Prognostic Factors and Clinical Outcomes after Treatment of Periprosthetic Femoral Fractures Using a Cable-plate / 대한고관절학회지

PURPOSE: To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct. MATERIALS AND METHODS: A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12–58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed. RESULTS: At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12–24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II. CONCLUSION: The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.

Correlation between Optic Disc Tomography and Frequency Doubling Technology in Glaucoma Suspect

PURPOSE: To evaluate the relationship between results obtained by Heidelberg Retina Tomography (HRT) and frequency-doubling technology (FDT) in glaucoma suspect. METHODS: A total of 24 patients with glaucoma suspect were included in this study. Each subject underwent 2 visual field tests (Humphrey central 30-2 and FDT N-30), a comprehensive ophthalmic examination, and HRT upon each eye. RESULTS: A comparison of FDT global indices with the parameters of HRT, MD and PSD of FDT showed no correlation with HRT parameters. However, there was a significant correlation between the number of abnormal points in FDT and the following HRT parameters cup-disc area ratio, rim volume, mean nerve fiber layer thickness, retinal nerve fiber layer cross sectional area, and classification (p<0.05). When comparing the group having two or less abnormal points by FDT to the group having three or more abnormal points by FDT, differences were found in the following HRT parameters disc area, cup-disc area ratio, rim volume, cup shape measure, mean nerve fiber layer thickness, nerve fiber layer cross sectional area, and classification (p<0.05). CONCLUSIONS: Significant correlations were found between the number of abnormal points in FDT and HRT parameters. We believe that the correlations between the results of FDT and HRT parameters in preperimetric glaucoma with normal achromatic visual field suggest that FDT may be used for early diagnosis in patients with glaucoma.

Availability of Optical Coherence Tomography in Diagnosis and Classification of Choroidal Neovascularization

PURPOSE: The author used optical coherence tomography (OCT) in the identification and classification of choroidal neovascularization to evaluate the potential of this imaging technique for better defining choroidal neovascularization. METHODS: Optical coherence tomography was performed on 20 eyes of 20 patients with the clinical diagnosis of choroidal neovascularization. Its result was compared with fluorescein angiography and indocyanine green angiography RESULTS: Of the 20 eyes, 6 eyes (30%) were identified as classic choroidal neovascularization on fluorescein angiography. Of the 6 eyes, 5 cases were identified as well-demarcated choroidal neovascularization on indocyanine green angiography and optical coherence tomography. One case was identified as fibrovascular pigment epithelial detachment on optical coherence tomograpphy. Of the 13 eyes identified as occult choroidal neovascularization on fluorescein angiography, 6 eyes were identified as well-demarcated choroidal neovascularization on indocyanine green angiography and 7 eyes were identified as well-demarcated choroidal neovascularization on optical coherence tomography. Of the 20 eyes identified as choroidal neovascularization on fluorescein angiography, 3 eyes were missed as choroidal neovascularization on optical coherence tomography. Optical coherence tomography was useful to identify the position and the size of choroidal neovascularization. CONCLUSIONS: OCT was able to distinguish the cross-sectional morphology of various lesions accompanying choroidal neovascularization. This study suggests that OCT may have potential in diagnosing and managing choroidal neovascularization.