Debridement Arthroplasty for Post-traumatic Stiff Elbow: Intraoperative Factors Affecting the Clinical Results of Surgical Treatment

BACKGROUND: This study evaluated the outcomes of debridement arthroplasty for stiff elbows, as well as the factors affecting clinical outcomes after surgical treatment. METHODS: Eighteen patients with post-traumatic stiff elbows were treated with debridement arthroplasty using a posterior approach. The mean patient age was 33 years (range, 16 to 59 years), and the average follow-up period was 59 months (range, 24 to 141 months). The patient's ability to perform activities of daily living, including combing their hair, feeding themselves, performing hygiene, and putting on shirt and shoes, were evaluated using the Mayo Elbow Performance Score. RESULTS: At the last follow-up, 16 elbows had painless motion. Two patients continued to complain of mild intermittent pain. The flexion and extension improved to 121degrees and 10degrees after surgery, respectively, indicating an average 34degrees increase in elbow flexion range and an average 25degrees increase in elbow extension range (p < 0.001, p < 0.001). The Mayo Elbow Performance Score at the last follow-up was excellent in nine elbows (50%) and good in nine elbows (50%). CONCLUSIONS: Debridement arthroplasty is a predictable procedure for the treatment of intractable stiff elbow, provided that the elbow is stable and congruous.

Clinical Outcome of Shoulder Replacement in Non-Traumatic Arthritis: A Comparison of Hemiarthroplasty and Total Shoulder Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes and complications of hemiarthroplasty (HHR) and total shoulder arthroplasty (TSR) in non-traumatic arthritis patients. MATERIALS AND METHODS: Thirty-two patients (34 shoulders) underwent shoulder arthroplasty for nontraumatic shoulder arthropathy. There were sixteen patients with rheumatoid arthritis, nine with osteoarthritis, four with avascular necrosis and etc. HHR was performed in eleven shoulders and TSR in twentythree shoulders. RESULTS: In HHR, the pain score decreased from preoperatively 7.09 to 0.91 postoperatively. The mean forward elevation was 137degrees and the mean external rotation at the side and abduction were 55degrees and 131degrees, respectively. The mean ASES score was 82.4. In TSR, the pain score decreased from 7.04 preoperatively to 1.17 postoperatively. The mean forward elevation, external rotation at the side and abduction were 132degrees, 44degrees, and 132degrees, respectively. The mean ASES score was 81.2. In rheumatoid arthritis, the mean ASES score of the HHR and TSR were 77.8 and 78.1, respectively. In osteoarthritis, the mean ASES score was 84.7 and 90.8, respectively. During the follow up, glenoid erosion was observed in three HHR cases, and glenoid loosening in two TSR case. CONCLUSION: HHR and TSR produced similar results in terms of the functional improvement. The clinical results were much better in patients with osteoarthritis than in those with rheumatoid arthritis, and TSR was performed on most cases of rheumatoid arthritis.

Isolated SLAP Lesions of the Shoulder: Surgical Treatment and Outcome / 대한정형외과학회잡지

PURPOSE: To analyze the general characteristics of isolated SLAP (superior labrum anterior to posterior) lesions of shoulder and to evaluate efficacy of arthroscopic treatment. MATERIALS AND METHODS: We retrospectively reviewed 43 athletic patients with 46 isolated SLAP lesions. The mean follow-up period was 21 months, and mean patient age was 25 years. Twenty seven patients presented with injury to the dominant shoulder, and 3 had bilateral involvement. RESULTS: Pain and clicking were the most common symptoms. The mechanism of injury was assumed to be chafing in 27 cases, compression in 9 cases. Type 2 lesion was commonest (30 cases). The single most sensitive test was the compression-rotation test, which was positive in 92% of patients. The average UCLA score at the last follow-up was 31.6 points; 18 cases ranked as excellent and 21 as good.Postoperative performance data was obtained for in 27 athletes, 19 were able to return to their sports. CONCLUSION: Arthroscopic surgery for an isolated SLAP lesion resulted in 85% of patients being rated good or above, and 70% of athletic patients were able to resume sporting activity.

Total Knee Arthroplasty in Complete or Partial Ankylosed Knee

PURPOSE: The purpose of this study is to analyse clinical and radiologic results of total knee arthroplasty in complete or partial ankylosed knee. MATERIALS AND METHODS: From July 1986 to August 1996, total knee arthroplasties were performed in 37 ankylosed knees. Of these, five patients were lost to follow-up. Thirty two patients were evaluated. The average follow up period was 5 years 2 months (2 years-11 years 10month). Average age of patients at the time of total knee arthroplasty was 40.4 years (20~63 years). There were seven men and twenty five women. Twenty patients had complete ankylosis and twelve patients had partial ankylosis. Quadriceps tendon was lengthened with the method of modified V-Y advancement technique in 10 cases. Tibial tubercle was proximally transferred in 3 cases. RESULTS: The postoperative average range of motion was 75.3 degrees (30 degrees - 115 degrees) in complete ankylosis, 98.7 degrees (60 degrees -130 degrees) in partial ankylosis. The average HSS knee score improved from 56.8 points preoperatively to 85.6 points postoperatively. Radiolucent line was observed in two knees with less than 2mm width in 3 years and 4 years postoperatively, but the patient had no pain. CONCLUSION: In patient selection, healthy extensor mechanism and adequate soft tissue condition are most important. With meticulous surgical technique and aggressive rehabilitation, patients can obtain reasonable restoration of function in ankylosed knee after total knee arthroplasty.

Fixation with Bioabsorbable Polylactide Screws for the Treatment of the Ankle Fractures with Syndesmotic Injuries / 대한정형외과학회잡지

PURPOSE: The purpose of this article is to show the efficacy of a bioabsorbable polylactide (PLA) screw for treating syndesmotic injuries of ankle fractures. MATERIALS AND METHODS: Ten patients who underwent an open reduction and internal fixation operation for ankle fractures that had syndesmotic injuries from Dec. 1992 to Feb. 1997 were enrolled into the study. There were 6 men and 4 women. The average age of the patients was 42.6 years and the average follow-up period was 2 years 7 months. The cases were analyzed by clinical and radiological findings at the time of their last follow-up evaluation. RESULTS: According to the clinical results, there was statistically no significant difference between finding an average of 15.8 degrees of dorsiflexion and 45.8 degrees of plantar flexion of the ankle on the affected side of the individuals and that of 17.8 degrees of dorsiflexion and 48.5 degrees of plantar flexion on their normal contralateral side. Upon radiological analysis, the medial clear space was decreased from 7.3+/-1.8 mm to 3.1+/-1.0 mm, the tibio-fibular clear space was decreased from 7.8+/-0.9 mm to 4.9+/-0.5 mm and the tibio-fibular overlap increased from 4.6+/-1.8 mm to 10.5+/-1.4 mm. Also there was no pain and instability in the affected side in any of the patients at the time of the last follow-up. CONCLUSION: A bioabsorbable PLA screw is a good implant for stabilizing syndesmotic injuries of the ankle fractures because there is no evidence of a significant osteolysis resulting around the implant, there is a gradual transfer of stress to the surrounding bone, and there is no requirement for a subsequent removal.