The Treatment of Subtrochanteric Fracture with Cephallomedually Nail: Minimal Incision and Lowman Clamp Assisted Reduction

PURPOSE: To evaluate the radiographic results of patients with subtrochanteric femoral fracture using minimal incision and cephalomedullary nail technique. MATERIALS AND METHODS: This study was performed on 54 patients, 54 cases of hip, recruited among patients who underwent minimal incision and Cephalomedullary nail from September 2005 to August 2008 and were available for 1-year or longer follow up. The gender ratio was 37 males and 17 females, and the mean age at the time of surgery was 57.4 years (range; 16~81 years). According to injury mechanism, traffic accident was 29 cases, fall down form high height was 18 cases, slip down was 7 cases. In classification by Seinsheimer, type II was 23 cases (m/c), type III was 18 cases, type IV was 13 cases. Average follow up period was 14 months (12~18). Radiographic evaluation was performed for time taking union, mal-union and complication. RESULTS: 53 of the 54 cases united. 39 of 54 reductions were anatomic. 19 fractures had a monir varus deformity of proximal fragment (between 2degrees and 5degrees). There was no varus deformity of more than 5degrees. 1 case that had been treated with PFN had nail breakage without trauma. There were no other complications. CONCLUSION: Surgical treatment of subtrochanteric fractures with minimal incision and Cephalomedullary nail technique can reslut in excellent reduction without complications including inflammation & malunion. Careful attention to detail for using Lowman clamp is demanding to decrease soft tissue injury.

Arthroscopic Repair of Combined Rotator Cuff Tears Involving the Subscapularis Tendon / 대한정형외과학회잡지

PURPOSE: Subscapularis tendon tears associated with supraspinatus tendon tears are often found during rotator cuff repair. However, there have been only a few reports about both subscapularis and rotator cuff repair. The authors conducted arthroscopic repair for cuff tear associated with subscapularis tendon tear and assessed its outcomes. MATERIALS AND METHODS: We evaluated 320 cases of arthroscopic repair following rotator cuff tear between June 2006 and January 2009 at Gil Medical Center. Out of 66 cases (21%) associated with subscapularis tear, forty cases of bone to tendon repair using suture anchor were selected except for 26 cases of tendon to tendon repair. Clinical outcomes of 25 cases followed up for over a year were finally assessed. Clinical outcomes were evaluated using the following measures: range of shoulder motion, muscle strength, belly press test, Visual Analogue Scale (VAS) on pain, and University of California Los Angeles (UCLA) score. RESULTS: The average VAS pain scale improved from 5.3 preoperatively to 1.4 postoperatively. Internal rotation strength increased from its preoperative level, 4.1 to 4.2 in postoperative 6 months and to 4.6 at last follow-up. Range of internal rotation increased from the second lumbar level at postoperative 6 months to the 11th thoracic level at last follow-up. UCLA score had significantly improved from 17.4 to 30.8 (p<0.05). CONCLUSION: It is recommended that concurrent repair of the subscapularis tendon during rotator cuff repair for a satisfactory treatment result.