Nail Lengthening using the Eponychial Flap / 대한정형외과학회잡지

PURPOSE: We wanted to introduce a nail lengthening technique with an eponychial flap for treating finger tip amputation, and we review the relevant literature. MATERIALS AND METHODS: Twenty-five patients who received eponychial flap surgery between November 2001 and April 2006 were enrolled in this study. Retrospectively, the patients were asked, by using a questionnaire, about their satisfaction with their nail shape and length. The preoperative findings and the findings at the last follow up and the contralateral finger nail lengths were measured with a ruler and those were all compared according to the percentage of change. RESULTS: The average operation time was fourteen minutes (range: 10 to 19 minutes). All the flaps survived and there was no infection, congestion of the flap, or additional deformity of nail. The average follow up period was five months. The nails were lengthened an average of 0.35 cm. The last follow up questionnaire showed that the patients were satisfied with their nail's appearance with an average score of 95.5 points. CONCLUSION: Nail lengthening using an eponychial flap is a convenient, safe and aestheticall pleasing procedure.

Clinical and Radiological Results of Revision Acetabular Arthroplasty using an Acetabular Roof Reinforcement Ring / 대한정형외과학회잡지

PURPOSE: We evaluated the clinical and radiological results of acetabular reconstructions using an acetabular roof reinforcement ring (ARR). MATERIALS AND METHODS: From May 1993 to November 1999, 18 hips revised with ARR were evaluated. The mean age at operation was 53 years. The average follow-up period was 51 months (24-94 months). Acetabular defects were classified based on the AAOS classification system. There was one case of type IIA defect, six cases of type IIB defect, ten cases of type III defect and one case of type IV defect. All were treated with morselized allografts and autografts, and three were reconstructed with additional structural autografts. RESULTS: The average Harris hip score improved from 54 preoperatively to 76 postoperatively, but five patients complained of intermittent hip pain. On the last follow-up radiographs, the bone grafts were united and remodeled in all cases, but only partial resorption was observed in two hips. We found evidence of osteolysis in four hips and observed cup migration in three hips. Three hips, in which Muller rings were used, were re-revised during the follow-up period. CONCLUSION: Acetabular reconstruction using ARR led to good clinical and radiological results, but a relative high rate of rerevision was shown in the cases fitted with the Muller ring. Appropriate ARR should be used depending on the extent of the acetabular defect.

Scoliosis in Children after Surgery for Congenital Heart Disease / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze natural history and clinical features of scoliosis developed after surgery for congenital heart disease and to investigate the influence of cardiac surgery on the onset and progression of scoliosis. MATERIALS AND METHODS: Three hundred and five patients who had been operated for congenital heart disease from Jan.1988 to Dec.1990 and followed up for more than 5 years were analyzed. The curve which was more than 10 degrees on radiography was defined as significant scoliosis and the patients with congenital spinal anomalies were excluded. We compared age at surgery, cardiac disease and effect of cyanosis between scoliosis and non-scoliosis group. Furthermore, in scoliosis group, prevalence, onset of significant scoliosis, and manifestation of curve according to side of thoracotomy were assessed. RESULTS: Fifty-six patients(18.4%) had scoliosis of more than 10 degrees. As for location, high thoracic in 19, thoracic in 23, double thoracic in 8, thoraco-lumbar in 5 and double major in 1. Of the 42 patients with thoracic or high thoracic curves, 17(40%) showed convexity to the left. The magnitudes of curves were less than 40 degrees except 1. There was no significant difference in prevalence(p=0.513) and Cobb angle(p=0.634) between cyanosis and acyanosis group. Scoliosis developed between 3 and 6 years after cardiac operation in 26 patients(46%). In high thoracic curve, 6 of 7 patients with left thoracotomy demonstrated convexity to the left and 5 of 6 patients with right thoracotomy demonstrated convexity to the right(p=0.026). CONCLUSIONS: The prevalence of scoliosis after surgery for congenital heart disease was 18.4%. High thoracic and left thoracic curves were more frequent compared to idiopathic curves and a half of them developed 3 to 6 years after cardiac surgery. Most patients did not have severe curve to need surgical intervention and there was no correlation between severity of scoliosis and age at cardiac operation and cyanosis. In high thoracic curve, the tendency for the curve to be convex to the side of cardiac approach was demonstrated.

