The Effect of Platelet Rich Plasma from Bone Marrow Aspirate with Added Bone Morphogenetic Protein-2 on the Achilles Tendon-Bone Junction in Rabbits

BACKGROUND: To determine if exogenously injected bone marrow derived platelet-rich plasma (PRP) plus bone morphogenetic protein (BMP)-2 could accelerate the healing of bone-tendon junction injuries and increase the junction holding strength during the early regeneration period. METHODS: A direct injury model of the bone-tendon junction was made using an Achilles tendon-calcaneus bone junction in a rabbit. In the PRP/BMP-2/fibrin group, 0.05 mL of bone marrow derived PRP and 100 ng/mL of BMP-2 both incorporated into 0.1 mL of fibrin glue were injected into Achilles tendon-calcaneus bone junctions. The effect of the intervention was tested by comparing the results of an intervention group to a control group. The results of biomechanical testing, and histological and gross analyses were compared between the 2 groups at the following time points after surgery: 2 weeks, 4 weeks, and 8 weeks. RESULTS: Histologic examinations showed that woven bone developed in tendon-bone junctions at 2 weeks after surgery in the PRP/BMP-2/fibrin group. Mechanical test results showed no significant difference between the PRP/BMP-2/fibrin and control groups at 2 and 4 weeks after surgery, but the mean maximal load in the PRP/BMP-2/fibrin group was significantly higher than in the control group (p < 0.05) at 8 weeks after surgery. CONCLUSIONS: Bone marrow derived PRP and BMP-2 in fibrin glue accelerated healing in a rabbit model of tendon-bone junction injury.

Changes in Level of the Conus after Corrective Surgery for Scoliosis: MRI-Based Preliminary Study in 31 Patients

BACKGROUND: Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future. METHODS: To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared. RESULTS: The mean pre- and postoperative Cobb's angle of the coronal curve was 76.80degrees +/- 17.19degrees and 33.23degrees +/- 14.39degrees, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively). CONCLUSIONS: The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction.

2-5 Year Results of the Cemented Polished Versys Heritage(R) Femoral Stem / 대한정형외과학회잡지

PURPOSE: Surface finishing of a cemented femoral stem is a subject of controversy even though contemporary cementing techniques have improved results. Versys Heritage femoral stem was used with a contemporary cementing technique to determine the outcome of using a polished surface. MATERIALS AND METHODS: Between October 2000 and August 2003, 131 primary hybrid hip arthroplasty procedures were performed in 117 patients. The mean age at the time of the index arthroplasty was 52 years and 9 months (24-78 years). The average follow up period was 49 months (range, 24-71 months). All the hips were evaluated clinically by the Harris hip score and radiologically by the cement grade, osteolysis as well as stress shielding. RESULTS: At the final follow up, the Harris hip score for all patients had improved from preoperative 59.1 (range, 17-91) to post operative 92.8 (range, 78-100). The cement grade was measured using Barrack's method. Of 131 hips, 75, 54 and 2 were grade A, grade B and grade C1 at the final follow up, respectively. None of the hips showed a C2 or D grade. There was no evidence of aseptic loosening or osteolysis on the femoral side during follow up. 45% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. CONCLUSION: In this study, the Polished Versys Heritage femoral stem(R) showed excellent results at the short to mid term follow up period. However, a longer-term follow-up study will be needed to clarify the implications of the femoral prosthesis surface finish or design.

Comparison of LC-DCP versus LCP for Internal Fixation of Humeral Shaft Fractures in Elderly Patient

PURPOSE: To compare outcomes of humeral shaft fractures fixed with locking compression plate and those fixed with dynamic compression plate in elderly patients. MATERIALS AND METHODS: Nineteen consecutive elderly patients with a fracture of the humeral diaphysis were evaluated retrospectively. Ten patients had been fixed with LC-DCP, and nine had been fixed with LCP. Radiological and clinical results were compared and comparison of implants was done. RESULTS: Loosening of the plate occurred in one case each from the LCP group and the LC-DCP group. The rest of the patients achieved union uneventfully without any complications. Union rate, clinical score and hardware were not significantly different between the two groups. One patient who developed loosening in the LC DCP underwent reoperation whereas one patient with loosening in the LCP was successfully managed conservatively. CONCLUSION: Principle of fracture fixation was more important than plate selection in humeral shaft fracture of elderly patient.

