Idiopathic Osteonecrosis of the Patella: A Case Report / 대한정형외과학회잡지

It is important to recognize idiopathic osteonecrosis or avascular necrosis of the patella not only because of its rarity but because a majority of the patients remain asymptomatic without treatment. The etiology of osteonecrosis is unclear. Certain conditions and diseases have been associated with osteonecrosis of the patella including the systemic administration of steroids, a fracture of the patella, a total knee arthroplasty and other traumatic conditions. The diagnosis is usually made with radiographs, MR imaging and a radioisotopic bone scan. It is believed to have a benign course and a favorable prognosis. We report for the first time in Korea a patient with idiopathic osteonecrosis diffusely involving the whole patella without any obvious cause.

Treatment of Failed Internal Fixation of Intertrochanteric Fractures of Femur

PURPOSE: To compare the result of failed internal fixation of intertrochanteric fractures treated with arthroplasty and 95degrees angled blade plate. MATERIALS AND METHODS: From June 2000 to may 2003, there were 12 cases with failed internal fixation of intertrochanteric fractures among 185 cases treated with dynamic hip screw and followed up for more than 1 year. The 4 cases were treated with bipolar hemiarthroplasty, 1 case with total hip arthroplasty, and other 7 cases were treated with 95degrees angled blade plate with allograft, evaluated clinically the operation times, blood loss, walking ability and complication. RESULTS: In the 7 cases, which treated with 95degrees angled blade plate, the average operation time was 109 minutes, the average blood loss was 431 ml. The result of keeping abreast of 1 year, no aid ambulation was 4 cases, the cane ambulation was 2 cases, the walker ambulation was 1 case, and there was no pain in 3 cases, mild pain in 4 cases, and no moderate pain. In the 5 cases, which treated with arthroplasty, the average operation time was 157 minutes, the average blood loss was 618 ml. During 1 year, no aid ambulation was 3 cases, the cane ambulation was 1 case, the walker ambulation was 1 case, and no pain in 2 cases, mild pain in 1 case, moderate pain in 1 case. CONCLUSION: Both 95degrees angled blade plate and arthroplasty can be useful for failed internal fixation of intertrochanteric fractures, and the choice of implant must be determined with caution, considering the surgical conditions of patient, as well as benefits of each devices

Operative Treatment of Intraarticular Calcaneal Fracture: Comparison of Outcomes between Open Reduction and Closed Reduction

PURPOSE: To evaluate the clinical outcomes and radiographic results of operative treatment for intraarticular calcaneal fracture. MATERIALS AND METHODS: We reviewed 57 cases of intraarticular calcaneal fracture managed with operative treatment, from January, 2000 to June, 2003. The type of intraarticular calcaneal fracture is classified by the Essex-Lopresti classification and Sanders by computed tomography. The 20 cases were managed by open reduction, 37 cases by closed reduction. RESULTS: On clinical outcomes in the case of open reduction and internal fixation, above good in 13 cases, poor in 2 cases; closed reduction, above good in 16 cases, poor in 10 cases. Averages of Bohler angle were increased from 11degrees (preoperative state) to 21degrees (last follow up) in open reduction, and from 14degrees to 20.9degrees in closed reduction. CONCLUSION: Open reduction was considered to be one of good treatment option if the anatomical reduction and stable fixation can be obtained.

Traumatic False Aneurysms of the Upper Extremity: 2 Case Reports / 대한정형외과학회잡지

An aneurysm in the upper extremity is rarer than in the lower extremity, and a traumatic false aneurysm is very rare. We encountered two patients with a traumatic false aneurysm in the upper extremity. The first case developed from a posterior interosseous artery injury after an internal fixation using a plate and circumferential wiring for a comminuted fracture of the proximal shaft of radius associated with a dislocation of the left elbow joint. This patient was managed by excision of the false aneurysm, and ligation of the artery. The second case developed from a radial artery catheterization on the left wrist. This was managed by excision of the false aneurysm and an end-to-end anastomosis and resulted in the disappearance of the false aneurysm and a good vascular patency. We report two rare cases of traumatic false aneurysm in the upper extremity and a review of the literature.

Neurologic Injury and Recovery Patterns in the Spinal Fractures by Denis Classification / 대한척추외과학회지

PURPOSE: To determine whether there was a preponderance of a fracture type associated with early and late neurologic deterioration. MATERIALS AND METHODS: The review of all the surgically managed spinal fractures from October 1989 to July 1999 was performed. Of the 83 surgically managed patients, 39 had spinal cord injury. The other 44 patients in this consecutive series had no spinal cord injury. Charts, operative notes, preoperative and postoperative plain radiographs, computed tomography scans, and follow up records of all patients were reviewed carefully from the time of surgery until last follow-up assessment. The classification of Denis had been used prospectively for all patients before their surgery to determine the fracture morphology. Frankel Scale and American Spinal Injury Association Spinal Cord Injury Assessment Form(ASIA) were obtained during follow-up evaluation for all patients. RESULTS: All patients were observed over mean 57.4 months except 1 patient who died of pulmonary thromboembolism 1 week after surgery. In Denis classification, the most common injuries were burst fracture and fracture-dislocation. The degree of neurologic injury when first seen and at the latest follow up was different between burst fracture and fracture-dislocation. The extent of neurologic recovery was not different between burst fracture and fracture-dislocation. The fracture-dislocation was common in thoracic spine and the degree of neurologic injury was most severe in thoracic spine. Instead, the burst fracture was more common in lumbar spine and the degree of neurologic injury was relatively mild in lumbar spine. CONCLUSIONS: The severity of initial posttraumatic and the last follow up neurologic injuries were correlated with the fracture patterns by Denis classification, but the extent of neurologic recovery was not correlated with the fracture patterns by Denis classification. The lumbar fracture, injuring the cauda equina and the sacral nerve roots, shows greater recovery patterns than thoracic spine fractures.