Comparative Study Using of Treatment with Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Interlocking Intramedullary Nailing in Distal Tibia Fractures

PURPOSE: To compare the result of treatment between minimally invasive plate osteosynthesis (MIPO) using periarticular plate and intramedullary nailing in treatment of distal tibia fractures. MATERIALS AND METHODS: 28 cases of distal tibia fractures form Jan. 2006 to Mar. 2008 were divided into two group. Minimum follow-up was for 12 month. Group 1 consisted of 14 patients who were treated by MIPO technique and group 2 consisted of 14 patients who were treated by interlocking intramedullary nailing. The results were compared by assessing radiologic and clinical result. RESULTS: The mean bony union time was 14 weeks (8~17) in group 1 and 15 weeks (11~20) in group 2. Operation time was 58 minutes (55~65) in group 1 and 82.7 minutes (70~100) in group 2. The average angulation in AP view was 1.5 degrees (0~2) in group 1 and 2 degrees (0~5) in group 2, in lateral view was 1.8 degrees (0~4) in group 1 and 2.3 degrees (0~12) in group 2. The average range of motion for dorsi flextion was 17.5 degrees (15~20) in group 1 and 18 degrees (16~20) in group 2, for plantar flextion was 45 degrees (42~50) in group 1 and 44 degrees (42~50) in group 2, which means that there were no severe limitation of motion in all patients, resulting in satisfactory ambulation. There was no post operative complications such as skin irritation problem caused by internal device and no implant failure and superficial wound infection. CONCLUSION: There were no difference in bony union time, clinical result and anatomical reduction between Group 1 and Group 2 in distal tibia fractures, but operation time was shorter in MIPO than nailing.

Their Roles and Functions of the Tissue Banks

Tissue bank with profer personnels (medical director, tissue bank speciality, and so on), facilities, equipments, standard of procedures (SOP) and quality control (QC) programs should get the permission from Korea Food and Drug Administration (KFDA). All kinds of tissues are donated from live donors, cadavers or brain deaths without any rewards. Permission to acquire tissues shall be obtained through the granting of informed consent by a consenting person in accordance with applicable Korean law and regulations for anatomical gifts. One or two more tissue banks participate in recovery, preservation, quarantine, processing, packaging, storage, and/or distribution. The relationship and responsibilities of each shall be delineated in writing and that documentation shall be maintained at each participating bank or facility. Each tissue bank should keep the safety for all tissues under the strict SOP and QC programs, including donor screening, donor testing and donor exclusion criteria. And also, the final human tissue products should keep in sterile package and transfer to medical facilities for reconstruction of patients' defects under profer temperature within transportation containers. Potential adverse reactions, suspected transmission of disease or complications, directly or indirectly related the allograft, shall be reported to KFDA for the further safety

Delayed Diagnosis of Acute Hematogenous Osteomyelitis of the Acetabulum: Report of Two Cases / 대한정형외과학회잡지

Acute hematogenous osteomyelitis of the acetabulum is not a common disease with similar clinical symptoms and hematological findings to those of pyogenic arthritis of the hip joint. This symptom similarity might lead to a delayed diagnosis of the disease, and even to unnecessary surgery. We report two cases of acute hematogenous osteomyelitis of the acetabulum. One was a 13-year-old boy with non-specific radiological findings of the hip joint, who was initially diagnosed with fever of unknown origin. The other was an 11-year-old boy with hip joint pain and a recent history of minor trauma, which lead to a delayed diagnosis.

Comparative Study between In Situ Decompression of the Ulnar Nerve and Medial Epicondylectomy for Cubital Tunnel Syndrome

PURPOSE: We present our experience of operative results between in situ decompression of the ulnar nerve and medial epicondylectomy for cubital tunnel syndrome. MATERIALS AND METHODS: In 50 cases, we analyzed 32 cases followed more than 12 months. In 32 cases, 17 patients underwent in situ compression and 15 patients underwent medial epicondylectomy. After average follow-up period, we analyzed the operative results. The average follow-up period was 27 months(12~51 months). The results were divided into pain, sense, motor, and function using Gabel & Amadio grade (Table 1), and then estimated by 4 steps. Also, we divided into 3 grades using McGowan grade (Table 2), and then compared the score. RESULTS: The results of in situ decompression were 3 excellent cases, 5 good cases, 7 fair cases, and 2 poor cases by Gabel & Amadio grade. The results of medial epicondylectomy were 3 excellent cases, 4 good cases, 7 fair cases, and 1 poor case by Gabel & Amadio grade. However, there was no significant difference between the in situ decompression(5.45) and medial epicondylectomy(5.78). The results of McGowan grade I were 3 excellent cases, 1 good case. According to Gabel & Amadio grade, the average score was 8.5(range, 7~9) and the results of McGowan grade II were 3 excellent cases, 5 good cases, 5 fair cases, and 1 poor case. According to Gabel & Amadio grade, the average score was 6.7(range, 3~9). Finally, the results of McGowan grade III were 3 good cases, 9 fair cases, 2 bad cases. According to Gabel & Amadio grade, the average score was 4.85(range, 2~7), which was statistically significant difference. CONCLUSION: Statistically there was no significant difference between in situ decompression of the ulnar nerve and medial epicondylectomy for cubital tunnel syndrome. Both operative methods have short operation time, which makes it possible to exercise the joints earlier than other operations. In conclusion, we consider both methods are available for the treatment of cubital tunnel syndrome.

