Vertebral Recompression after Vertebroplasty or Kyphoplasty

PURPOSE: The purpose of this study was to examine incidence of recompression and risk factors in the patients with osteoporotic vertebral compression fracture (OVCF) after vertebroplasty or kyphoplasty. MATERIALS AND METHODS: This study was conducted on 179 vertebral bodies of 126 patients who underwent vertebroplasty or kyphoplasty on OVCF from January 2004 to August 2013. RESULTS: When anterior vertebral height of fractured vertebrae declined by more than 3 mm from the height immediately after vertebroplasty or kyphoplasty, it was judged that recompression had occurred. Recompression was observed in a total of 58 vertebrae (32.4%). Recompression occurrences were found to be decreasing significantly when fractured vertebrae were the thoracic spine. In addition, osteonecrosis occurred in the preoperative vertebrae and restoration degree of anterior vertebral height immediately after vertebroplasty or kyphoplasty affected recompression occurrences significantly. The other factors (age, sex, bone mineral density, steroid medication history, follow-up duration, cement volume, vertebroplasty or kyphoplasty, and approach method) were compared, but no statistical significance was found. CONCLUSION: The risk of vertebral recompression is more common, especially when osteonecrosis occurred in preoperative vertebrae or when vertebroplasty or kyphoplasty achieved remarkable restoration of anterior vertebra height. When performing vertebroplasty or kyphoplasty, such conditions should be considered carefully.

Incidence and Risk Factors of Subsequent Hip Fractures in Korea: Multicenter Study

This study analyzes the incidence of subsequent hip fractures and its risk factors in the northwestern region of Korea. We analyzed hip fracture patients who visited any of the 5 teaching hospitals in the Bucheon and Incheon area from January 2000 to December 2010. Medical records were reviewed and presence of subsequent hip fractures, alcohol history, marital status, live in solitude, dementia, dizziness, American society of anesthesiologists score, osteoporosis treatment after fracture, body mass index (BMI) and initial bone mineral density were analyzed. The average follow-up period was 12 months (range 1-130 months). A total of 2,546 patients (women 1,770, men 776) who had experienced hip fractures were included. Of these, subsequent hip fractures were found in 233 patients (9.2%) (women 187, men 46). Mean age at the time of the first fracture was 79.2 yr old (range 50-100 yr). The average interval between the first fracture and the subsequent hip fractures was 30.2 months (range 4 days-154 months). In this large-scale, retrospective, multicenter study, overall incidence of subsequent hip fractures is 9.2%. Independent risk factors of subsequent fracture are women, BMI<22 kg/m2, and being unmarried.

Primary Cementless Total Hip Arthroplasty with a Ceramic Sandwich Liner and a Third Zweymuller Stem: Minimum 8-Year Follow up Results / 대한고관절학회지

PURPOSE: The purpose of this study is to evaluate the minimum eight-year follow up results of primary total hip arthroplasty (THA) performed using an alumina sandwich liner and the third Zweymuller stem. MATERIALS AND METHODS: A total of 86 patients (107 hips) who underwent a THA with alumina sandwich liners and the third Zweymuller stems from July 2001 to December 2003 were analyzed. Mean age of patients at the time of THA was 50.8 years (range, 17-77 years) and the mean follow-up period was 112 months (range, 98-127 months). Clinical evaluation was performed using the Harris hip score and level of thigh pain. The radiographic evaluation was performed in terms of the radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: At the final follow-up, mean Harris hip score had improved from 57.8 points to 91.9 points. Radiolucent line was observed at Gruen zone 1 in 40 cases (37%) and at zone 7 in 35 cases (33%); however, no detectable loosening was observed. There were six cases (5.6%) of fracture of the ceramic liner, one case of ceramic liner dissociation, and one case of stem loosening due to infection. CONCLUSION: At the minimum eight-year follow up, survival rate of the third Zweymuller stem was 99.1%. However, owing to the high rate of fractures of the ceramic sandwich liners, the survival rate of the ceramic liner was 93.5%.

