Insufficiency Fracture of Olecranon after Total Elbow Replacement Arthroplasty in Rheumatoid Arthritis: Report of Three Cases / 대한정형외과학회잡지

Osteoporosis due to the rheumatoid arthritis and the glucocorticoid therapy predisposes patients to insufficiency fractures. Insufficiency fractures or periprosthetic fractures of the lower extremity in the rheumatoid arthritis have been frequently reported. But those of the upper extremity were rarely reported. We report three cases of the insufficiency fracture of the olecranon after total elbow replacement arthroplasty in patients with the rheumatoid arthritis. All the cases were successfully treated by immobilization for 3 weeks. At the last follow-up, there were no functional impairments or residual symptoms caused by the fractures.

Total Wrist Arthrodesis with the Sauve-Kapandji Procedure in the Rheumatoid Arthritis / 대한정형외과학회잡지

PURPOSE: To evaluate the functional results of total wrist arthrodesis with the Sauve-Kapandji procedure in the rheumatoid arthritis. MATERIALS AND METHODS: The clinical results of twenty wrists of 17 patients who underwent total wrist arthrodesis with the Sauve-Kapandji procedure for the treatment of the rheumatoid arthritis during the period of February 1996 to May 2003 were analyzed. The patients who were observed for more than 12 months postoperatively were chosen as subjects and the mean follow-up period was 42 months (range, 13 to 100 months). At last follow-up, radiological and functional evaluation were done. For the functional evaluation, the standard patient review questions of Weiss et al. and the Buck-Gramcko/Lohmann score were used. RESULTS: The mean time to clinical fusion of the wrist was 6 weeks. The postoperative range of motion is pronation 68degrees, supination 71degrees. The standard patient review questions of Weiss et al. revealed that 17 cases 85%) were satisfied with the functional results of the procedure. 16 cases (80%) wished that the procedure had been done earlier. The standard patient review questions also showed that maximum improvement in function after the procedure required an average of 6 months (range, 1 to 30 months). On a scale of 1 to 10, the mean score of the subjective overall functional evaluation by the patients was 8.25 points range, 5-10 points). The mean Buck-Gramcko/Lohmann score for the objective functional evaluation was 8.7 points (range, 1-10 points) out of 10 points, corresponding to good result. CONCLUSION: For the treatment of the advanced rheumatoid arthritis of wrist involving radio-carpal, midcarpal, and distal radio-ulnar joint, total wrist arthrodesis with the Sauve-Kapandji procedure was a reliable treatment method. These procedures offer satisfactory subjective and objective functions with few complications.

Lateral Approach for Internal Fixation of the Distal Humeral Shaft Fractures

PURPOSE: To investigate the efficacy and advantages of the lateral approach for internal fixation of the distal humeral shaft fractures. MATERIALS AND METHODS: Twelve patients with distal humeral shaft fractures who underwent open reduction and internal fixation using plate and screws by lateral approach from January, 1997 to May, 2002 were investigated. Postoperative results after a minimum 1 year follow-up were assessed using union rate, elapsed time to union, postoperative complications such as iatrogenic radial nerve palsy, range of motion of the elbow joint. Clinical outcomes were evaluated with Mayo elbow performance scoring system. RESULTS: Union was achieved in all cases. The average time to union was 9 weeks (range, 7~12 weeks). Four cases of preoperative radial nerve palsy were revealed as contusion of the intact nerve and resolved completely by three months. The mean elbow range of motion was from 5 to 138 degrees. The average Mayo elbow performance score was 91 points; 9 cases ranked as excellent and 3 as good. CONCLUSION: Distal humeral shaft fractures can be treated successfully through open reduction and internal fixation using plate and screws. Lateral approach is recommended to stabilize distal humeral shaft fractures without compromising the range of motion of the elbow, and to protect or explore the injured radial nerves easily