Treatment of Unstable Dorsal Proximal InterphalangealFracture/Dislocation using a Hemi-Hamate Autograft / 대한정형외과학회잡지

PURPOSE: To evaluate clinical and radiology assessments of the treatment outcomes of an unstable dorsal proximal interphalangeal (PIP) fracture and dislocation by hemi-hamate autograft. MATERIALS AND METHODS: Six patients underwent a hemi-hamate autograft for the treatment of an unstable dorsal PIP fracture dislocation of which the articular involvement of the PIP joint was >50%, or an unstable joint despite the lesser degree of involvement. The clinical results were evaluated from the following: postoperative patient satisfaction, range of motion, stability and grip strength. The radiographs were evaluated for the union, and graft incorporation, and/or collapse. RESULTS: All patients were satisfied with the results and the range of motion of the PIP joint was 81 degrees (75-100 degrees). In all cases, stability of the PIP joint was restored. The average grip strength was 82% (75-90%) of the uninjured side. Bone union was achieved in all patients. CONCLUSION: A hemi-hamate autograft is effective for reconstructing the cup-shaped contour of the articular surface, and for recovering the functional range of motion of the PIP joint after an unstable dorsal proximal interphalangeal (PIP) fracture and dislocation. However, more study will be needed through a mid-term and long-term follow up.

Limited Intercarpal Arthrodesis in Kienbock's Disease / 대한정형외과학회잡지

PURPOSE: To compare the treatment results of triscaphe and scaphocapitate arthrodesis in Lichtman's stage III Kienbock's disease. MATERIALS AND METHODS: Among 25 cases of Kienbock's disease (Lichtman's stage III), who were followed up more than 1 year after surgery from 1997 March to 2005 March, 15 cases of scaphocapitate and 10 cases of triscaphe arthrodesis were reviewed. The average age was 42.6 and the mean follow-up period was 33 months. The clinical and radiology results were analyzed before surgery and at the last follow-up. RESULTS: In the clinical assessments, there was good pain relief after each procedure and there was a similar limitation of the carpal range of motion before and after surgery. The radiology assessments revealed no difference between the two arthrodeses according to the carpal height ratio and lunate index. Regarding complications, there were 4 cases with a scaphocapitate including 1 nonunion and 4 cases with triscaphe arthrodesis including 2 superficial infections. CONCLUSION: The scaphocapitate arthrodesis is a technically simple, easy reducible to the anatomical position and produces similar clinical and radiology results to triscaphe arthrodesis. Overall, scaphocapitate arthrodesis appears to be an effective method for treating Lichtman's stage III Kienbock's disease.

Classification and Treatment of Degenerative Lumbar Spinal Deformity / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVE: To categorize and analyze clinical results of degenerative lumbar deformity patients according to the degree of scoliosis and kyphosis. SUMMARY AND LITERATURE REVIEW: A degenerative spinal deformity is classified into a coronal and sagittal deformity. There are some reports about treatment according to each classification but the classification is sometimes inappropriate and the treatment can vary. MATERIALS AND METHODS: From June 1998 to June 2003, 79 patients, who were diagnosed with a degenerative lumbar deformity and underwent conservative or operative treatment, were studied retrospectively. Group I had scoliosis ranging from 10 to 20degrees , and group II had scoliosis > 20degrees Each group was subdivided into A, B, and C according to the lordosis, group A > 30degrees , group B between 20 to 30degrees , and group C 20degrees or lordosis < 20degrees are expected to show more improvement in symptom after surgery than after conservative treatment.

The Operative Treatment of Radial Head or Neck Fracture: The Sub-classification of Mason Type II Fracture

PURPOSE: To evaluate the results of treatment according to the sub-classification of the Mason type II fracture. MATERIALS AND METHODS: From 1999 to 2003, according to the sub-classification of the Mason type II fracture, 33 patients were treated with miniplate in displaced neck fracture (IIa), with compression screw in displaced head fracture (IIb), with miniplate and/or compression screw in displaced head and neck fracture (IIc), with compression screw and miniplate in comminution fracture (III) or excision of head in irreducible state. The clinical results were evaluated by An and Morrey's functional rating index. RESULTS: Functional rate score averaged 92.7 in type IIa, 88.4 in IIb, 86.4 in IIc, 83.5 in type III with reduced fracture, 75.0 in type III with excised head, and 75.5 in type IV. Complications included heterotopic ossification (2 cases), metal loosening (1 case), malunion (1 case), partial ankylosis of elbow (3 cases), posttraumatic arthritis (1 case). CONCLUSION: These results supported the recommendation for internal fixation with compression screw in isolated radial head fracture (IIb) and with miniplate in fracuture combined with displaced neck (IIa, IIc, indicated some III). We concluded that sub-classification is useful for dicision making in radial head or neck fracture's treatment.