Tactics for Surgical Treatment of the Double Thoracic Scoliosis: Significance of T1 tilt, first rib elevation and correction ratio / 대한척추외과학회지

STUDY DESIGN: A retrospective clinical and radiographic review. OBJECTIVES: The purpose of this study is to suggest the indications and more ideal objective amount of corrections of for upper and lower curves. SUMMARY OF LITERATURE REVIEW: There are many controversies exist about the diagnosis and treatment of double thoracic scoliosis yet. MATERIALS AND METHODS: Thirty-nine double thoracic scoliosis patients with left shoulder elevation and/or positive T1 tilt and an upper curve of 25 degrees or more were divided into two groups. Group I (24 patients) underwent fusion on both curves, and Group II (15 patients), on the lower curve alone. Cobb angles, T1 tilt, left first rib elevation (represents trapezial prominence), and shoulder level difference were measured from standing on pre- and post-operative standing films. The correction ratio [Upper curve correction(%)/Lower curve correction(%)] was used to represent describe how much the upper curve was had been corrected compared to versus the lower curve. RESULTS: T1 tilt did not correlate well with left shoulder elevation, but correlated with left first rib elevation. In Group I, T1 tilt and left first rib elevation improved significantly after fusion of the upper curve, whereas these were aggravated in Group II. In Group I, most of the patients with the a correction ratio of more than 0.8, showed balanced shoulder levels finally. CONCLUSIONS: In double thoracic scoliosis patients, T1 tilt and left first rib elevation should be considered in addition to not only left shoulder elevation and the rigidity of upper curve, but also the T1 tilt and left first rib elevation should be considered as the indication of the extension of fusion to upper curve. The amount of upper curve correction should be more than at least 80% of that of the lower curve for a balanced correction in the treatment of double thoracic scoliosis.

Tardy Paraplegia due to Myelomalacia in a Patient with Tuberculous Thoracic Kyphosis: A Case Report / 대한정형외과학회잡지

Many cases of tardy paraplegia after bony fusion have been reported among well-treated tuberculous spondylitis patients. In most cases, the cause of the paraplegia is known to be spinal cord compression caused by kyphosis, and in these patients cord decompression and kyphotic deformity correction have been commonly performed. A 44 year-old-male patient presenting with thoracic kyphosis and tardy paraplegia was admitted to our department. The cause of his paraplegia was considered to be a compression of the spinal cord by progressive kyphosis. The initial therapeutic plan involved decompression of the spinal cord and surgical correction of kyphotic deformity. However an MRI of the thoracic spine revealed a myelomalacia of the whole thoracic cord associated with severe cord atrophy. Myelomalacia is known to be an irreversible condition with no surgical remedy. Although this condition is very rare, an unnecessary decompressive surgical procedure may be performed if this possiblity is not considered. Because of its rarity and the importance of planning a therapeutic treatment modality, the authors report this case and include a review of the literature.

The Management of Bone Defects in Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Bone defects in revision TKA were classified according to AORI (Anderson Orthopedic Research Institute) system and results of the treatment are reported according to this classification. MATERIALS AND METHODS: The results of 24 revision TKAs operated from Mar. 1991 to Apr. 1999 were analysed. Fourteen knees had type 1 tibial defects, four knees had type 2 and six knees had type 3. On the femoral side, twelve knees had type 1, four knees had type 2 and seven knees had type 3 defects. Cement and chip bone grafts were mainly used to fill bone defects in type 1, wedges or blocks in type 2 and structural allograft combined with the other methods in type 3. Results were evaluated using the knee and functional scores of the American knee society. RESULTS: The analysis of the results according to the method of treatment- cement filling, chip bone graft, structural bone graft, wedge or blocks and custom made prosthesis- revealed improvements of knee scores in all groups except for custom made prosthesis. CONCLUSION: Satisfactory clinical results were obtained for the management of bone defects according to the AORI classification system in revision total knee arthroplasty.

Reconstruction of Proximal Femoral Bone Loss using Autogenous Unicortical Iliac Bone Plate in Revision Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Since 1995, we have reconstructed defects of the proximal femoral bone with the autogenous unicortical iliac bone by revision hip arthroplasty. We report the preliminary results of this method. MATERIALS AND METHODS: Among cases of revision hip arthroplasty reconstructed with autogenous unicortical iliac bone graft between March 1995 and December 1997, we studied 45 cases, which had been followed for more than 2 years. The loss of femoral bone was classified using AAOS classification. Twenty four cases belonged to level 1, segmental type and 21 cases belonged to level 1, segmental with level 2 cavitary type. We documented the healing process of grafted bone by simple radiography every 6 months and evaluated clinical results by Harris scoring. RESULTS: The average Harris score improved from 67.2 to 79.5. Radiological union was found at an average 4.5 months, and complete union at an average 19 months. There were 2 cases of loosening, 4 prolonged pain on the bone-harvested site, 3 trochanteric nonunion, one sciatic nerve palsy and one pulmonary embolism. CONCLUSION: Small sized defects of the proximal femur are reconstructed satisfactorily by using autogenous unicortical iliac bone graft in revision hip arthroplasty.