Total Hip Arthroplasty without a Femoral Shortening Procedure for Treating a Highly Dislocated Hip

PURPOSE: This study evaluated the results of total hip arthroplasty (THA) without a femoral shortening procedure for the treatment of a highly dislocated hip. MATERIALS AND METHODS: A total of 11 hips of 11 patients who underwent THA between April 1996 and February 2001 were clinically and radiologically evaluated. Among these 11 hips, 5 hips were sequelae of developmental dysplasia of the hip and 6 hips were sequelae of pyogenic or tuberculous infection. The mean follow-up period was 98 months (range: 88~121 months). RESULTS: In all cases, the hip center was restored to the anatomic hip center. The mean Harris hip score increased from 56.2 preoperatively to 86.3 at the end of follow-up and the mean difference of the spino-malleolar distance decreased from 5.6 cm preoperatively to 1.4cm postoperatively. Non-union in the greater trochanter osteotomy site was encountered in two patients. Two cases of sciatic nerve palsy and one cases of heterotopic ossification occurred, but one case of sciatic nerve palsy recovered within 6 months. CONCLUSION: After enough soft tissue release, if reduction to the original hip center is difficult, then performing femoral osteotomy or shortening osteotomy should be considered during the THA for a highly dislocated hip.

Targon(R) Proximal Femoral Nail Used for Treatment of Intertrochanteric Femoral Fractures

PURPOSE: We evaluated the clinical and radiological outcomes related to use of the Targon(R) proximal femoral nail for repairing femoral intertrochanteric fractures. MATERIALS AND METHODS: Between April 2004 and November 2005, the records of 56 patients with intertrochanteric fractures treated with the proximal femoral nail, were analyzed. The mean patient age was 75.2 years. The mean duration of follow-up was 32 months. There were 26 stable fractures and 30 unstable fractures. Clinical assessment included parameters of operating time, transfusion rate, pain analysis by visual analogue scale (VAS), timing of maximum tolerable weight-bearing, functional evaluation by modified Koval index, and complications. Radiological assessment was directed toward adequacy of reduction, union time, and changes observed between immediate postoperative and final follow-up roentgenograms in various parameters. RESULTS: The mean operating time was 37 minutes. Visual analogue scale at final follow-up was 2.8 on average, and 38 of 43 preoperative ambulators (88%) were able to bear weight as much as tolerable within 6 weeks postoperatively. Postoperative mobility recovered to pre-injury levels in 40 cases (71%). Radiologic evaluation showed adequate reduction in all cases. Mean union time was 8.9+/-2.5 weeks. The neck-shaft angle changed at final follow-up an average of 3.6+/-1.9(R). The femoral shaft displaced medially an average of 2.8+/-0.9 mm, and the lag screw slid an average of 4.7+/-0.6 mm. Complications such as cutting through, Z-effect, and femoral shaft fracture were not observed in any cases. CONCLUSION: The Targon(R) proximal femoral nail showed excellent results in terms of early ambulation, clinical recovery, and radiologic parameters and may be a useful implant for treating femoral intertrochanteric fractures.

Spontaneous Intramuscular Hematoma associated with Acute Compartment Syndrome after Treatment of Low Molecular Weight Heparin: A Report of Two Cases

Low-molecular-weight heparin (LMWH) has been considered superior to unfractionated heparin in several facets such as more effective anticoagulant, more predictable bioavailability, and less bleeding complications. We report two cases of LMWH, enoxaparin-induced spontaneous intramuscular hematoma with compartment syndrome of the lower extremity in patients with cardiac problems. The patients were treated with enoxaparin (LMWH) as bridging anticoagulation before use of warfarin due to cardiac problems. At the average 3 days of enoxaparin treatment, large and painful swelling was noticed in the lower extremities without intramuscular injection or trauma. The patients were diagnosed as having compartment syndrome with large intramuscular hematoma by CT. The patients underwent immediate fasciotomy and hematoma evacuation, and recovered without any complications.