Comparison of the Results of Core Decompression and Sugioka's Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: This study conducted a comparative analysis on 49 hips treated with a core decompression procedure and 19 hips treated with a Sugioka's transtrochanteric rotational osteotomy for a osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: This study evaluated the relationship between the Ficat and Arlet Stage and the extent of the necrotic lesion (using Shimizu's Grade Classification), and the clinical outcome of each procedure. The patient's outcomes were assessed after a mean follow-up of 46 months (range=36-82 months) after the core decompression and 53 months (range=37-108 months) after the Sugioka's transtrochanteric rotational osteotomy. The results were considered successful if the patients were asymptomatic with no disease progression, and unsuccessful if there was radiographic (progression of the stage or collapse) or clinical failure (the need for an arthroplasty or subsequent salvage operation). RESULTS: Twenty one out of 49 cases (43%) in the core decompression group and 14 out of 19 (74%) in the rotational osteotomy group showed successful outcomes. In the core decompression group, among the 22 F-A Stage I hips, 15 (68%) hips had survived according to radiological criteria. All four (100%) Shimizu's Grade A hips of the F-A Stage I had successful results, which is in contrast to the 11 hips out of 18 hips (61%) of the Shimizu's Grade B and C hips (p<0.01). Six (38%) out of 16 F-A Stage IIA hips and two (25%) out of eight IIB hips in the core decompression group had successful results, while 11 (85%) out of 13 IIA and two (50%) out of four stage IIB hips in the rotational osteotomy group had successful results. In the F-A Stage III hips, all 2 hips in the Sugioka transtrochanteric rotational osteotomy treatment group had survived, while none of the three Shimizu's Grade C hips in the core decompression group were successful. CONCLUSION: A core decompression is effective only in the earliest stages of osteonecrosis (F-A Stage I), which means that its success strongly depends on the location and extent of the femoral head necrosis. Sugioka's transtrochanteric rotational osteotomy is a more dependable procedure than a core decompression for treating large lesions of nonsteroidal ONFH, particularly for patients under the age of 50.

Relationship of Risser Sign with Chronological Age, Menarche in Elementary, Middle, and High School Students in Korea / 대한정형외과학회잡지

PURPOSE: This study was undertaken to investigate the relationship between the Risser sign and chronological age and menarche in elementary, middle, and high school students, and to investigate the reliability of the Risser sign. MATERIALS AND METHODS: We reviewed 1, 870 spine standing AP X-rays, which included the iliac crest. We tried to identify a correlationbetween the Risser stage and chronological age, and between Risser stage and menarche. In addition, we investigated inter-observer error in the determination of Risser stage. RESULTS AND CONCLUSION: The mean ages of Risser 1, 2, 3 and 4 female students were 12.9, 13.3, 13.6, and 14.3 years, and the mean ages of Risser 1, 2, 3 and 4 male students were 14.0, 14.3, 14.5, and 15.6 years (Spearman's rho=0.560, p<0.01). The mean menarchal age of female students were 12 years 4 months, which is 7 months earlier than the mean chronological age of Risser 1 in female students. Wefound that it takes 24 months to progress from menarche to iliac crest maturation (Risser 4) (Spearman's rho=0.571, p<0.01). The percentage of agreement in the determination of Risser stage by three orthopaedic surgeons was 73.3%, showing good reliability with a Kappa value of 0.739-0.783.

Asymmetric Exercise and Scoliosis: A Study of Volleyball Athletes / 대한정형외과학회잡지

PURPOSE: To determine the prevalence of scoliosis in volleyball athletes and compare this with the prevalence in the general population. MATERIALS AND METHODS: One hundred and sixteen volleyball athletes who had been enrolled in the activity for more than one year were examined for prevalence of scoliosis. The Adams forward bending test was performed with a measurement of the truncal asymmetry using a scoliometer (Orthopaedic System, Inc, USA). Those atheletes who showed more than 5degreesof measurement were selected for an X-ray evaluation. Data from a randomized point prevalence survey of Korean Middle school students (46,428) in Seoul City, which had been performed by our department, was adopted for the control group. RESULTS: Among the 116 volleyball players, 60 (51.7%) showed more than a 5degreesof angle of trunk rotation, whereas controls of middle school students showed 2.5%. Cobb's angle more than 10degrees was 6 (5.17%) in athletes and the control group was 465 (1.0%). Despite higher frequency of prevalence, the Cobb' angle was below 15degrees whereas the control group showed a severe scoliosis which of Cobb's angle reaching to 45degrees. CONCLUSION: Volleyball athletes showed a higher incidence of truncal asymmetry and scoliotic spinal columns than the control group. However, we were able to conclude that asymmetrical muscle development can produce a mild scoliosis. However this doesn't have the potential for a severe progression as found in some cases of idiopathic scoliosis.