Ceramic on Ceramic Total Hip Arthroplasty: The Results of a Minimum 10-Years Follow up

PURPOSE: We wanted to evaluate the clinical and radiographic results of ceramic on ceramic bearing cementless total hip arthroplasty with a minimum of 10-years follow up. MATERIALS AND METHODS: This study was performed on 44 patients and 51 hips, and the patients were recruited among the patients who underwent ceramic-ceramic type cementless total hip arthroplasty from August 1998 to February 2000 and they were available for 10-years or longer follow up. The gender ratio was 28 males and 16 females, and the mean age at the time of surgery was 49 years (range: 26~77 years). Regarding the causality of disease, osteonecrosis was noted in 36 cases, degenerative arthritis was noted in 4 cases, acetabular dysplasia was noted in 4 cases and septic or tuberculous hip sequelae was noted in 7 cases. The clinical evaluation was performed according to the Harris hip score, and for the radiological evaluation of the femoral component, we assessed the degree of subsidence and the presence of periprosthetic osteolysis, endosteal new bone formation and cortical hypertrophy, and the final fixation state of the implant. In the cases with an acetabular cup osteoscleostic line in the vicinity of the acetabular cup, endosteal new bone formation, acetabular osteolysis and the vertical migration as well as the horizontal migration of the acetubular cup were assessed. RESULTS: Regarding the clinical outcomes, the Harris hip score was improved from an average 59 points to 93 points at the final follow up. For the radiological results, osteolysis was not detected in the acetabular and femoral components, the subsidence of femoral stem was not beyond 2 mm on average and significant subsidence was not detected. In regard to complications, linear fracture during surgery was noted in 6 cases and postoperative hip dislocation was noted in 1 case. A ceramic head fracture occurred in one case and a ceramic liner fracture occurred in 2 cases. CONCLUSION: This type of articulation is a promising option at a minimum of 10-years follow up of 51 hips that underwent ceramic-ceramic bearing cementless total hip arthroplasty. However, our results demonstrated that surgeons should be aware of the potential risks of ceramic fracture when using ceramic-on-ceramic bearing surfaces. Additional longer-term follow-up is necessary.

The Treatment of Subtrochanteric Fracture with Cephallomedually Nail: Minimal Incision and Lowman Clamp Assisted Reduction

PURPOSE: To evaluate the radiographic results of patients with subtrochanteric femoral fracture using minimal incision and cephalomedullary nail technique. MATERIALS AND METHODS: This study was performed on 54 patients, 54 cases of hip, recruited among patients who underwent minimal incision and Cephalomedullary nail from September 2005 to August 2008 and were available for 1-year or longer follow up. The gender ratio was 37 males and 17 females, and the mean age at the time of surgery was 57.4 years (range; 16~81 years). According to injury mechanism, traffic accident was 29 cases, fall down form high height was 18 cases, slip down was 7 cases. In classification by Seinsheimer, type II was 23 cases (m/c), type III was 18 cases, type IV was 13 cases. Average follow up period was 14 months (12~18). Radiographic evaluation was performed for time taking union, mal-union and complication. RESULTS: 53 of the 54 cases united. 39 of 54 reductions were anatomic. 19 fractures had a monir varus deformity of proximal fragment (between 2degrees and 5degrees). There was no varus deformity of more than 5degrees. 1 case that had been treated with PFN had nail breakage without trauma. There were no other complications. CONCLUSION: Surgical treatment of subtrochanteric fractures with minimal incision and Cephalomedullary nail technique can reslut in excellent reduction without complications including inflammation & malunion. Careful attention to detail for using Lowman clamp is demanding to decrease soft tissue injury.

The Value of Local Flaps in Lower Extrimity Reconstruction

PURPOSE: The aim of this study was to evaluate the outcome and the effectiveness of local flaps in lower extremity reconstruction. MATERIALS AND METHODS: We have performed lower extremity reconstruction with local flap in 14 cases (10 males and 4 females) from May 2006 to February 2008. The mean age was 40.1 years (range, 16~67). The defect site was the tibia in 5 cases, the ankle in 1 case and the foot in 8 cases. The local flaps were reverse flow sural artery flap in 7 cases, gastrocnemius flap in 3 cases, lateral supramalleolar flap in 2 cases, dorsalis pedis flap in 1 case and medial hemisoleus flap in 1 case. RESULTS: All flaps were survived. Venous congestion was developed in 1 case of the rerverse flow sural artery flap but healed with secondary rotational flap. Other flaps were good without any complications. CONCLUSION: If we choose precisely indicated local flap in lower extremity reconstruction, the resultant coverage of defect would be excellent.

Treatment using Reduction of Lateral and Posterior Displacement in Unstable Intertrochanteric Fractures of the Elderly

PURPOSE: To evaluate the advantages of reduction of lateral and posterior displacement in unstable intertrochanteric fractures of the elderly. MATERIALS AND METHODS: From January, 1997 to December, 2001, we reviewed 23 cases of unstable intertrochanteric fractures in the elderly, which underwent by reduction of lateral and posterior displacement. Using the device of internal fixation is dynamic compression hip screw (DHS), the follow up period was minimally 12 months (mean 16 months). We estimated the clinical results, the radiologic results and complications. RESULTS: The satisfactory results was regarded as walking with walking frame and 21 cases (91.3%) showed satisfactory results. The average period of radiologic union was 18 weeks. The average sliding of lag screw was 5.3 mm and the average changes of femoral neck-shaft angle was 2.6 degree. As for the complications, 2 cases showed superficial infection and 2 cases showed pain over trochanteric area. CONCLUSION: In the unstable intertrochanteric fractures of the elderly, treatment with reduction of lateral and posterior displacement can be considered one of reduction technique.

