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.

Reconstruction of the Medial Collateral Ligament for the Medial Instability after Primary Total Knee Arthroplasty: A Case Report / 대한정형외과학회잡지

An absence or compromise of the medial collateral ligament that occurs after primary total knee arthroplasty is a challenging reconstructive problem. Treatment usually requires unlinked-constrained total knee arthroplasty. Revision with unlinked-constrained prostheses often causes more bone loss and transmits increased stress to the bone-cement and prosthesis-cement interfaces, which can increase the risk of aseptic loosening. However, there are no treatment options other than constrained prostheses. We present a 47-year-old female who suffered from medial instability that occurred after total knee arthroplasty, which was treated successfully by a medial collateral ligament reconstruction.

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.

Analysis of the Relationship between Posterior Cruciate Ligament Preservation and Femoral Component Sizein Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: How PCL preservation affects the selection of femoral component size in total knee arthroplasty. MATERIALS AND METHODS: One hundred and fifty-seven patients, two-hundred and twenty-two knees, underwent total knee arthroplasties with Scorpio(R). One hundred and eighteen knees underwent PCL-preserving procedures, and one-hundred and four knees underwent PCL-substituting procedures. For minimization of error, we performed soft tissue balancing and then bone cutting by a Linker system with certain posterior slope (< or = 3 degrees). We compared the sizes of the femoral components between the PCL-preserving and PCL-substituting procedures in order to determine how flexion gap differences affect femoral component sizes (Wilcoxon signed rank test). RESULTS: With a certain minimal posterior slope (< or = 3 degrees), the PCL-preservation procedure led to selection of a 2.4 mm smaller femoral component than the PCL substituting procedure (p<0.05). CONCLUSION: Selection of femoral component size was affected by PCL preservation, and the size of the femoral component was decreased in the PCL preservation group.

Osteochondromas of the Bilateral Tali / 대한족부족관절학회지

Benign and malignant tumors are found in the foot, although the incidence is low. The most common bone tumor in the foot is osteochondroma, which is thought to develop in bones that form through the process of enchondral ossification. In particularly, osteochondromas in the foot mostly occur in metatarsal bones and phalanges. It is seldom found in talus. It is usually confused with osteophyte or enthesis. We report an osteochondroma case confirmed by roentgenographical and pathological investigation, after removing the masses form bilateral tali of a 19-year-old male patient presented with bilateral ankle joint pain for three years.

Analysis of the Need and Predictive Factors for Allotransfusion in Autotransfused TKA & Non-Autotransfused TKA

PURPOSE: Authors attempted to evaluate the efficacy of autotransfusion and analyzed the relationship between patient 's factors and need for postoperative allo-blood transfusion in total knee arthroplasty(TKA). MATERIALS AND METHODS: Retrospective analysis of 214 patients (Group A - unilateral TKA without autotransfusion, 103; Group B - unilateral TKA with autotransfusion, 111) was conducted. We tried to transfuse allogeneic blood to patients whose hemoglobin fell below 9g/dL or vital sign was unstable on postoperative day 1. The requirement of allogeneic blood for each group was compared and the relationship between patient 's factors and postoperative allo-transfusion was analyzed with multivariate logistic regression analysis. RESULTS: Only 12.6% of patients in Group B required allogeneic blood transfusion compared with 23.3% in group A after TKA. Multivariate analysis identified significant predictive factors of the need for banked blood transfusion; preoperative hemoglobin levels and usage of autotransfusion instrument. CONCLUSION: Use of allogeneic blood replacement in the group using autotransfusion instrument decreased significantly compared with the group that did not use autotransfusion. The factors associated with reducing the need for postoperative blood transfusion were usage of autotransfusion instrument and high preoperative hemoglobin levels in TKA.

Discoid Lateral Meniscus in Children: Analysis of the Clinical Manifestations in relation to the Shape of the Discoid Lateral Meniscus / 대한정형외과학회잡지

PURPOSE: The clinical manifestations of discoid meniscus in children are usually different from those in adults. We attempted to find the relationship between the clinical symptoms and shape of discoid meniscus in children. MATERIALS AND METHODS: Thirty-one children, ranging from 5 to 17 years of age, with 32 discoid lateral menisci that underwent arthroscopic examination and MRI study were included. The clinical symtoms were reviewed by medical records. MR images were reviewed for the presence of meniscal tear and Wrisberg ligament, etc. Also, the absolute and relative thickness in anterior, posterior, mid-medial and mid-lateral portions were measured. The shape of the menisci were classified by the modified Hall's scheme. RESULT: The two most frequent complaints were pain (21 cases, 66.6%) and extension block (23 cases, 72.9%) . In 18 cases without surface tear, the most frequent clinical findings were extension block (14 cases, 78.8%) . The shape of the menisci correlated with the extension block. The mean thickness of the anterior portion of discoid lateral meniscus (7.12mm) in extension block (+) group was significantly larger than that (4.01mm) of the extension block (-) group (P=0.019) . The extension block was significantly higher in anterior asymmetric type (3/3) and slab type (19/21) than posterior asymmetric type (2/8) (P=0.003) . CONCLUSION: The main clinical symptoms in children with discoid meniscus were pain and extension block. The extension block seemed to strongly correlate with the shape of the meniscus. The thickness of the anterior portion of the discoid lateral meniscus is also considered a related mechanical factor that determines knee extension.

Instability Patterns of Normal Midcarpal and Radiocarpal Joint in the Sagittal Plane / 대한정형외과학회잡지

The midcarpal joint has inherent instability in the sagittal plane. Several instability patterns of midcarpal joint due to ligament insufficiency have been presented. We ohserved the normal midcarpal and radiocarpal behaviors of ligament laxity in the sagittal plane to investigate the significance of dorsal and palmar stress test which has been used for evaluation of the non-dissociative carpal instahilities. We performed the dorsal and palmar displacement stress test on fifty pairs of normal wrist joints under the flouroscopic views. The midcarpal joints were subluxed, more on dorsal stress, with variable degrees. Dorsal subluxations in females and third decades were more prominent than males and fourth decades. Three types of radiocarpal instability on dorsal stress test could be observed. We think that displacement stress test in the sagittal plane should be interpreted in consideration of normal instability patterns in the evaluation of ahnormal midcarpal and radiocarpal instabilities since there are variable patterns and degrees of ligament laxity in normal wrist joints.