Idiopathic Scoliosis in Korean Middle School Students: Prevalence study / 대한정형외과학회잡지

PURPOSE: To update and reevaluate the scoliosis prevalence in middle school students in Korea, and correlate those data with past references and other countries general prevalence. MATERIALS AND METHODS: Among the middle schools in Seoul city, forty-five middle schools were randomly selected for screening. Total number of students were 46,428 who were screened for the prevalence of adolescent idiopathic scoliosis. There were 24,892 boys and 21,536 girls. Their age ranged from 12 to 15 years. Adams forward bending test and "Scoliometer" (Orthopaedic Systems, Inc, USA) were used to detect and measure the degree of rotation of trunk. Students more than 5 (ATR were assessed subsequently by standardized clinical and radiological examinations. RESULTS: Using 10 degrees as cut-off points, 465 students were found to have structural idiopathic scoliosis, representing a prevalence of 0.9% overall. CONCLUSION: The prevalence of the scoliosis has not changed from previously estimated rates in Korea, which was about 20 years ago. It nearly approximates with the prevalence of the world wide reported. We also confirmed that it is not necessary to issue a mass screening, considering the cost and effectiveness aspect, due to its low prevalence.

A Clinical Study on the Multiple Pin Fixation of the Femoral Neck Fracture / 대한정형외과학회잡지

Fractures of the neck of the femur have always presented great challenges to orthopedic surgeons and still remain as one of the unsolved fracture as far as treatment and results are concerned. With life expectancy increasing with each decade, becoming more and more patients suffering from femoral neck fractures and their sequelae. The objoct of this study is to observe the relationship between the clinical results and the degree of displacement of fracture, degree of osteoporosis and duration between injury and operation in femoral neck fractures treated with multiple pin fixation. The author clinically analyzed 56 patients of the femoral neck fractures treated with closed reduction and multiple Knowles pinning followed by more than 1 year at Korea University Hospital from January 1986 to December 1991. There were 20 male and 36 female. The age of patients were ranged from 32 to 88 years(average:65.1 years) and most commonly occurred in 7th decade (23cases,41%). The most common cause was slip down(44 cases;79%). The most common type of fracture was stage III (48%) following to Gardens classification. The obtained results were as follows; 1. Union occurred in 49 cases(88%). 2. Among fifty-six cases, five cases(9%) of avascular necrosis, two cases(4%) Of non-union, two cases(4%) of malunion and one case of posttraumatic arthritis were occurred. 3. The functional results by Lunceford criteria were excellent in 30 cases(53% ), good in 13 cases(23%), fair in 5 cases(10%) and poor in 8 cases(14%). 4. Unsatisfactory results were noted in Garden stage II or IV, osteoporosis below Singh index 3 and delayed treatment over 1 week. Above results suggest that multiple Knowles pinning in femoral neck fractures offers high union rate and low complication rate, and so is also one of salvaging method of femoral head.

A clinical study of the tibial condylar fractures / 대한정형외과학회잡지

No abstract available.

Resurfacing arthroplasty in proximal interphalangeal joint by perichondrium / 대한정형외과학회잡지

No abstract available.

Primary hyperparathyroidism associated with pathologic fracture: a case report / 대한정형외과학회잡지

No abstract available.

A Report of Slipped Capital Femoral Epiphysis (6 Patients 8 Cases) / 대한정형외과학회잡지

The authors have experienced 8 hips of slipped capital femoral epiphysis out of 6 adolescents which are known to be very rare in this country since September, 1983 at Department of Orthopaedic Surgery, The Korea University Guro Hospital. They were 3 males and 3 females at age range between 10 to 14 years. Laterality of involvement was 3 in left, 1 in right and 2 in bilateral. Staging was acute in 1 case, acute on chronic in 3 cases and chronic in 4 cases. And the degree of slipping was mild in 4 cases, moderate in 4 cases. Among the 6 patients, 2 were associated with primary hyperparathyroidism and 1 with hypothyroidism. Treatments offered were closed reduction and pin fixation for 5 hips and conservative with control of underlying disease for 2 hips. One hip which was chronic was treated with Southwick osteotomy. The prognoses of the cases were generally good except one which showed slowness in regaining of motion after Southwick osteotomy.