Two Stage Revision using Custom Articulating Spacer in an infected TKA: A Novel Method for an Intraoperative Construction of an Articulating Spacer / 대한정형외과학회잡지

PURPOSE: This paper reports a novel technique to create an antibiotic spacer for the treatment of infected total knee replacements (TKA) with surface contours similar to that of the original TKA. MATERIALS AND METHODS: This new technique involved the intra-operative construction of a custom mold made from bone cement along with the removed implant. Twelve consecutive patients treated with this technique were reviewed in the aspect of the degree of flexion, difficulty in exposure at the 2nd stage reimplantation, and complications related to the technique. The functional status was evaluated using the Knee Society score. RESULTS: The degree of flexion was 85 (40-130) preoperatively and 100 (70-110) prior to reimplantation. The postoperative flexion was 112 (90-140) at 6 weeks, 108 (70-140) at 3 months, and 110 (75-140) at 1 year postoperatively. A rectus snip was required in 8 out of 12 cases. Other extensile approaches were not needed. The knee society score was significantly improved from 30/24 to 87/80. No specific complications were noted at the final follow-up. CONCLUSION: This technique allows the immediate stability and mobility after the first stage of reimplantation. This technique offers ease and convenience of surgical technique without considerable increase in surgical cost or time. In addition, it eliminates the requirement for costly commercial mold or special pre-manufactured implants.

Case of a Soleus Muscle Hematoma with Compartment Syndrome Complicated by Enoxaparin and Aspirin Therapy

Enoxaparin is a low-molecular-weight heparin that has been widely used in acute coronary syndrome patients. The tolerability profile of enoxaparin is at least similar to that of unfractionated heparin, but the incidences of local hematomas and increased liver enzymes are lower. We experienced one case of enoxaparin-associated soleus muscle hematoma with compartment syndrome. An 83 year-old woman received enoxaparin (1 mg/kg q 12 hours) and oral aspirin (100 mg qd) therapy due to a non-ST elevation myocardial infarction. On the 3rd hospital day, she complained of pain and a tingling sensation in her left calf muscle. A left lower leg CT scan showed a 5.1 x 2.3 x 1.5 cm hematoma compressing the left soleus muscle. An Emergency operation was done to extract the large hematoma. Whenever acute symptoms, including leg pain, tingling sensation, and anemia occur during anticoagulation therapy, the possibility of enoxaparin-associated hematoma should be considered.

The Validity of the Radiographic Measurement of Acetabular Anteversion after Total Hip Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study was performed to evaluate the efficacies and the reliabilities of methods used to measure acetabular anteversion in plain radiographs. MATERIALS AND METHODS: Three orthopedic surgeons measured prosthetic acetabular anteversions in three plain AP and three translateral radiographs of ten patients who underwent total hip arthroplasty. In each film, we measured anteversions three times using three methods in AP and a direct method in translateral radiographs. Data were collected and analyzed statistically with CT axial and planar anteversion measured by a radiologist. RESULTS: All methods with plain AP film showed very low inter and intraobserver variances and correlated well with CT planar and axial anteversions. Although the data obtained from translateral radiographs were showed low variances, they did not correlate with those of the other methods. CONCLUSION: Simple estimation alone or mathematical methods can be reliably and reproducibly used to assess planar anteversion in a clinical setting. Data from translateral radiographs were unreliable and did not correlated well with the other methods, and they are not recommended for clinical use.

Morphologic Study of the Facet Joint in Spondylolysis and Isthmic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: Radiological investigation to study the morphologic difference of posterior facet joint in spondylolysis and isthmic spondylolisthesis. OBJECTIVES: To study the correlation of the clinical differences between the one with spondylolysis and another with isthmic spondylolisthesis with morphological analysis of posterior facets of lumbar spine in low back pain, anterior displacement and segmental instability. SUMMARY OF LITERATURE REVEIW: There are many studies for the lumbar facet in back pain, disc degeneration, degenerative spondylolisthesis. However, little is known about the correlation of facet joint between the spondylolysis and isthmic spondylolisthesis. METHODS: This study is done with 27 specimens which contain posterior facet and lamina from 25 patients due to spondylolysis or isthmic spondylolisthesis. We took the computed tomograms in each specimen and obtained the areas and angles of posterior facets of lumbar spine. RESULTS: The group with spondylolysis has mean area(Rt/Lt) of 158.4/159.3mnfand angle(Rt/Lt) of 49.8u/54.0u. The group with isthmic spondylolisthesis has mean area(Rt/Lt) of 172.3/189.6mnfand angle(Rt/Lt) of 44.3u/44.8u. The group with segmental instability has mean(Rt/Lt) area of 155.9/161.8mnfand angle of 48.1u/50.4u. The group without instability has mean area(Rt/Lt) of 173.4/185.2mnfand angle(Rt/Lt) of 46.2u/48.5u. CONCLUSION: There are no significant differences between the morphologic difference of facets with back pain and without back pain. The group with isthmic spondylolisthesis has greater mean area and less mean angle of facet than the group with spondylolysis, but, there are no statistical significant differences(p>0.05). There are no significant morphologic differences of facet between the group with segmental instability and without segmental instability.