A Novel Medial Soft Tissue Release Method for Varus Deformity during Total Knee Arthroplasty: Femoral Origin Release of the Medial Collateral Ligament

INTRODUCTION: Numerous methods of medial soft tissue release for severe varus deformity during total knee arthroplasty (TKA) have been reported. These include tibial stripping of the superficial medial collateral ligament (MCL), pie-crusting technique, and medial epicondylar osteotomy. However, there are inherent disadvantages in these techniques. Authors hereby present a novel quantitative method: femoral origin release of the medial collateral ligament (FORM). SURGICAL TECHNIQUE: For medial tightness remaining even after the release of the deep MCL and semimembranosus, the FORM is initiated with identification of the femoral insertion area of the MCL with the knee in flexion. Starting from the most posterior part of the femoral insertion, one third of the MCL femoral insertion is released from its attachment. If necessary, further sequential medial release is performed. MATERIALS AND METHODS: Seventeen knees that underwent the FORM were evaluated for radiological and clinical outcomes. RESULTS: Regardless of the extent of the FORM, no knees showed residual valgus instability at 24 weeks after surgery. CONCLUSIONS: As the FORM is performed in a stepwise manner, fine adjustment during medial release might be beneficial to prevent inadvertent over-release of the medial structures of the knee.

Usefulness of the Biochemical Markers in the Elderly Hip Fracture Patients / 대한정형외과연구학회지

PURPOSE: The authors evaluated the usefulness of the biochemical markers in the elderly hip fracture patients. MATERIALS AND METHODS: Eighty-two hip fractures above 65 years old were enrolled in this study. Serum level of C-telopeptide, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, calcium were checked and bone mineral density was assessed by DXA. RESULTS: 83% vitamin D deficiency and 43% calcium insufficiency were observed. There were statistically significance between C-telopeptide and osteocalcin, calcium and 25-hydroxyvitamin D, and calcium and DXA results in the Chi-Square test. Spearmann correlation coefficient results showed that there were statically significant correlations between C-telopeptide and osteocalcin, calcium and DXA results. In the multiple logistic regression analysis results, calcium had the statically significant correlations with DXA results. CONCLUSION: There was correlation between bone turnover markers and vitamin D deficiency, and calcium insufficiency was observed in the elderly hip fracture patients.

Usefulness of the Biochemical Markers in the Elderly Hip Fracture Patients / 대한정형외과연구학회지

PURPOSE: The authors evaluated the usefulness of the biochemical markers in the elderly hip fracture patients. MATERIALS AND METHODS: Eighty-two hip fractures above 65 years old were enrolled in this study. Serum level of C-telopeptide, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, calcium were checked and bone mineral density was assessed by DXA. RESULTS: 83% vitamin D deficiency and 43% calcium insufficiency were observed. There were statistically significance between C-telopeptide and osteocalcin, calcium and 25-hydroxyvitamin D, and calcium and DXA results in the Chi-Square test. Spearmann correlation coefficient results showed that there were statically significant correlations between C-telopeptide and osteocalcin, calcium and DXA results. In the multiple logistic regression analysis results, calcium had the statically significant correlations with DXA results. CONCLUSION: There was correlation between bone turnover markers and vitamin D deficiency, and calcium insufficiency was observed in the elderly hip fracture patients.

The Usefulness of Intraoperative Radiography for Prevention of Malalignment of the Cemented Femoral Stem / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment. MATERIALS AND METHODS: A total of 103 hips were enrolled in this study. All patients underwentprimary hip arthroplasty from October 2011 to February 2013. The study was conductedretrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) thatmight affect intraoperatively estimated femoral stem alignment. RESULTS: The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment. CONCLUSION: Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment.

Inferior alveolar nerve injury following removal of mandibular third molar and panoramic radiological risk sign

The effect of PRP and fibrin sealant with the deprotenized bovine bone in the rabbit cranium

PURPOSE: The purpose of this study is to evaluation of effect on bone formation of PRP and fibrin sealant with deproteinized bovine bone(Bio-Oss) grafts on rabbit cranial defect. MATERIAL AND METHODS: Twelve rabbits were used as experimental animal Two equal 9mm diameter cranial bone defects were created in each rabbit and immediately grafted with Bio-Oss only, Bio-Oss and PRP, and Bio-Oss and Fibrin sealant. Rabbits were sacrificed at 4 and 8 week. The defects were evaluated by histomorphometric analysis. Results: Kruskal-Wallis tests were performed comparing new bone formation via histomorphometric analysis. No statistically significant difference of new bone formation was found between Bio-Oss only, Bio-Oss and PRP, and Bio-Oss and fibrin sealant at 4 and 8 weeks (P>0.05). CONCLUSION: This study fails to find a stimulatory effect of PRP and Fibrin sealant on New bone formation of Bio-Oss grafts by histomorphometric analyses.

