Efficiency of Implant Removal for Treatment of the Thoraco-lumbar Unstable Fractures: Multi Segments Fixation, Single Segment Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion. SUMMARY OF LITERATURE REVIEW: There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture. MATERIALS AND METHODS: We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean follow-up was 21.3 months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants. RESULTS: Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1degrees, 18.5degrees and 62.0%, respectively, and, postoperatively, these were corrected by 9.0degrees, 9.3degrees and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4degrees(P=0.258) and 3.7degrees(P=0.000), 0.5%(P=0.756), and at the last follow-up, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9degrees on average at 6-months after the hardware removal. CONCLUSIONS: The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary.

Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients: Minimum 2-Years Follow-up Results

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. MATERIALS AND METHODS: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval's classification before the fracture and at last follow-up, and Harris's hip score at the last follow up. Radiological evaluation was done via the plain radiographs. RESULTS: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%), degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. CONCLUSION: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.

Injury to Soft Tissue Knee Structures in Patients with Tibia Plateau Fracture

PURPOSE: We wanted to analyze the incidence of soft tissue injury associated with fractures of the tibial plateau. MATERIALS AND METHODS: From November 2005 to December 2008, 36 patients with tibial plateau fractures were examined by radiologic studies. The fractures classified according to Schatzker's classification by using the plain radiographs and computed tomography, and then magnetic resonance imaging was done for assessing the accompanied injuries of the knee structure. RESULTS: For the 36 cases, accompanying lesions were observed in 30 cases (83.3%). Lateral meniscus damage was the most frequently associated damage, and this was observed in 17 cases (47.2%). Medial meniscus damage was found in 13 cases (36.1%). Anterior crucial ligament damage was found in 11 cases (30.6%). Posterior crucial ligament damage was found in 3 cases (8.3%). Medial collateral ligament damage was found in 16 cases (44.4%) and lateral collateral ligament was found in 8 cases (33.3%). CONCLUSION: Because soft tissue injury frequently accompanies tibial plateau fracture, MRI evaluation and proper management are necessary regardless of the severity of the fractures.

Comparison of Conventional and Digital Templating Technique in Total Hip Arthroplasty

PURPOSE: To examine the effectiveness of digital templating in patients who underwent primary total hip arthroplasty by comparing and analyzing the accuracy of acetate and digital templating. MATERIALS AND METHODS: One hundred and nine patients who underwent primary total hip arthroplasty between November 2002 and May 2006 were assigned to the acetate templating group (group I), and 113 patients between June 2006 and April 2009 were assigned to the digital templating group (group II). The sizes of the acetebular cup and femoral stem were examined to determine the accuracy of each method. RESULTS: In group I, acetabular cup accuracy was found in 46.8% of cases, and 94.5% showed a mismatch less than +/- 1 sizes. In the case of the femoral stem, accuracy was found in 53.2% and 92.7% showed a mismatch. In group II, acetebular cup accuracy was observed in 43.4% of cases, and 92.9% showed a mismatch below +/- 1 size. In femoral stem cases, 46.9% were accurate and 93.8% showed a mismatch. CONCLUSION: The accuracy of the digital templating method is equivalent to that of acetate templating, and should replace acetate templating before the operation.