Antegrade Intramedullary Prebent K-wire Fixation for the 5th Metacarpal Neck Fracture

PURPOSE: To evaluate radiological and clinical results of the antegrade intramedullary prebent K-wire fixation for the 5th metacarpal neck fracture. MATERIALS AND METHODS: Between January, 2006 and December, 2009, 31 patients with displaced neck fracture of the fifth metacarpal who received antegrade intramedullary prebent K-wire fixation were included in this study. Radiological and clinical outcome evaluations were performed. RESULTS: All the fractures were completely united. In the oblique radiographs, the average of preoperative angulation was corrected from 38.9degrees to 4.4degrees. The average difference between postoperative and final follow-up was 1.2degrees. Clinical outcomes were satisfactory except for one patient who had sustained ulnar nerve dorsal branch injury during surgery. CONCLUSION: Antegrade intramedullary prebent K-wire fixation may be preferentially considered as one of the best ways to fix the displaced neck fractures of the fifth metacarpal.

Open Synovectomy in Diffuse Pigmented Villonodular Synovitis of Ankle Joint: A Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. PVNS occurs in two types: localized and diffuse. Localized type is characterized by focal involvement of the synovium with either nodular or pedunculated masses, Diffuse type affects virtually the entire synovium. Diffuse type has reported more recurrence rate. We have experienced a patient who has diffuse type PVNS of ankle joint and report an optimal method of surgical treatment.

Loss of Distal Femur Combined with Popliteal Artery Occlusion: Reconstructive Arthroplasty Using Modular Segmental Endoprosthesis: A Case Report

Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.

Fixation of Pipkin Fractures with Acutrak Screws: A Report of Three Cases

Femoral head fracture with posterior dislocation of the hip occurs relatively infrequently. Many treatment options exist for this condition. The fracture fragments of the femoral head can be internally fixed or removed depending on the severity of fracture comminution, fragment size, and location on the weight-bearing surface of the femoral head. In Pipkin type I and II fractures, the fragments are typically located anteriorly. Hence, it is important to strongly fix the fracture fragments to the femoral head rather than to excise them, in the interest of securing a better outcome. Even if the fragments are caudal to the fovea centralis, the discarding of large portions of the femoral head that are amenable to rigid fixation is not preferred. Three femoral head fractures were treated using Acutrak screws incorporated with a self-compression mechanism. We report the results and consider ways to use Acutrak screws.

Popliteal Artery Occlusion after Total Knee Replacement Arthroplasty: A Case Report

The injury of popliteal artery in association with a total knee arthroplasty is rare with the incidence reported 0.03% to 0.05%, but the result of popliteal artery occlusion is extremely poor. Preexisting peripheral arterial disease, flexion deformity, tourniquet use, inadequate procedure during TKA, close proximity of popliteal artery to posterior cortex of tibia plateau, all of these are likely to increase the risk of the injury of popliteal artery during a knee replacement operation. We have experienced a patient who developed an arterial complication in association with a total knee arthroplasty and report the treatment as well as the discussion about the mechanisms of injury of popliteal artery.

Clinical and Radiological Findings of Foraminal Disc Herniation / 대한척추외과학회지

STUDY DESIGN: Retrospective study of clinical experiences. OBJECTIVES: The correct discrimination of a compressed root is very important for proper decompression. With a foraminal disc herniation, the cephalad root is compressed. The diagnostic importance of the clinical and radiological findings was investigated. SUMMARY OF LITERATURE REVIEW: A compressed root, due to a herniated disc, is known as a caudal root (i. e. L5 root compressed by L4-5 disc herniation). In some cases, a prolapsed disc may compress the cephalad root, resulting in a difficult diagnosis. MATERIAL AND METHOD: The medical records, plain X-ray and MRI of 17 patients were reviewed, and the physical examination and MRI findings were carefully evaluated to retrospectively document the efficacy of the diagnoses. Every MRI image of each patient was graded according to the 4 point ranking system of diagnostic efficacy devised by the authors. The clinical outcomes and postoperative complications were also investigated. RESULTS: Ten, 5 and 2 of the 17 patients had L4-5, L5-S1 and L3-4 foraminal disc herniations, respectively. Eight of 10 L4-5 cases showed a positive femoral nerve stretching test. The knee jerk reflex was diminished in 7 patients, with bilateral hyporeflexia in the other 3. The body-cut axial MRI image was the most effective, and the coronal images were also very helpful, whereas the routine axial images were of least value. Most cases achieved a satisfactory clinical result. CONCLUSIONS: Foraminal disc herniations seem to be reasonably common. For the accurate discrimination of a compressed root, a thorough physical examination seems to be very important. When MRI is performed for these cases, in addition to routine studies, the body-cut axial and coronal MRI images are effective and useful, and their use is strongly recommended.

Comparison of Treating Tibial Nonunion with Bone and Soft Tissue Defect: Ilizarov Only Versus Free Flap and Ilizarov / 대한정형외과학회잡지

PURPOSE: To statistically analyze the advantages of distraction osteogenesis in combination with free flap in the treatment of tibial open fracture with bone and soft tissue defect. MATERIALS AND METHODS: Twenty patients with tibial open fracture with bone and soft tissue defect were treated by distraction osteogenesis with or without flap. Patients were followed up for a minimum of 12 months and retrospectively analyzed, for the admission period, the out patient follow-up period, and the intravenous antibiotic period, and distraction consolidation indices were determined. RESULTS: Those treated with free flap showed statistically significance shorter antibiotic period, admission period, and distraction consolidation indices. CONCLUSION: Free flap and distraction osteogenesis with an Ilizarov external fixator has many advantages for treating tibial open fracture with bone and soft tissue defect.