Current Concepts of Bone Healing

Bone injuries induce an inflammatory response that promotes bone healing. On the other hand, an aberrant process, where inflammation becomes chronic, can inhibit the healing of injured bone. At the first stage of the bone healing process, inflammatory cells, such as neutrophils and macrophages, are assembled and secrete various cytokines, chemokines, and growth factors. During callus formation, cells differentiated from mesenchymal stem cells, such as osteoblasts and chondrocytes, play leading roles in bone healing. Currently, various treatment modalities have been developed through the known mechanism of bone healing, and the clinical outcomes of bone defect and fracture nonunion have been good.

Fifteen-year Results of Precoated Femoral Stem in Primary Hybrid Total Hip Arthroplasty

BACKGROUND: There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties. METHODS: On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases. RESULTS: Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1). CONCLUSIONS: An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.

Delirium after Intertrochanteric Fractures of Femur in Elderly Patients

PURPOSE: To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur. MATERIALS AND METHODS: 162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors. RESULTS: 2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium. CONCLUSION: Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.

Analysis and Management of Failed Intertrochanteric Fracture Fixation

PURPOSE: We wanted to analyze the causes of fixation failure after performing compression hip screw fixation for intertrochanteric fracture and we wanted to evaluate the methods to mange this type of failure. MATERIALS AND METHODS: From January 1999 to August 2005, 15 patients who underwent operation due to fixation failure after compression hip screw fixation for intertrochanteric fracture were evaluated, with at least 1 year follow up, for the fracture type, the status of the reduction, the aspects of failure, the causes of the failure and the clinical and radiologic results after operation. RESULTS: There were 7 cases of cut out by the hip screw, 1 case of hip screw breakage, 1 case of dislodging the hip screw, 2 cases of excessive sliding of the hip screw, 2 cases of plate breakage and 2 cases of fixation loss of the plate. The failure of cases was due to incorrect choice of the implants, and that of 9 cases was due to technical error. The Harris Hip score was an average of 67.8 for 10 cases of failed arthroplasty at the last follow up and 88.4 for 4 cases of re-fixation with a 95 degree angled blade plate, and bone union was achieved at a minimum of 5 months. CONCLUSION: It is important to choose an adequate implant and a precise technique to achieve a successful result for fixation of unstable intertrochanteric fracture, and refixation with a 95 degree angled blade plate could be considered for the management of failed intertrochanteric fracture with arthroplasty.

Pathologic Fracture of Femoral Neck due to Mass suspicious of Gossypiboma in Proximal Thigh: Case Report

Gossypiboma is the foreign body granuloma that's due to retained surgical gauze after an operation. The reports of gossypiboma are not infrequent after thoracic, abdominal and pelvic operation, but they are rare after operation on the extremities. Some patients with gossypiboma may remain asymptomatic for several months or several years, but others experience complications such as abscess formation, chronically infectious fistulae formation, neighboring bone erosion and vessel occlusion and sepsis; physicians may suffer some serious legal problems if they are responsible for this condition. We experienced the gossypiboma that developed in the proximal thigh; a 60 year-old patient experienced pathologic fracture of the femoral neck due to this gossypiboma.

Double-Chevron Subtrochanteric Osteotomy Combined with Total Hip Replacement Arthroplasty for Treatment of Neglected Highly Dislocated Hip in Adults / 대한정형외과학회잡지

PURPOSE: This study evaluated total hip replacement arthroplasty (THRA) combined with a double-chevron subtrochanteric osteotomy for the treatment of neglected highly dislocated hips in adults. MATERIALS AND METHODS: Six cases treated with THRA combined with a double-chevron subtrochanteric osteotomy under the diagnosis of a neglected highly dislocated hip (Crowe classification IV) from April 1997 to October 2001 were followed up for between 21 months and 75 months. Harris hip scores, leg length discrepancy pre and postoperatively, osteotomy site union and implant loosening were chekced. RESULTS: The average Harris hip score increased from 61 points preoperatively to 94 points postoperatively. The average leg length discrepancy was decreased from 6 cm preoperatively to 1.8 cm postoperatively. Bone union of the osteotomy site was obtained at 4 months after surgery. The radiographs showed no acetabular and femoral loosening sign at the latest follow up. CONCLUSION: According to the clinical and radiological assessments, THRA combined with doublechevron subtrochanteric osteotomy gave satisfactory results in adults with a neglected highly dislocated hip in adults on a midterm follow up.

Recurred Diffuse Pigmented Villonodular Synovitis of Ankle Joint: Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) in ankle is relatively uncommon. This disorder results in increased proliferation of synovium causing villous or nodular changes containing histiocytes, fibroblasts, multinucleated giant cell, and hemosiderin. PVNS is classified into two different type : localized and diffuse. Diffuse type of PVNS in ankle is more common than localized type. Also, recurrence of diffuse type is more frequent. We report a case of diffuse type of PVNS which was recurred soon after the excision.

The Sequential Development of Elbow-Ossification Centers in Children / 대한정형외과학회잡지

PURPOSE: We aimed to study the cross-sectional ossification pattern of the elbow, the sequence, and the time in Korean children. MATERIALS AND METHODS: The radiographs of the elbow joint of 1418 children from newborn to age of 16 years taken from January 1993 to February 1999 were reviewed. The presence of 6 secondary ossification centers were recorded with all-or-none approach, and sex and chronologic age were also recorded. We took the point of 50% positive ossification as the reference mean for comparison, and found the point by cubic spline method. X2 test was done to compare the ossification time between boys and girls and injured elbow against normal elbow. RESULTS: The boys had following sequential development of ossification centers; capitulum, radial head, medial epicondyle, olecranon, trochlea, lateral epicondyle at age of 1, 6.7, 7.3, 10.8, 11.2, and 13 years, respectively; and the girls, capitulum, medial epicondyle, radial head, olecranon, trochlea, lateral epicondyle, at age of 1, 4.3, 4.3, 9.5, 9.5, and 10 years, respectively. Appearance of ossification centers except capitulum was delayed approximately for 2 years in boys as compared with that in girls (p0.05) . SUMMARY: The authors reported the patterns for the development of secondary ossification centers of Korean children using the cross-sectional study.