Biomechanical and Histological Effects of Different Regimens of Immobilzation after Operative Treatment in a Ruptured Rabbit Achilles Tendon / 대한정형외과학회잡지

PURPOSE: To evaluate the effects of the different regimens of immobilization after surgery in a rabbit model. MATERIALS AND METHODS: The study was performed on the right Achilles tendon of 30 rabbits. Modified Kessler method was used to suture the transected tendon. Rabbits were divided into three groups, Group I (n=10) underwent long leg cast with equinus position for 6 weeks, Group II (n=10) underwent weekly cast correction to full dorsiflexion from 1 week after surgery, and Group III (n=10) underwent daily correction of equinous position with external fixator from 1 week after surgery. The contralateral Achilles tendon served as an unoperated control. And three groups were compared at 6 weeks after surgery. RESULTS: The maximal load at rupture (N) was 55.50, 97.46, 140.27, 180.98 for group I, II, III and control respectively. The strain was 0.44, 0.49, 0.74, 0.67. The stiffness (N/mm) was 9.63, 17.87, 19.01, 23.33. The absorbed energy to rupture (J) was 12.23, 23.98, 51.20, 60.78. Values among groups were significantly different considering the maximal load, strain, stiffness, and absorbed energy to rupture (p<0.05). Histological finding was revealed more mature restoration and more parallel arrangement of fiber bundles in the group II, and especially group III. Achilles tendon rupture, Maximal load, Strain, Stiffness, Tensile loading. CONCLUSION: Tensile loading of the healing tendon by postoperative continuous correction leads to changes in more similar to the normal Achilles tendon, biomechanically and historically.

The Distributions and Changes of Nerve Fiber in Human Nucleus Pulposus According to the Degenerative Changes / 대한척추외과학회지

STUDY DESIGN: This was a retrospective study to evaluate the nerve fibers in human nucleus pulposus. OBJECTIVE: To study the changes in the pain receptor, including the nerve fiber of the disc, immunohistologic studies were performed for S-100, synaptophysin and CD 31. SUMMARY OF LITERATURE REVIEW: Degeneration in a human intervertebral disc is one of the most important causes of back pain. MATERIALS AND METHODS: This study used disc materials obtained from patients that had undergone an operation. According to the patient`s age and diagnoses, the disc materials were subdivided into 3 groups. Group 1; HNP patients aged in their twenties and thirties, with a mean age of 28.3 years. Group 2; HNP patients aged above forty, with a mean age of 43.8 years. Group 3; patients diagnosed with degenerative disc disease through preoperative MRI or discogram, with a mean age of 40.2 years. There were ten in each group. H & E staining, immunohistologic studies for S-100, synaptophysin and CD 31 staining were investigated to find the relationship between blood vessels and nerve fibers. RESULTS: From the H & E staining, inflammatory cells were detected in groups 1 and 2, and partially detected in group 3, but no significant differences were detected between the groups. The chondrocyte morphologies were similar in groups 1 and 2, but the number of chondrocyte in group 3 was significantly decreased, and degeneration was also detected. From the S-100 staining, 0, 10 and 40% positive findings were detected in groups 1, 2 and 3, respectively. For the synaptophysin staining, no positive findings were detected in groups 1 and 2, whereas, 30% positive findings were detected in group 3. No positive results for the CD 31 staining were seen in any of the three groups. CONCLUSION: Pain due to a degenerative disc can be explained by the above results, but its relationship to blood vessels was insufficient. Further study on the changes in the vertebral endplate and annulus fibrosus is recommended.