In Vitro Release of Vancomycin from Vancomycin-loaded Demineralized Bone Coated with Hematoma / 대한정형외과연구학회지

PURPOSE: This study was performed to find a method to utilize demineralized bone matrix as a vehicle for local delivery of the antibiotics for the treatment of chronic osteomyelitis. MATERIALS AND METHODS: Bovine bone blocks with the same size were randomly divided into 4 groups. Using Demineralization and hematoma coating, the different characteristics were given to each group, and Vancomycin was adsorbed to these bone blocks. We performed two identical experiments with Phosphate-buffered Saline and Fetal Bovine Serum as a solute. We exchange the solution with 24-hour interval for 6 weeks. The eluted concentrations of Vancomycin at each week were measured. RESULTS: Regardless of the solution used, the eluted concentration of Vancomycin was significantly higher in demineralized and hematoma-coated group than those of other groups. The eluted concentration of Vancomycin were 22.6ng/ml at week 6 in saline condition and 12.4ng/ml at week 5 in serum condition. CONCLUSIONS: We thought that demineralized and hematoma-coated cancellous bone can be used as a good vehicle for local antibiotics delivery.

Short Term Results of Cementless Revision Total Hip Arthroplasty using an Interlocking Femoral Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term results of cementless revision total hip arthroplasty using an interlocking femoral stem. MATERIALS AND METHODS: Between November 1997 and October 1999, 73 hips were revised using a cementless, proximally-coated, long femoral stem with distal holes for interlocking screw fixation (BiCONTACT(R)). Among them, 66 patients (68 hips) were followed both clinically and radiologically for at least two years. RESULTS: The average Harris hip score was 61 (range, 33-78) preoperatively, and this improved to 85 (range, 68-95) at the last follow-up. Mild thigh pain was present in 4 patients, but was not associated with loosening. Radiologically, significant subsidence (>5 mm) of the stem was noticed in no case. A radiolucent line wider than 2 mm was present in 1 hip (zones 4 and 5), but was not progressive. At the most recent follow-up, all stems were fixed by bony ingrowth and no visible osteolysis was detected. CONCLUSION: The short term results of revision total hip arthroplasty using an interlocking femoral stem (BiCONTACT(R)) were satisfactory.

The Prevalence of Shoulder Pain in Adults over 40 years old in Rural Area of Chonan City / 대한정형외과학회잡지

PURPOSE: To determine the prevalence of shoulder pain and pain degree in a population exceeding 40 years of age in a rural area of Chonan, Korea, and to correlate those data with other countries general population. MATERIALS AND METHODS: Two hundred and fifty three people (over 40 years old) who received a free medical examination. There were 93 men and 160 women with an average age of 65 years (range, 40 to 88 years). Patients were assessed in terms of pain degrees and shoulder function using the standard method of the Research Committee of American Shoulder and Elbow Surgeons (ASES). RESULTS: One hundred and ten (43%) people reported shoulder pain and 83 (33%) complained of night pain, Thirty-five percents (33/93) of men and 48% (77/160) of women had shoulder pain. Average pain degree was 2.1 (range: 0-10) in general, 1.6 (range: 0-10) in male and 2.5 (range: 0-10) in female for shoulder pain, respectively. CONCLUSION: Shoulder pain can occur in all age groups, however, more aggressive preventive and therapeutic programs should be considered in the elderly.

Extension of Necrotic Area by Recurrent Ischemic Episodes in Osteonecrosis of the Femoral Head: A Report of Three Cases / 대한정형외과학회잡지

We describe three cases of osteonecrosis of the femoral head (ONFH) in which the extent of necrosis increased after repeated episodes of ischemic attack. In all cases the evidence for two different ischemic attacks was clearly seen on MR images. The significance of the recurrent ischemic attacks is not clear yet but the detectable incidence of recurrence seems to be very low. We discuss the possibility that the increased extent of osteonecrosis may be the result of multiple ischemic attacks.