Treatment of Fractures of the Hip in Children

PURPOSE: To evaluate the result of early anatomical reduction and internal fixation of hip fracture in children. MATERIALS AND METHODS: From January 1996 to July 2002, 21 cases (mean, 9 years) of hip fracture were available for follow-up more than 1 year. We performed early anatomical reduction and internal fixation within 24 hours as possible. Fractures were classified according to the 4 types described by Delbet. The results were analyzed according to the functional results by Ratliff and the incidence of complication. RESULTS: There were no type I, 7 type II, 10 type III and 4 type IV fractures. Avascular necrosis of femoral head in 2 cases (type II, III). Functional result was 18 Good, 1 Fair and 2 Poor. CONCLUSION: Fractures of the hip in children have been associated with a very high rate of serious complications, but our treatment by early anatomical reduction and interal fixation reduced rates of complication and had good functional result.

Open Reduction and Internal Fixation of the Displaced Fractures of the Acetabulum / 대한정형외과학회잡지

Authors reviewed 28 cases of displaced acetabular fracture treated operatively from Februay 1991 to January 1996 and followed up more than 1 year. The clinical results were retrospectively analyzed with consideration of surgical problems and complications. The results were as follows; 1. According to Letournels classification, we had 16 elementary fractures(57%) and 12 associated fractures(43%). 2. Kocher-Langenbeck approach in 16 cases, ilioinguinal in 9 cases, extended iliofemoral 2 cases and combined approach in 1 case were used. 3. The devices for internal fixation were as follows: screw only in 12 cases(elementary fracture 9cases, associated fracture 3 cases), plate and screw in 16 cases(elementary fracture 7 cases, as-sociated fracture 9 cases). 4. There were complications such as 3 degenerative arthritis, 2 superficial wound infection, 1 iatrog-enic sciatic nerve palsy and 1 avascular necrosis of femoral head and no postoperative heterotro-phic ossification. 5. Satisfactory reduction by radiologic criteria was gained in 23 cases(82%). Satisfactory results by clinical criteria(by dAubigne & Postels) was gained in 21 cases(75%). Only 2 patient with a satisfactory radiologic reduction was clinically unsatisfactory. It seems that the satisfactory operative reduction of the fracture is the factor that correlates best with a satisfact-ory clinical result.

Factors Influencing Angular Deformity of Tibia Fracture below Isthmus Treated with Interlocking Nails / 대한정형외과학회잡지

This study analyzed the factors causing the angular deformity as the tibia fracture below isthmus were treated with interlocking nails. For this purpose, we observed 70 cases of tibia fractures in the Gil General Hospital as subjects. Of the 70 cases under the treatment, 32(45.7%) showed the angulation of over one degree, and 11(15.7%) showed that of 5-10 degrees in any plane. According to the outcomes of this studies, the degree of angulation seemed to have close relation to the length of fracture line. Also, if the fracture line reached to the isthmus, angulation was apt to be caused. Even though most angulated cases had concomitant fibular fracture, fibular fracture, itself, seemed to have no direct relation to angulation. In consequence, the intramedullary interlocking nailing needs special carefulness in the case of breakage of cortical buttress such as long fracture line, butterfly fragment and fracture including isthmus.

The Effect of Knee Joint Function after ACL Reconstruction with Accelerated Rehabilitation / 대한정형외과학회잡지

We studied 30 patients who participated in accelerated rehabilitation program after ACL reconstruction to evaluate the effects on knee joint function prospectively. This program emphasizes early full hyperextension, early weight bearing as tolerated, and closed-chain quadriceps functional activities with rapid return to sports. Timing of the return to occupation, activity level, manual knee test, range of motion, thigh circumference, Lysholm knee score and KT-2000 arthrometer measurement were checked at the latest follow-up which is at least more than 1 year. The result were as follows: 1. The mean time for patients to return to occupation was 7.5 weeks (2 weeks-6 months). 2. Range of motion of the knee were not limited in 25 cases (83%) at 1 year after reconstruction. 3. The mean Lysholm score was 92.7. 4. The mean manual maximum KT-2000 arthrometer score was 2.0mm. The results of this study show that patients who had an ACL reconstruction with an autogenous central 1/3 patellar tendon graft and followed an accelerated rehabilitation program obtained longterm stability, achieved full range of motion, had a low complication rate, and were able to return to full sporting activities predictably.