Assessment of Quality of Life and Psychological Status in Spinal Cord Injury after Spinal Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To study the socio-psychological adaptation through the psychoanalysis in the patients with spinal cord injury. MATERIALS AND METHODS: From May 1998 to Aug. 2003 we chose the 15 patients who have been undergone surgery for spinal cord injury after spinal fracture. Psycological analysis were based on the Korean version of Beck Depression Index(K-BDI), Hamilton Anxiety Scale, and the Minnesota Multiphasic Personality Inventory(MMPI), and valuation of quality of life. RESULTS: K-BDI applied results showed an average of 33.5+/-10.3, having a higher average than normal. Hamilton Anxiety Scale resulted with an average of 32.4+/-9.4. 4 patients were taken intensive care psychologically beause of depression. The Lie score out of the MMPI`s suitability scale showed 43.3+/-9.7, Validity score as 75.4+/-23.6, and Defensiveness score with 47.7+/-10.6 as average and standard deviation, resulting a higher as to normal. Further more, clinical scales of Hypochondriasis scale was 69.9+/-12.6, Depression as 65.5+/-15.3, Hysteria scale as 67.9+/-11.5, Psychopathic deviate as 65.6+/-12.1, Paranonia as 71.9+/-17.6, Psychasthenia scale as 67.9+/-12.3, Schizophrenia as 70.4+/-17.8, Hypomania scale as 54.0+/-11.3, and social introversion scale as much as 60.1+/-15.0 higher than normal. In evaluation the quality of life, there was a prominent issue in the occupation(0.1) and economic independence(0.5) out of the total 6 items, difference was 0.6, social adaptation was 0.8, physical independence was 0.7 and orientation(1.6) was similar to normal person. CONCLUSION: As the physical and the psychological changes abrupt at the same time with the spinal cord injury, it is important to encourage the patients to have a strong ego to have an optimistic confidence of recuperation.

Assessment of Quality of Life and Psychological Status in Spinal Cord Injury after Spinal Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To study the socio-psychological adaptation through the psychoanalysis in the patients with spinal cord injury. MATERIALS AND METHODS: From May 1998 to Aug. 2003 we chose the 15 patients who have been undergone surgery for spinal cord injury after spinal fracture. Psycological analysis were based on the Korean version of Beck Depression Index(K-BDI), Hamilton Anxiety Scale, and the Minnesota Multiphasic Personality Inventory(MMPI), and valuation of quality of life. RESULTS: K-BDI applied results showed an average of 33.5+/-10.3, having a higher average than normal. Hamilton Anxiety Scale resulted with an average of 32.4+/-9.4. 4 patients were taken intensive care psychologically beause of depression. The Lie score out of the MMPI`s suitability scale showed 43.3+/-9.7, Validity score as 75.4+/-23.6, and Defensiveness score with 47.7+/-10.6 as average and standard deviation, resulting a higher as to normal. Further more, clinical scales of Hypochondriasis scale was 69.9+/-12.6, Depression as 65.5+/-15.3, Hysteria scale as 67.9+/-11.5, Psychopathic deviate as 65.6+/-12.1, Paranonia as 71.9+/-17.6, Psychasthenia scale as 67.9+/-12.3, Schizophrenia as 70.4+/-17.8, Hypomania scale as 54.0+/-11.3, and social introversion scale as much as 60.1+/-15.0 higher than normal. In evaluation the quality of life, there was a prominent issue in the occupation(0.1) and economic independence(0.5) out of the total 6 items, difference was 0.6, social adaptation was 0.8, physical independence was 0.7 and orientation(1.6) was similar to normal person. CONCLUSION: As the physical and the psychological changes abrupt at the same time with the spinal cord injury, it is important to encourage the patients to have a strong ego to have an optimistic confidence of recuperation.

Conservative Treatment of the Displaced Clavicular Shaft Fracture in Multiple Injury

PURPOSE: To analyse the comparative clinical results between adults with multiple injury including the clavicular shaft fracture and only clavicular shaft fracture who had supportive care through retrospective aspect. MATERIALS AND METHODS: We had 48 adult patients in this hospital with simple fracture and multiple injury including the clavicular shaft whom we were able to evaluate at least more than a year. 12 of 48 patients were with only clavicular shaft fracture and the rest of them were with multiple injury. We classified patients into two groups those who had fracture with displacement for group A (A1 for the cases with over 50% of fracture surface contact rate and A2 for less than 50% from the images of simple X-ray) and those who had comminuted fracture for B. We compared the time of bone union, nonunion rate of only clavicular fractures and multiple injury, clinical results for patients who had supportive care with retrospective aspect. RESULTS: A1 (7 cases), A2 (4 cases), B (1 case) were prevalent in the group of only clavicular shaft fracture and A1 (8 cases) and A2 (16 cases) and B (12 cases) were prevalent in the group of multiple injury. For the cases with supportive care, we could find 1 nonunion case (8%) and 11 union cases on average 2.91 months in the group of only clavicular shaft fracture and 7 nonunion cases (19%) and 29 union cases on average 3.58 months in the group of multiple injury. The best clinical results had occurred in 8 cases (67%) of only clavicular shaft fracture group and 19 cases (53%) of multiple injury group. We could find out the union from all 8 nonunion cases that took operation afterward. CONCLUSION: Although the choice of treatment of clavicular fracture is supportive care, but multiple injury including the clavicular fracture is a high-energy injury, so the possibility of comminuted and displacement is high, so that nonunion rate is high. The possibility of early surgery must be considered seriously.