Avulsion of the Tibial Attachment of the Posterior Cruciate Ligament of the Knee Joint (Seven Cases Report) / 대한정형외과학회잡지

The posterior cruciate ligament plays as basic stabilizer of the knee. Therefore the knee becomes unstable when tibial insertion of the posterior cruciate ligament is avulsed. The diagnosis may be delsyed or missed because of surgeon's 1sck of awareness or rare condition. The authors treated seven cases of avulsion fracture of posterior cruciate ligsment at the tibial attachment ares ranged from ten to thirty-two years. There were five male and two female. The results were as follows : 1. The cause of all seven cases injury was traffic accident. 2. The physical findings were seven positive posterior drawer test, seven cases of abrasion or laceration over the anterior proximal tibial surface and antero-medial surfsce of the knee joint. 3. The associated injury was comminuted fracture of the tibia and femur (1 case), rupture of collateral ligsment and comminuted fracture of the tibia (1 case) and zygomatic fracture (1 case). 4. The treatment methods were four cancellous fixation, one K-wire fixation after epiphyseal plate fusion but each one pull out wire and dexon suture before epiphyseal plate fusion. 5. The motion of knee joint was within normal limit and no instsbility was inspected at the three months after reduction.

A Case Report of Surgical Treatment in Mulitple Tophaceous Gout / 대한정형외과학회잡지

The gout is a hereditary condition of disturbed uric acid metabolism. There are medical and surgical management in tophaceous gout for prevention of recurrence of acute attack and creation of a negative uric acid balance. The surgical management is removal of tophaceous material in the soft tissue and osseous structure. Aditionally, the resection of bone and joint, arthrodesis and bone graft improve the functional capacity of the gouty patients. A 53 years old man was managed by removal of tophaceous materials in both prepatellar area, left olecranon area and both feet and arthrodesis of left first metatarsophalangeal joint with autogenous iliac bone graft and supportive medication with probenecid and indomethacine, and was followed up from March, 1986 to April, 1987. There was no significant difference in duration between the union of nonpathologic fracture and the union of arthrodesis area in this gouty patient. We found the progressive recovery of normal trabeculation in previous destructive bone lesions with drug therapy, but there was no specific change in the soft tissue lesions.

Intra-uterine Fracture of the Femur in Infant: A Case Report / 대한정형외과학회잡지

Intra-uterine fracture of normal bone is extremely rare. It was reported few cases in the other contries, but it was very rare in Korea. It is difficult to distinguish it from birth fracture and the other fractures or deformities seen at birth. The authors experienced a case of intra-uterine fracture of the femur in the middle third of the shaft, with abundant callus formation in infant without serious injury to the mother.

An Experimental Study of the Effect of Bone Cement upon the Epiphyseal Plate of Growing Rabbits / 대한정형외과학회잡지

Acrylic bone cement is now widely used in surgery for many purposes. Therefore, the effect of bone cement on the growth plate of a growing bone may be an interesting subject, particularly in the orthopedic field. The authors carried out an experiment to study the effect of bone cement on the growth plate of the bone, using 32 growing rabbits weighing from 800 to 1000 gm, which were divided into 2 main groups. In Group I, which was the control group, the growth plates were injured mechanically by inserting a Kirschner wire and a stainless screw, 1.5 mm and 2.5 mm in diameter, respectively, which were then removed. In Group II, the growth plates were also injured by the same method as in Group I, and bone cement was inserted into the holes made by the insertion of the Kirschner wire and the screw. Then the histological findings of the injured plates were studied at 2, 4, 6 and 10 weeks after injury. Following observations were made. 1. In Group I, in which the growth plates were only mechanically damaged, the histologic changes were localized only in that portion of the plate which had been injured by a wire or a screw, leaving the rest of the plate relatively normal. In Group II, the extent and severity of the injury were more wide and severe. 2. Proliferation of mesenchymal fibroblasts and deformity of the growth plate were more severe in Group II. 3. In both groups the extent and severity of growth plate injury were more marked when injured by a screw.