of intercondylar notch (alpha) were measured. Three groups were compared with each other by statistical analysis. Stastistically, the acute ACL tear group had narrow upper portion of intercondylar notch than chronic ACL tear group and more acute angle of roof of the intercondylar notch than intact ACL group. So in notchplasty, the upper one-third of intercondylar notch should be carefully widened. And after fixation of femoral interference screw, arthroscopic observation should be done whether reconstruced graft touchs the roof of the intercondylar notch during the extension of the knee.