Choice of Internal Fixatives for the Intertrochanteric Fractures of the Femur in the Elderly

PURPOSE: To prepare the appropriate guideline in choosing the internal fixatives for the intertrochanteric fractures of the femur in the elderly. MATERIALS AND METHODS: We reviewed 95 cases of intertrochanteric fractures of the femur from January, 1999 to December, 2003. We fixed the fracture with Proximal Femoral Nail in 37 cases (PFN group), Dynamic Hip Screw in 56 (DHS group), Dynamic Condylar Screw in 2 cases (DHS group). We reviewed operation time, blood loss during operation, changes in neck-shaft angle and sliding of lag screw. RESULTS: There were no significant differences in the parameters between the 2 groups in stable fracture. In unstable fractures, operation time in PFN group and DHS group revealed 103.9 and 128.2 minutes respectively; mean amount of blood loss during operation revealed 523.2 and 573.1 ml respectively. Mean changes in the neck-shaft angle at final follow-up in PFN group and DHS group revealed 4.6 degrees and 4.1 degrees; sliding of lag screw averaged 3.4 and 6.5 mm respectively. Among the DHS group, cases of additional fixation with trochanteric supporting plate revealed 3.1 degrees of changes in neck-shaft angle and 4.2 mm of lag screw sliding. CONCLUSION: In cases of stable fractures, any fixative might suffice. In cases of unstable fractures, there were no significant differences in results of treatment between these two groups, however, PFN group revealed shoter operation time and less blood loss during operation. It seemed to be necessary to apply additional fixation with trochanteric supporting plate when using DHS in unstable cases.

Interleukin-6 Level as a Marker of Disease Activity in Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation of synovial joints accompanied by a marked acute phase response, and interleukin-6 (IL-6) is a major mediator of the inflammatory response which is involved in the induction of acute phase protein, To evaluate the significance of IL-6 levels in patients with RA, IL-6 activity was measured by radioimmunoassay in 13 patients with RA and 5 patients with traumatic arthritis (TA) or osteoarthritis (OA) was used as a control group. Serum IL-6 activity was significantly elevated in 2 RA patients without treatment compared with that of 11 RA patients with treatment and all the TA and OA patients. Synovial fluid IL-6 activity was elevated in all RA patients (markedly elevated in 2 RA patients without treatment) compared with that of TA and OA patients. Immunohistochemical analysis of synovial tissue from 3 RA patients revealed strong expression of IL-6 in most inflammatory synovial cells. The results indicate that IL-6 level, especially that of synovial fluid, is related to disease activity in patients with RA.

Result of Charnley Low Friction Arthroplasty in Old Tuberculosis of the Hip / 대한정형외과학회잡지

No abstract available in English.

Review of Trochanteric approach in 285 Total Hip Arthroplasties / 대한정형외과학회잡지

This paper is a consecutive series of total hip arthroplasties were performed over 6 years period by the same group surgeons utilizing the Charnley method as well as the lateral approach with trochanteric osteo. tomy. Trochanteric reattachment was accomplished in 285 hips and method of reattachment were basically standard Charnley technique which we used in most of our series. In addition, some modification of original Charnley technique which we used in early this trial were also included for this study. As far as trochanteric complications are concerned, there are 18 cases of hips where there was wire breakage, proximal drift of greater trochanter and 6 established cases of nonunion also reported. By the use of wire mash, we have performed a revisional surgery which has re-inforced of the greater trochanter. This was the case when the greater trocyhanter was very osteoporotic. Finally, biomechanical considerations of the re-attachment of the greater trochanter and new Charnley staple clamp method were introduced with review of our cases and analysed for technical failures.

Non-Union of Greater Trochanter Following Low Friction Torque Arthroplasly (LFTA) / 대한정형외과학회잡지

This paper is intended to draw attention to the cases of non-union of reattached greater trochanter after LFTA for hip disorders with an our short experience of this subject. Previous information on this subject is scanty. Charnley mentioned on his paper of the long time result of LFTA of the hip for non-union of the great trochanter was reported in 4.2% of 379 hips followed for a minium of four years. Of these, a quarter went on to separation of the bony fragment. With his report, wire breakage occured in 28 cases in the presence of a united trochanter, a phenmenon which results from loops of the wire passing through soft tissues, out side the bone, and becoming fatigued by repeated bending movements. However, he pointed that the clinical result does not seems to be impaired althrough such patients occasionally complain of a feeling of insecurity when weight bearing. Among our series, two cases of non-union of the greater trochanter, after LFTA, is reported. Those of two patient were bilateral hip disorders who has indicated both hip total hip replacement. But we have done only one hip each because of inevitable patients physical conditions during the surgery. Presumably, the principal cause of non-union appeared to be excessive force on the operated one hip. The type of internal fixation for reattachment of the greater trochanter was investigated, six types which we used in this series, two separate knots for security of wire breakage after Bechtol resulted satisfactory union of the detached greater trochanter. A case of detached trochanter for revision which we used original Charnley technique with additional figure of eight wire fixation for re-enforcement. Eventually, we agree that advantage of bilateral total hip replacement at the same operative session.

A Case of LFTA of the Hip Joint with Splatt for Stroke Patient / 대한정형외과학회잡지

The clinical picture of adult hemiplegia caused by cerebrovascular lesion shows many variation, depending on the degree and distribution of paresis and spasticity. One of the most common deformities resulting from a stroke is equino-varus of the involved foot. If the equino-varus is due to moderately excessive pattern response, or moderate spasticity in the calf muscles, it can be controlled by a short leg brace. When the deforming forces are severe, surgery is necessary to make it possible for the patient to walk safely. It is quite obvious that there is some incidence of hip fracture following sequence of unsafe hemiplegic gait, among post stroke patients as reported by Rancho-Los-Amigo Hospital. This study reviews a preliminary report of a case of surgical treatment of a patient with post stroke who had sustained a hip fracture due to falling because of unbalanced hemiplegic gait. In this case there was performed a low friction arthroplasty of the hip joint because of the original X-ray. The former treatment was ignored because it would inevitably have produced avascular necrosis of the femoral head. The spastic equino-varus deformity was well corrected by means of split anterior tibialis tendon transfer, which is the normal surgery for stroke.