A study of bone resorption at the posterior border of distal segment after bilateral sagittal split ramus osteotomy of manibular prognathic patients

PURPOSE: This study is to predict the changes of the distal segment by investing the resorption of the excessive distal segment regarding the amount of setback after BSSRO. MATERIAL AND METHODS: 20 patients with Mandible prognathism treated by Obwegeser-Dal Pont method during the years 2000 to 2002 were selected for this study. Group A consisted of 5 males and 5 females with a setback amount of 10mm and above(Mean 10.80mm+/-1.03, n=20) and Group B consisted of 2 males and 8 females with a setback amount of below 10mm.(Mean 6.10mm+/-1.10, n=20) Panorama X-ray was taken at day 1, 1month, 3months, 6months, and 12months after the surgery. Resorption areas of excessive distal segment were measured on these panorama X-rays and compared. RESULTS: There was bone resorption in both groups. Group A showed more bone resorption than Group B. Group B showed slightly higher resorption rate than Group A. However, there was no statistically significant difference between the resorption rates of Group A and Group B. (P>0.05) CONCLUSION: More bone resorption occurred with a larger amount of setback and about one third of the excessive distal segment underwent resorption, irrespective of the amount of setback.

The Pupillary Dilatation Effect of Phenylephrine 2.5% Versus 10% in Patients with Diabetes

We assessed the degree of mydriasis induced by 1% tropicamide and 2.5% phenylephrine compared with that induced by 1% tropicamide and 10% phenylephrine in 100 patients with diabetes. Additionally we studied the difference of pupillary dilatation according to duration of dibetes, severity of retinopathy, and performance of photocoagulation. Maximum dilated pupillary diameter was 7.25+/-1.27mm in 2.5% phenylephrine group and 7.32+/-1.36mm in 10% phenylephrine group, respectively the difference in pupillary dilatation between two groups was not statistically significant. We advise the use of the 2.5% phenylephrine in patients with diabetes, who already exhibit a higher prevalence of vascular disease and autonomic nerve system dysfunction because 2.5% phenylephrine may produce a lower incidence of side effects than 10% concentration and have the same effect of pupil dilatation as 10% phenylephrine.

Clinical Feature and Factors of Operative Result on Infantile Esotropia

We present the retrospective study to identify the clinical characteristics and the results of surgical correction for 50 patients with diagnosis of infantile esotropia at Soonchunhyang Chunan University Hospital from January 1990 to August 1994. The following results were obtained. Of 50 patients, 29(58%) patients were male and 21(42%)patients were female. Initial visit was most common between age of 2 and 3 years. 14% of patients were seen at age of 2 years or less. Average initial visit was 5.16 years. Esotropia was noted most commonly 2 to 4 month after birth in 23 patients(46%). Preoperative deviation angle was over 30PD in 88% of patients, and preoperative cycloplegic refraction showed +2.0D-O in 62%. The prevalence of associated findings such as amblyopia, dissociated vertical deviation(DVD), inferior oblique muscle overaction, and nystagmus were 32%, 14%, 38%, 4% by sequence. Surgical correction was performed before age of 2 year if noted at initial visit. The average age of surgical correction was 5.42 years. Bilateral medial rectus muscle recessions were performed in 30%, Unilateral resection and recession were performed in 35 patients(70%), Orthophoria(within +10 prism diopters) was achieved in 58% of the patients postoperatively. In 16% of patients residual esotropia of more than 20PD remained, which required further operation. These patients had average preoparative esotropia of 51PD and amblopia and inferior oblique overaction were seen in 87.5% preoperatively. We found that the two variables of amblyopia and inferior oblique muscle overaction lead to less satisfactory outcomes(P<0.01). Since amblyopia and inferior oblique muscle overaciton were seen more commonly in those patients that required reoperation. The average follow up time was 9.4 months.