Scoliosis Associated with Marfan Syndrome / 대한척추외과학회지

OBJECTIVES: To evaluate characteristics and results of treatment of scoliosis associated with Marfan syndrome METHODS: The clinical data of 57 patients diagnosed as Marfan syndrome from January 1989 to June 1999 were reviewed. Thirty one patients had major curves more than 10 degrees by Cobb's method on whole spine standing film and their curve patterns and treatment methods were analyzed. Twelve cases of Marfan scoliosis who underwent posterior instrumented fusion were compared with randomly-sampled cases with idiopathic scoliosis about flexibility, correctability and correction loss of curves. RESULTS: Scoliosis was identified in 31 of 57 patients (54.4%) and among them 15 patients had the curve more than 40 degrees. Twelve curves were double major, 10 were thoracic, and 8 were double thoracic. Seventy-five per cent of the 57 patients had congenital heart disease and 40% had lens dislocation. Twelve of 31 cases underwent posterior fusion with pedicle screw instrumentation. Marfan scoliosis (mean flexibility; 39% in thoracic, 52% in lumbar) were significantly less flexible than idiopathic scoliosis (60% in thoracic, 93% in lumbar) (P0.05). Mean correction loss in Marfan syndrome was 3.2% at the mean 4.1 year follow-up in 9 cases. CONCLUSIONS: The prevalence of scoliosis in Marfan syndrome shows positive correlation with severity of the disease. As compared to idiopathic scoliosis, the curve associated with Marfan syndrome was larger and less flexible. After posterior fusion using pedicle screw instrumentation, the correctability of Marfan curve was poorer than that of idiopathic curve, which is, however, insignificant statistically. So it was considered to be a good method to treat Marfan scoliosis.

Gait Analysis after Total Knee Arthroplasty / 대한정형외과학회잡지

In order to identify the correlations between clinical results and quantitative data of gait analysis, we analyzed the results of 20 cases of total knee joint replacement arthroplasty in 15 patients with degenerative arthritis. We also evaluated the gait analysis of ten age-matched healthy candidates as a control group. Mean follow-up periods were 30 months. Clinical results included post-operative HSS (Hospital for Special Surgery) knee rating scores and the changes of the tibiofemoral angles. The three dimensional gait analysis included clinical assessment, video-taping, three dimensional kinematics and kinetics. The three dimensional kinematics were obtained using a 5 camera VICON system, and the three dimensional kinetic data was collected using two AMTI force plates. There was no statistical difference in linear parameters between the patient and control group. In patients group, however, double support time decreased as the HSS score increased, and range of knee motion and maximum knee flexion increased in accordance with the increase of pain score. Kinematic data of the patients group revealed that some parameters, such as knee flexion during loading response, knee flexion in swing phase, and knee varus during swing phase, were decreased. On the other hand, internal rotation of the knee from initial contact to initial swing was increased when compared with that of control group. There was no significant correlation between the degrees of tibiofemoral angle and coronal plane moment in the patients group. In three cases which showed mild varus instability post-operatively, knee flexion during loading response decreased and valgus moment in midstance increased as compared with the cases without instability. We believe that three dimensional gait analysis will be a good modality for evaluation of the results after total knee arthroplasty. With further accumulation of long term. follow-up data of gait analysis, we might be able to predict the long term results of total knee arthroplasty including possibility of loosening.

In Vivo reaction of the Highly Porous Glass Ceramics in the Rabbit Tibia: Radiological and Histological Analysis / 대한정형외과학회잡지

To evaluate the possibility of the newly developed highly porous glass ceramics as a space-filler in the cavitary bone defect, we made the opening sized 1 × 0.5 cm on the medial aspect of the right proximal tibia of nine rabbits. We impacted the highly porous glass ceramics firmly to the medullary cavity of rabbit tibia through the opening. Each three were sacrificed at 4th, 8th, and 12th week and analyze in vivo reaction of the glass ceramics in rabbit tibia with radiological and histological methods. On radiological examination, radiolucent line was seen around impacted glass ceramics at 4th week, but this radiolucent line was obliterated gradually to 12th week. On histological examination, new bone formation with osteoblast was appeared at 4th week without foreign body reactions. At 8th week, newly formed bone infiltrated into the porous space between glass ceramics particles was noticed, and the surface of glass ceramics was tightly bound by newly formed bone with osteoblastic rim and mature bone, At 12th week, the amount of newly formed mature bone increased, though there was on evidence of resorption of glass ceramics particle. So, we suggest that the highly porous glass ceramics is one of the possible artificial bone graft substitutes, especially as a space-filler.

A study on changes of the Vertebral Pedicles and Mechanical Strengths after Screw Insertion / 대한정형외과학회잡지

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.